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Published: March 14th 2007
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the doctor at work
that piece of equipment you see is a dual microscope for the doc and his/her assistant. It's also great for everyone else in the room, because what's happening is displayed crystal clear on a monitor for us to follow Okay, I know what you're thinking... I'm not in medical school this won't be interesting, but it WILLLL! These cases that I'll highlight quickly and show some pictures were mad cool. Read ON! For those of you who are medical... cut me a little slack, okay! Remember, this is me translating/interpreting from the italians... i think I did okay, but the lingo isn't perfect! here's five crazy cases for you... * 56 y/o M. 4th time re-op on a infiltrating Medullablastoma in posterior cranial fossa, L cerebellum. hemispheric approah. s/p chemo and XRT regimens. The chairman did this surgery and he was skin to skin in one hour... it was phenomenal. During the dissection, I was looking at the screen thinking, what is that graceful white thing crossing the screen... ummm, CRANIAL NERVE 5... hellll-oo. that was followed by 7 and 9-11. it was awesome to see.
* 4 y/o girl. presented with epilepsy about 6 months ago, had an MRI and a parieto-occipital lesion was found. Recent MRI showed the lesion had grown significantly and is most likely the cause of her seizures. high grade glioma in her right parieto-occipital region. will most
GBM, R parietal region
T1-weighted MRI showing the tumor in the sagittal, axial, and coronal planes likely need chemo/XRT, but prognosis is still poor. 😞
Now how can I make this sound the most striking. Either... each of the above cases he did, skin-to-skin in one hour. Or... two cases were started at 9pm and completely done by 13:30, including room turn-over. Or maybe... he removed two HUGE brain tumor faster than many general surgeons can take out a gall bladder! incredible. ps- no pictures of these ones, unfortunately. it wasn't until this week that i gathered up the courage to even ask if I could take them. the response was, "OF COURSE!" the italians LOVE to be photographed!
*46 y/o M with large GBM of R parietal region.
* 71 y/o F. Cavernous sinus meningioma, fully incasing the carotid artery. A frontal-temporal craniotomy was performed, along with a Silvian fissure dissection, and exposure of CN2 (including optic chiasm!), CN3, ICA where it bifurcates into the ACA and MCA, the basilar a., the SCA, the PCoA, as well as the hypophysis, the tentorium, and part of the sphenoid bone. Obviously, it wouldn't be safe/prudent to try and remove the whole tumor, but he dissected out the ICA pretty impressively and removed quite a empty GBM surgical cavity
The white discs release chemotheraputic agents and are frequently implanted in the empty surgical cavity intraoperative in high grade GBMs. bit of the tumor!
* 46 y/oF. GIGANTIC aneurysm of the L internal carotid artery. (A-P dia 3cm, and M-L and C-C 2.5cm!) this thing was peri-sellar and so big it was displacing both ACAs laterally and partially obstructing the third ventricle! A bipass from the External carotid to the MCA was attempted twoce and it thrombosed both times. Not long before this surgery, the patient developed aphasia and a motor deficit of her Right hand. Hence the need for operative intervention. To access it, a Bi-frontal craniotomy was done first (one on each side), followed by partial removal of the bilateral orbits and sphenoid wings. Now if you're trying to picture this in your head, there's three way you can do it. 1. you know how they say, "things go in one ear and out the other?" well in this case, they did! he dissected from one craniotomy to the other!!! 2. standing behind the surgeon, it looked like the mask of darth vader with the two eye sockets. 3. standing to the side or at the feet, it looked like the mask of the grim-reeper or something like that. It was WILD. I had one of those, "Melissa,
Cavernous sinus menigioma
T1 weighted... both axial and coronal views... impressive. close you mouth moments" because my mouth was hanging open in disbelief when I saw the back of the eyeball out in the breeze! This was a long and complicated operation, but in basic steps: First, they exposed the left carotid in the neck. They performed the craniotomies followed by careful dissection of all the structures through the arachnoid and adequate exposure of the aneurysm and arteries. Next, they clamped both A1s and someone held pressure on the L ICA with his finger. Next they clamped the shit out of the aneurysm and poked a hole in it and sucked the blood out. Next they let up pressure on the carotid and unclamped both A1s and tested them all with doppler. Then, a florescent tracer was injected via central line into the R heart, which eventually makes it to the arteries and the Circle of Willis. Finally, this was *cool*, they shut off all the lights and put the scope light on infrared and we saw the whole circle of willis light up WITHOUT the aneurysm. At that point they new the procedure was a success.
Enjoy the pictures! Also, if you're interested in a pic of that
Cavernous sinus menigioma
see the black sqiggly thing in the middle (but close to the bottom of the screen), surrounded by grey? well that's the carotid artery coursing up and completely surrounded by tumor! last case's craniotomy, let me know... I won't post it, in an effort not to gross out the non-medical people. The chairman likes that I'm super into this, and today he gave me a cd of over 200 of his procedures... complete with pictures and op-techniques. Can't wait to check that out!
okay, time for bed... meeting the chairman early for a combined case!
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Nicole
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sweet!
It's like I'm studying for my neurology rotation by reading your travel blog! NICE! And that's a gi-freakin-gantic aneurysm!!!! OMG! I'm so freakin jealous of you right now!!!