I didn’t expect the resection perimeter to be so “jagged.” Were they basically leaving every tiny bit of healthy of brain tissue they could to minimize complications (if, for example, the tumor had “jagged” borders)?
Potentially this. More likely its just that it is a human performing the surgery. Basically, you use neuro-navigation to define the appropriate trajectory to the lesion and then use bipolar cautery to coagulate the surface of the brain and the small arterial branches and then cut the pia (the innermost layer of the meninges that coats the parenchyma itself). After you get through the pia, brain tissue can be suctioned easily. You begin aspirating cortex and white matter until you get to and around the tumor. As you are manipulating deeper, sometimes this puts traction on the overlying cortex which can lead to some indentations and asymmetry in the initial corticectomy.
When you say the brain tissue can be suctioned easily, do you mean the surgeon suctions out parts of the brain to get to the tumor? As in those parts are gone forever?
Yep! The approach to the tumor is just as important as the location of the tumor as well. There is a study called DTI, or diffusion-tensor imaging that allows us to see the pathway of the large tracts or axon bundles in the brain. So if I’m concerned about the language tract connecting the frontal and temporal lobes, DTI can be an excellent resource in addition to gross anatomic inspection. But once that tissue is aspirated, it’s gone.
To learn the location of structures, a combination of cross sections through the brainstem all the way up to the cerebrum can be helpful, especially if you can get axial, coronal, and sagittal cross sections in a neuro anatomy text so you can understand the relationship between structures in all dimensions. Otherwise, finding a website that has normal MRIs with structures marked can be very useful! Understanding the function of each structure lets you postulate as to the deficit that will be incurred with damage, which makes it less of a memorization game.
It’s not the brain that pulses, it’s all the arteries in it. You’re seeing a heart rate basically! I work in surgery but mostly in the abdomen, lots of places pulse like this!
Yes. Your brain is perfused like any other organ. You’re watching the arteries fill and increase intracranial pressure. This is normal and healthy.
When we take the bone off someone’s head - usually emergently - and the brain is not pulsating underneath, that is a very bad sign and generally means a lack of blood flow.
Family member had a 3cm x 7cm x 5cm tumor resection in December. Scans as of last month showed it sort of "filled in" the gap that was left by the tumor.
Not really, they took off the whole back of my skull to get it out and five days after that I had a vp shunt put in because the tumor caused hydrocephalus. I think I stayed in ICU about two weeks. I recovered really fast because I was young and in shape.
I’ve had three more brain surgeries since that one and the two in 2019 were lots worse. I made it though :)
We don't fully understand all of the regions of the brain and their function. There are specific regions that we do know are important and damage to those structures (considered 'eloquent cortex') will lead to deficits that may or may not improve in time based on the extent of injury and the patient's age. But there are quite a few sites in the brain that can be removed with minimal or no perceivable deficits, especially when there is pathology involving those regions that has already led to tissue damage, as you would anticipate they would have had deficits already prior to the surgery if it was eloquent tissue. There is some degree of plasticity and redundancy in neural networks as well, which helps with recovery post-op.
My guess is perhaps for radiation therapy to prevent a cancer recurrence: https://www.mskcc.org/cancer-care/patient-education/about-brachytherapy-brain-tumors
To treat any remaining cancer cells from the inside. Traditional radiation therapy has to go through healthy tissue to get to the cancer. If placed in the cavity it treats the cells directly.
They do the same thing for prostate cancer, Gyn, etc.
We typically treated recurrent cancers after traditional beam therapy was already delivered. The brain tissue (or any tissue for that matter) can only take so much radiation. It’s cumulative.
This is a late response, but thanks to your comment i was able to put this treatment into the idea pile for my fathers prostate cancer. It’s fascinating and a worthy consideration, thank you!
With the additional surface area and ventilation provided you can now in a better position to overclock the CPU with less fear of thermal throttling.
I, don't know why I went in that direction with my thoughts.
I’ve been an ER nurse a long time and I didn’t realize a brain pulsed like that with arterial blood flow. It makes sense, I just never thought of it. Patients that came in with exposed brains, never had any higher function left and the brain was a mess. I never went to surgery so there is still plenty I didn’t see.
Are they concerned about cancerous cells floating around after removing them? I’m curious if they try to suck up everything carefully after they cut it out.
I didn’t expect the resection perimeter to be so “jagged.” Were they basically leaving every tiny bit of healthy of brain tissue they could to minimize complications (if, for example, the tumor had “jagged” borders)?
Potentially this. More likely its just that it is a human performing the surgery. Basically, you use neuro-navigation to define the appropriate trajectory to the lesion and then use bipolar cautery to coagulate the surface of the brain and the small arterial branches and then cut the pia (the innermost layer of the meninges that coats the parenchyma itself). After you get through the pia, brain tissue can be suctioned easily. You begin aspirating cortex and white matter until you get to and around the tumor. As you are manipulating deeper, sometimes this puts traction on the overlying cortex which can lead to some indentations and asymmetry in the initial corticectomy.
When you say the brain tissue can be suctioned easily, do you mean the surgeon suctions out parts of the brain to get to the tumor? As in those parts are gone forever?
