Hello again!
This second follow-up to brain shifts is more technical. Some of you may be wondering why I haven't discussed any case studies on this blog yet. Patient confidentiality is an extremely serious issue, so I am unable to write (or say) in much detail what I have seen. I will try my best to talk about the procedural side and my experiences at the hospital while respecting patient privacy.
That being said, there are quite a few videos on YouTube about DBS. If you really are interested in seeing how it's done, this is a video released by Stanford Medical Center. It's graphic. The surgery starts at around 5:30.
So, back to brain shifts. There have been hypotheses that patients whose surface brain structures shift significantly will also experience more shift/deformation in the deeper structures of the brain. A study was done in which doctors identified a surface structure with the greatest shift and deep structure with the greatest shift and plotted the shift values on a graph. There was no significant correlation, so this hypothesis does not hold true.
Why does this hypothesis matter? Well, if the magnitude of a surface structure brain shift was correlated to a deep structure brain shift, then doctors would be able to predict how much specific structures of the brain would move during surgery.
In case you were wondering if the age and gender of the patient had any influence on brain shift, there is none. Like I said in my previous post, there have been contrasting results in studies examining brain shift. Some think that craniotomy size affects how much the brain will shift. Others believe that the shift is independent of orientation of the patient and cranial opening.
Sometimes, DBS surgeries are performed while the patient is awake so the surgeon can immediately determine if he/she has inserted the electrode in the correct location. Here's a pretty awesome video about a DBS awake surgery done on an awake patient (the patient is playing violin during the surgery!)
While that patient didn't have Parkinson's Disease, the concept of awake surgery is similar.
Why should you care about brain shift? Well, that's up to you. It may seem odd that there seems to be a collective anxiety over brain shifts in the neurosurgical community. If the brain moves a little, so what? Can't the surgeon tweak the procedure a bit and everything will be fixed?
And I will say that you are somewhat correct. Superficial shifts are visible during surgery, and can be carefully monitored by the surgeon. However, deep brain structure shifts can cannot be easily seen are more concerning as a surgeon could damage a critical area controlling language, speech formation, etc. There have also been studies showing that if the placement of an electrode is 2mm off the optimal location while stimulating the STN (subthalamic nucleus - a common target to stimulate for Parkinson's patients), the results of DBS are less effective. This is where the Intraoperative MRI comes in handy. It can stream a live feed of the location of the brain structures to the surgeon.
Another thing not related to anything medical, but only after I've started working have I realized how nice everyone dresses. Of course, coming from high school where sweatpants (and frankly pajamas) are acceptable attire, it's suddenly a huge change. I never really put much thought into what doctors and hospital employees wear. To me, their wardrobes seemed to consist solely of scrubs (in different shades of blue and green), stethoscopes looped around their necks, and white coats for warmth. I've seen some female doctors dress in heels and skirts and male doctors walking around in suits.
I guess I shouldn't be surprised. A doctor's appearance is a huge part of their profession, and maintaining cleanliness, personal hygiene and professionalism towards their patients is not only respectful, but necessary to earn trust. If my surgeon introduced him/herself in a pair of joggers and a muscle tee (and crocs with socks on), I don't know how I would react, but "I am completely comfortable letting you cut into my body" would not be the first thought that would come to mind.
Hospital employees don't walk around in jeans and tank tops. They have an image to uphold, and now I'm experiencing it for the first time. Long gone are the days of sleeping in the morning and showing up to class wearing jeans and a tee shirt. Dressing up in pencil skirts, blouses, and slacks is the requirement for joining the workforce. Plus, it gives me an excuse to go shopping.
That is all for today. Thank you for tuning in! Pardon me as I start queueing for that delicious chicken tortilla soup.
Holly
Main article:Brain shift during bur hole–based procedures using interventional MRI
This second follow-up to brain shifts is more technical. Some of you may be wondering why I haven't discussed any case studies on this blog yet. Patient confidentiality is an extremely serious issue, so I am unable to write (or say) in much detail what I have seen. I will try my best to talk about the procedural side and my experiences at the hospital while respecting patient privacy.
