What Makes Brain Surgery So Hard?
Brain surgeons operate on the most complex structure known to humans. Neurosurgeons are responsible for the treatment of disorders of the brain and spinal cord. It’s an area of medicine that has evolved from crude practices like lobotomy to intricate operations performed under microscopes with the assistance of robots. The field is notoriously complex, and many surgeons choose to specialize in a particular area, including neuro-oncology (tumors), pediatric neurosurgery (babies and children), functional neurosurgery (chronic diseases like epilepsy), neurovascular surgery (aneurysms and blood vessel disorders), or traumatology (head injuries). And surgery only makes up a part of a brain surgeon’s week.
They can spend a couple of days in theatre, but the remainder of the time is often spent working with patients outside of the operating room. They attend clinics to diagnose and monitor, and conduct ward rounds to follow up on their patients after they’ve been operated on.
There are numerous risks and challenges associated with operating on the brain
A blood clot could develop during or after surgery, potentially obstructing blood supply to part of the brain.
It’s critical to keep everything sterile to prevent infection inside the brain.
The brain is covered with a rich network of blood vessels, so surgeons use clamps and cuffs to minimize bleeding.
The brain can swell after surgery, and sometimes the flap of bone is left off for a few days to allow it to subside.
Patients can experience seizures during surgery, particularly if they are conscious while the operation is taking place.
The brain is cushioned by cerebrospinal fluid, and this can leak out during and after surgery, causing headaches and blurred vision.
Surgeons work within mille meter margins, but surgery can cause damage to senses, speech, and memory and muscle control.
Breaking bad news
Surgery can be risky, and part of a brain surgeon’s job is to inform family members when operations don’t go well.
Advanced surgical tools
In brain surgery, the tiniest movements make a difference, so surgeons are turning to robots for help. Endoscopes are already used to perform precision surgery with minimal disruption to surrounding tissue, but tech in development aims to take this even further.
Robots are better than human hands when it comes to holding cameras steady, and with their help, laser microscopes should be able to capture high-resolution images inside the brain. Tumor paint is also in development to light up cancer cells. It sticks only to the affected cells, avoiding healthy tissue, and should help to guide surgeons to the parts of the brain that need to be removed. Live images enable surgeons to work with pinpoint accuracy.
Evolution of brain surgery
Ancient bones suggest brain surgery has a long history
Archaeological evidence suggests that the first surgery ever performed was brain surgery. Trepanation involved making a hole in the skull, thought to release spirits and relieve headaches.
In this year, William Macewen removed a brain tumor from a patient for the first time. The woman is thought to have had a slow-growing, noncancerous growth called a meningioma.
Wilder Penfield began developing the techniques for a wake craniotomy, using local anesthetic to perform brain surgery while patients were conscious, to help avoid damaging functional areas.
The first lobotomy was performed in an attempt to treat mental illness, disrupting connections in the frontal lobes. The practice stopped when drug treatments became available in the 1950s.
A patient known as HM underwent radical surgery to cure his epilepsy, and ended up with severe memory problems. His case was followed for 50 years, revealing a lot about memory.
The first ever human head transplant is set to be attempted by Italian surgeon Professor Sergio Canavero on a terminally ill man. He will use a specially developed knife that cuts with micro meter accuracy. A neck down paralyzed Russian man and a perfectly healthy woman from Kerala, India have volunteered for this surgery.
Major surgery is most often performed under general anesthetic, but operating on the brain is a bit different. Keeping patients awake through the procedure can help to protect critical parts of the brain from damage.
At the start of the procedure, the patient is often put to sleep under sedation, allowing a section of the skull is removed. They are then woken up again. The brain itself doesn’t feel any pain, and the scalp is numbed using local anesthetic. Using electrical probes, the surgeons stimulate different parts of the brain while the patient reads talks or even plays an instrument. If there’s any change, the surgeons know to avoid that particular area.
Heroes of Brain Surgery
Harvey Williams Cushing
Cushing pioneered delicate surgical techniques and performed over 2,000 operations. He gathered samples from every case and created a vast registry, complete with patient notes and photos.
Sir William Macewen
Macewen produced the Atlas of Head Sections, a book that mapped the brain with images of real specimens. He was able to pinpoint damaged areas just by watching for the muscles and senses affected.
Penfield pioneered ‘awake surgery’ for patients with epilepsy, keeping them conscious when mapping the areas of the brain responsible for different functions, including speech and memory.