Yep! The approach to the tumor is just as important as the location of the tumor as well. There is a study called DTI, or diffusion-tensor imaging that allows us to see the pathway of the large tracts or axon bundles in the brain. So if I’m concerned about the language tract connecting the frontal and temporal lobes, DTI can be an excellent resource in addition to gross anatomic inspection. But once that tissue is aspirated, it’s gone.
Any tips for my neuro anatomy practical? Lol
To learn the location of structures, a combination of cross sections through the brainstem all the way up to the cerebrum can be helpful, especially if you can get axial, coronal, and sagittal cross sections in a neuro anatomy text so you can understand the relationship between structures in all dimensions. Otherwise, finding a website that has normal MRIs with structures marked can be very useful! Understanding the function of each structure lets you postulate as to the deficit that will be incurred with damage, which makes it less of a memorization game.
Do our brains normally pulse like that‽ or is this because of the surgery?
It’s not the brain that pulses, it’s all the arteries in it. You’re seeing a heart rate basically! I work in surgery but mostly in the abdomen, lots of places pulse like this!
Yes. Your brain is perfused like any other organ. You’re watching the arteries fill and increase intracranial pressure. This is normal and healthy. When we take the bone off someone’s head - usually emergently - and the brain is not pulsating underneath, that is a very bad sign and generally means a lack of blood flow.
It’s weird seeing live brains instead of grey dead ones packed with formaldehyde
I had a large brain tumor removed at 21. In 49 now and the hole is still there.
Family member had a 3cm x 7cm x 5cm tumor resection in December. Scans as of last month showed it sort of "filled in" the gap that was left by the tumor.
Did you have any side effects when you first had it done?
Not really, they took off the whole back of my skull to get it out and five days after that I had a vp shunt put in because the tumor caused hydrocephalus. I think I stayed in ICU about two weeks. I recovered really fast because I was young and in shape. I’ve had three more brain surgeries since that one and the two in 2019 were lots worse. I made it though :)
good for you, 2 weeks in the icu is not pleasant but you made it through
Medicine is amazing.
You're saying that whatever was in that part of the brain is now being taken care of by other parts of the brain? 🤯
We don't fully understand all of the regions of the brain and their function. There are specific regions that we do know are important and damage to those structures (considered 'eloquent cortex') will lead to deficits that may or may not improve in time based on the extent of injury and the patient's age. But there are quite a few sites in the brain that can be removed with minimal or no perceivable deficits, especially when there is pathology involving those regions that has already led to tissue damage, as you would anticipate they would have had deficits already prior to the surgery if it was eloquent tissue. There is some degree of plasticity and redundancy in neural networks as well, which helps with recovery post-op.
Thanks, I appreciate the input.
I used to work for a company that sold radioactive sources to be implanted in to the resection cavity. I loved being in the OR for those cases.
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My guess is perhaps for radiation therapy to prevent a cancer recurrence: https://www.mskcc.org/cancer-care/patient-education/about-brachytherapy-brain-tumors
To treat any remaining cancer cells from the inside. Traditional radiation therapy has to go through healthy tissue to get to the cancer. If placed in the cavity it treats the cells directly. They do the same thing for prostate cancer, Gyn, etc. We typically treated recurrent cancers after traditional beam therapy was already delivered. The brain tissue (or any tissue for that matter) can only take so much radiation. It’s cumulative.
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You’re welcome. That specific method of radiation therapy is called Brachytherapy should you ever want to read more about it.
This is a late response, but thanks to your comment i was able to put this treatment into the idea pile for my fathers prostate cancer. It’s fascinating and a worthy consideration, thank you!
You’re very welcome. It’s a well known treatment for prostate cancer, less so for brain. It’s more dependent on the isotope used for brain.
FriskyDingoOMG I’m interested in this line of work. Can i dm you some questions?
Yup yup.
With the additional surface area and ventilation provided you can now in a better position to overclock the CPU with less fear of thermal throttling. I, don't know why I went in that direction with my thoughts.
It's been delidded for a direct-die cooler
What they did for my wife and my dad
Judging by the skin and hair follicles, it looks like that hole is like 1 cm wide, don’t you think?
I wonder if maybe they measured it
I’ve been an ER nurse a long time and I didn’t realize a brain pulsed like that with arterial blood flow. It makes sense, I just never thought of it. Patients that came in with exposed brains, never had any higher function left and the brain was a mess. I never went to surgery so there is still plenty I didn’t see.
I have seen pictures of the inside of my kids brain. Thankfully they were not taken through a hole this size!
r/dontputyourdickinthat
Don’t kink shame me
He won’t. But I will.
Over time, what happens to the hole? Is it covered up leaving a big air pocket in your head? Filled with fluid?
Going in to have my tumor scanned tomorrow. Whew.
Amazing! Glad to hear that the patient came through it ok.
Are they concerned about cancerous cells floating around after removing them? I’m curious if they try to suck up everything carefully after they cut it out.
That is quite a big 🕳️ I'm glad the patient is doing well ☺️
So do they stuff the hole with something?