Neurosurgery up close

When we walked into the OR, we first noticed the site at the head of the bed. In fact, the patients head was open with the temporalis and skin flaps peeled back.
We were in the OR to observe neurosurgery cases as part of the operating room tours that are offered to first year medical students during the Brain, Mind and Behavior block. The OR tours provide students with a unique view of the brain and surgical approaches to treating a number of neurological conditions.

The temporalis is a muscle that helps in mastication and normally sits on the temples. The muscle was glistening, the red from fresh blood was visible as the surgeon worked in the small space of the skull. He was completing the case by sewing up the dura mater, a layer of connective tissue that covers the brain.

The neurosurgeon skillfully sutured the dura and then moved on to reinsert the piece of skull that had been removed at the beginning of the procedure to gain access to the specific brain region he had worked on. The surgery was being performed to treat an aneurysm of the ophthalmic artery. Aneurysms develop when a blood vessel dilates and balloons out, weakening the walls. With time, such an artery can rupture, bleed and cause death. A surgical intervention is sometimes needed to prevent such complications.

The initial incision was an inverted question mark that was made along the temple. The skull piece was screwed together; a drill was used to create the holes for the screws. Once the skull piece was in place, the muscle could be sutured. The scalp was reattached with the assistance of a special staple gun.

Later, we saw another neurosurgeon remove a meningeoma (typically a benign mass) from the cortex. As we watched the neurosurgeon slowly cut away at mass, I stood in awe, while he remained focused on the small surgical field. We could see the brain exposed, the vascular surface, the gyri and sulci and the pulsations.

Neurosurgery amazes me. Neurosurgeons can cut the skin, pull back the muscles, cut open the skull and gain access to the brain to repair a damaged vessel or remove a tumor. And once the damage is repaired, they can go back and rebuild what had been deconstructed, piece by piece.