Monday, October 27, 2008

Epilepsy

Hey peeps,

Here is everyone's favorite character from House and/or Scrubs, me!

Today I shadowed a pediatric Neurosurgeon at Children's Hospital. I observed a long epilepsy surgery. There were two parts to this procedure: the corpus callotomy and the implatation of electrodes. First the surgeon opened up the scalp and removed a piece of bone about 2.5 inch by 1.5 inch. He was very careful to avoid an important feature of the brain cavity where he was working, the superior sagital sinus. That is an important vein that carries much of the blood from the brain back to the heart. If he nicked it bad the patient could have died or suffered a major stroke. He then opened up the brain's surrounding membrane, the dura mater, and gently separated the brain away from the membrane that lies in its middle. Finally, he removed the corpus callosum with suction. That is a structure that is the only interconnection between the two halves of the brain and transmits seizures from one side to the other. By cutting it, the seizures cannot spread and are therefore not magnified.

The second part of the surgery was when the surgeon put electrodes on the surface of the brain. Since the brain was already exposed, it was easy for him to slide them between the dura mater and the surface of the brain without many further incisions.

It is so amazing to have witnessed this surgery. This is the first time that I have seen a live human brain. The brain pulsates with each beat of the heart. "Two organs beat as one..." (think U2). It was so amazing and reminded me why I wanted to be a physician and how cool my future role is. I will have the tools and knowledge to cure disease--to save patients from states that are awful. Epilepsy is horrible. But physicians can treat it. I really wanted a job where I could serve, and I see once again that medical school gives me the tools to do so in a very meaningful manner. I dedicate my life to learning now so that I may be a blessing to others later. I think that a doctors labor mirrors the Savior's better than almost any other career.

Well, hope you enjoyed me sharing this experience with you.

Love,

Ben

6 comments:

Patrick said...

Ben,
Keep the med school posts coming. I find it super interesting to live vicariously through you.

What else does the corpus collosum do besides transmit seizures?

Is there really enough blood flowing through the brain to "swell"? Does the brain leak intercranial fluid when opened up like that? Do they replace it?

Cheryl said...

Good questions, Patrick! I too enjoy reading about your experiences, Ben! I feel smarter just reading your posts!

Sarah said...

Cool Ben...uh just wanted to say that my profession is great too. Love you!

Ben or Sarah said...

Patrick,

Well, the corpus collosum is the only connection between the left and right sides of your brain. If it is cut, then the main problem lies in the cooperation of the two sides. Some functions, like speech, are lateralized to (i.e. are more dominant in) the left side of your brain. Others, like writing, are lateralized to the right. If you sever the connection between the two sides they cannot work together. For example, they may not be able to write what they hear. These symptoms are not always present and are unpredictable.

There is enough blood flowing around the brain each minute that a simple rupture of a blood vessel (a hemorrhage) could cause a stroke in seconds. There is also a fluid that exists only within the brain called cerebrospinal fluid (CSF). A blockage of CSF will cause hydrocephaly, or "water on the brain".

When you open up the brain and CSF leaks out, you just have to wait for the brain to produce more of it. The brain makes enough CSF to flush out the brain 3 times a day. So this patient could have normal CSF levels within 8 hours. A cool thing they did was to place a membrane of artificial dura mater on the site where it was leaking. This blocks more CSF from being released, and this artificial dura mater will be resorbed by the body to become normal dura mater.

Sarah's job is great, too.

-Ben

Kirsti said...

Ben, It doesn't surprise me one bit you're in medical school. It's great to see what you have been up to. You and Sarah are sure a cute couple. Congrats on all your success!

Patrick said...

Interesting. I think I'd puke watching any surgery...then I'd be able pay attention to the cool stuff like watching the brain pulse.