Ryan - Week 4

I hope everyone enjoyed the 4th this week! I know we did watching fireworks over the Hudson River! All the festivities were a good start to a pretty good week. In the OR, Sara and Andrew came with me to shadow Dr. Boockvar. We first attended a cervical fusion surgery of the cervical vertebrae 4-5 on an old man. Dr. Boockvar isolated and stabilized the vertebral bodies with screws and rods to keep the spinal cord stretched to the right length since the intervertebral disc was collapsing. Then we waited around for the second surgery to begin. Apparently this next patient was supposed to be the first of the day, but when she was wheeled to the OR, she had second thoughts because she was worried about complications with her preexisting neurological disease, multiple sclerosis (MS), and backed out. So Dr. Boockvar told her that she needed to have surgery to remove the growth she had in her brain, which wasn’t established as a brain tumor or a cyst yet but regardless, she needed surgery to remove it before it could grow any bigger and cause more problems. So finally, they wheeled the patient in and she decided that she was going to go through with the surgery. Dr. Boockvar performed a right temporal craniotomy and resection of glioblastoma multiforme (GBM) on her, which is a very sad diagnosis because while it’s good that they caught it relatively early and can work to help maximize her longevity, a diagnosis of GBM is a death sentence. Later in the week, there were two more GBM cases. The first was a right temporal craniotomy and resection of a recurring high grade malignant GBM brain tumor in an old man. Next, Dr. Boockvar performed a left frontal craniotomy and resection of a recurrent malignant GBM brain tumor on another old man. Both of these surgeries were pretty textbook craniotomies and resections without any complications.

Then in clinic, Dr. Boockvar started with a meeting with an old friend of his, a very successful plastic surgeon from the NYC area. He’s suffering from a vertebral disc impingement on his spinal cord, which requires a minor micro-discectomy and laminotomy. The rest of the patients were all post-operation checkups that were all upbeat and they all left the office happy. Dr. Boockvar said it was just one of those rare, lucky days where everything goes well and there aren’t bad news or upset patients. There was also a lot of it was scheduling vertebral disc surgery and post-operation brain surgery follow-ups. A high school student named Alastair came into the office on Thursday to ask Dr. Boockvar if he could volunteer in his lab during this upcoming school year. We talked for a while about what I’ve done in my undergrad and what I’ve been doing thus far at Cornell. Also, he told me about how he’s interested in either becoming a surgeon or working as a researcher. So I gave him some advice on how I made my decision and what I weighed when making it. Hopefully it was helpful. Later, Dr. Boockvar brought me along for a brain tumor diagnosis and treatment lecture in the med. school. This was one part of a series of lectures for the neurosurgery residents where they discuss a wide range of things from how to radiate tumors (the tumor tissue plus a 2 cm margin), to the Stupp protocol for GBM therapy, to the use of Ki67 staining (a mitotic index staining that shows rapidly dividing cells, i.e. tumor cells). During the course of the lecture, Dr. Boockvar was grilling the students and even asked me a question. What is the stem cell theory? To which I answered, the theory that tumors are derived from a small source of normal neural stem cells that have mutated. When treated with leading chemo- and radiotherapies, all other cells produced by these stem cells are affected but the stem cells remain, thereby allowing the tumor to recur. Thankfully this was one of the few questions that Dr. Boockvar asked that I could actually answer, so I was proud when he told me “good job” for my correct response.

After the lecture, I went to the OR to meet with Dr. Schwartz to get the pituitary endoscopy videos I need for my summer immersion project. When I walked into the OR room, he was performing a left temporal craniotomy and resection of a brain tumor. Since the operation was going to take quite a while and I had our weekly summer immersion meeting, I left but asked one of Dr. Schwartz’s students, Eliza, to text me when the surgery was over so that I could meet up with them in Dr. Schwartz’s office. In our weekly update meeting with Dr. Wang and Dr. Frayer, we all went around the conference room again and shared our most interesting experiences for the week and how our projects are going, over sandwiches. Since last week, I got in touch with Dr. Schwartz to get copies of his endoscopic pituitary tumor resection videos so that I can analyze the pixel color of the tumor vs. healthy tissue using a computer program called Matlab. After talking with Dr. Schwartz about what I’d like to do with the videos, he seemed skeptical that I could do what I’d like to do: use the videos to determine an identifying wavelength to create a band-limit filter for tumor tissue that could help the neurosurgeons differentiate between healthy and tumor tissues. His main concern was that when blood covers up the tissue, it makes using a band-pass filter less useful. However, he said to analyze it anyway and see what I could find and we’ll go from there.

This week’s Multidisciplinary Brain Tumor Conference was again pretty much the same as last week. Sara joined Liz and me for this week’s meeting and the three of us discussed the many cases from this week’s meeting afterward and how depressing it is to discuss all these patients who basically have death sentences placed upon them after their brain tumor diagnoses. I really don’t know how the neurosurgeons can handle all this but I definitely have a strong respect for what they are able to handle and do.