As my title suggests I did more research this week. Dr. Schwartz had very few surgeries this week and was in town for just Monday and Tuesday. So on Monday I got to see two surgeries. The first surgery was about removing an already placed shunt from the brain of a patient. The shunt was to remove brain fluid. It was placed due to an accident in the past which the patient had recently recovered from. It was an interesting surgery as I got to see the shunt placed on the skull. As Dr. Schwartz removed it, one could clearly see a depression and a small hole in the skull. A metallic plate – blue shiny snow flake shaped – was used to cover up the hole. Further application of bone cement evened the skull surface. It was a simple surgery, yet fascinating. The second surgery lasted almost 6 hours. It was for a patient having a meningioma. Surgeons did an olfactory lobe craniotomy as the tumor was located close to the sphenoid bone. The surgery was unique with patient’s head oriented sideways for the surgery. And to avoid CSF leak, lumbar drain was conducted. To prevent increases in intracranial pressure, anesthesia levels were varied very often during the course of the surgery. Since the tumor was deep inside, brain retraction was performed, which involved parting the brain slightly and slowly to reach the tumor. The tumor was removed in totality without any complications.
My Tuesday began with surgery around 9am. First surgery involved a patient having a pituitary tumor. This time, I saw Dr. Vijay Anand perform endoscopic sinus surgery with his team, before Dr. Schwartz took over when the pituitary gland was exposed. This surgery was different, as tumor size was in microns and could not be seen in the scans. Since, tumor was diagnosed to be in the left side of pituitary gland, whole of the left side was removed. A patient can function normally, in such a case by taking hormone supplements. In this particular case, the patient suffered from overproduction of cortisol due to the tumor. During follow up Dr. Schwartz recommend that patient would be taking cortisol tablets to compensate for the removed tissue. The most striking part was that the surgeons were not sure of the presence of tumor in the excised pituitary tissue. If the pathology report suggested an absence of a tumor, they would have to go in again for a surgery. An instant pathology in the OR seems to be the need of the day. My second surgery was an aortic valve replacement by Dr. Leonard Girardi . It was a deviation from my usual neurosurgeries and realized the major difference as I entered the OR - not a single screen projecting the surgery. The surgeons broke open the rib cage and cut through the muscle to expose the aortic valve. My view was very restricted and I caught some glimpses of the heart after standing tiptoed near the head of the bed. Seeing the heart beating was certainly the highlight of my week. In cardiopulmonary bypass surgeries a heart-lung machine is used that drains all the blood and replaces the pumping action of the heart. Large doses of heparin are added to prevent clotting of blood inside the machine. It was a huge machine replacing the pumping action of our small heart. Later, on clinical rounds with Dr. Schwartz we met different patients in post and pre surgery states. Some of the aged patients were very unresponsive; their status was determined by finger reflexes.
The rest of the week was spent doing research in Dr. Schwartz lab with Dr. Hongtao. I progressed with my research in taking cortical blood flow measurements using laser doppler technique and measuring tissue oxygen concentration in response to electrical stimulations of varying intensity in rat cortex.
No comments:
Post a Comment