That being said, there are quite a few videos on YouTube about DBS. If you really are interested in seeing how it's done, this is a video released by Stanford Medical Center. It's graphic. The surgery starts at around 5:30.
So, back to brain shifts. There have been hypotheses that patients whose surface brain structures shift significantly will also experience more shift/deformation in the deeper structures of the brain. A study was done in which doctors identified a surface structure with the greatest shift and deep structure with the greatest shift and plotted the shift values on a graph. There was no significant correlation, so this hypothesis does not hold true.
Why does this hypothesis matter? Well, if the magnitude of a surface structure brain shift was correlated to a deep structure brain shift, then doctors would be able to predict how much specific structures of the brain would move during surgery.
In case you were wondering if the age and gender of the patient had any influence on brain shift, there is none. Like I said in my previous post, there have been contrasting results in studies examining brain shift. Some think that craniotomy size affects how much the brain will shift. Others believe that the shift is independent of orientation of the patient and cranial opening.
Sometimes, DBS surgeries are performed while the patient is awake so the surgeon can immediately determine if he/she has inserted the electrode in the correct location. Here's a pretty awesome video about a DBS awake surgery done on an awake patient (the patient is playing violin during the surgery!)
While that patient didn't have Parkinson's Disease, the concept of awake surgery is similar.
Why should you care about brain shift? Well, that's up to you. It may seem odd that there seems to be a collective anxiety over brain shifts in the neurosurgical community. If the brain moves a little, so what? Can't the surgeon tweak the procedure a bit and everything will be fixed?
And I will say that you are somewhat correct. Superficial shifts are visible during surgery, and can be carefully monitored by the surgeon. However, deep brain structure shifts can cannot be easily seen are more concerning as a surgeon could damage a critical area controlling language, speech formation, etc. There have also been studies showing that if the placement of an electrode is 2mm off the optimal location while stimulating the STN (subthalamic nucleus - a common target to stimulate for Parkinson's patients), the results of DBS are less effective. This is where the Intraoperative MRI comes in handy. It can stream a live feed of the location of the brain structures to the surgeon.
Another thing not related to anything medical, but only after I've started working have I realized how nice everyone dresses. Of course, coming from high school where sweatpants (and frankly pajamas) are acceptable attire, it's suddenly a huge change. I never really put much thought into what doctors and hospital employees wear. To me, their wardrobes seemed to consist solely of scrubs (in different shades of blue and green), stethoscopes looped around their necks, and white coats for warmth. I've seen some female doctors dress in heels and skirts and male doctors walking around in suits.
I guess I shouldn't be surprised. A doctor's appearance is a huge part of their profession, and maintaining cleanliness, personal hygiene and professionalism towards their patients is not only respectful, but necessary to earn trust. If my surgeon introduced him/herself in a pair of joggers and a muscle tee (and crocs with socks on), I don't know how I would react, but "I am completely comfortable letting you cut into my body" would not be the first thought that would come to mind.
Hospital employees don't walk around in jeans and tank tops. They have an image to uphold, and now I'm experiencing it for the first time. Long gone are the days of sleeping in the morning and showing up to class wearing jeans and a tee shirt. Dressing up in pencil skirts, blouses, and slacks is the requirement for joining the workforce. Plus, it gives me an excuse to go shopping.
That is all for today. Thank you for tuning in! Pardon me as I start queueing for that delicious chicken tortilla soup.
Holly
Main article:Brain shift during bur hole–based procedures using interventional MRI
Michael e. ivan, M.D.,1 Jay yarlagaDDa, M.D.,2 akriti P. Saxena, M.D.,3alaStair J. Martin, Ph.D.,4 PhiliP a. Starr, M.D., Ph.D.,1 W. keith SootSMan, r.t., anD Paul S. larSon, M.D.1
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