Haoyang Du - Dr. Theodore Schwartz- Week2

Second week of the summer immersion is a good combination of OR surgery watching and lab experiences. I have spent both Monday and Wednesday in the OR and have luckily seen 4 different kinds of brain surgeries. The first surgery this Monday is for implanting the device for vagus nerve stimulation for an epilepsy patient. The implant is consisted of a long wire with electrodes on one end, connecting to a battery/pulse generator. There was a camera recording the surgery and showing the incision site for implantation at the screen. However, it was still pretty hard to identify the vagus nerve and the electrode wrapping around due to the scale of everything. Luckily, besides the surgeons and the nurse running the surgery, there was also a technician from the device implant company in the OR during the surgery guiding the implantation of the device and testing it before actually put into use. He gave me a model of the battery/pulse maker and have showed me what would it look like if we assemble the whole system, showing by the picture below. The second surgery on Monday is a craniotomy on a patient with brain tumor to collect tumor tissue sample for further biopsy. A small part of the skull was removed and parts of a tumor was taken out for biopsy. This was my first time to actually see a tumor from a patient. 

I was able to watch an endoscopy tumor resection surgery on Wednesday morning by Dr. Schwartz. The patient had a pituitary tumor that need to be removed through the surgery. An endoscope is placed in through the nasal cavity of the patient and a tiny craniotomy was performed at the bottom of the brain. Tumor was then removed through this access route. The second surgery on Wednesday was following the electrode implant surgery I watched last week, in which electrodes were placed in to the brain of a patient with epilepsy to find the seizure focus and to monitor seizure propagation. After a week of monitoring, the surgeons have identify two focuses of the patient, one on the temporal lobe neocortex and the other focus on the hippocampus. With the seizure focus identified, the current surgery approach to deal with epilepsy is to remove the brain regions having the seizure. In this case, Dr. Schwartz went on to remove the entire temporal lobe neocortex and the entire hippocampus on the right side of the brain. It was fascinating seeing the removed human brain regions and I was also shocked by how large of the brain was removed. I was concerned about the functional deficit that could caused by removing this large area of the brain. However, this was a trade off of being seizure-free and what influence we want to have on the functionality of the brain. Dr. Schwartz expressed his thought on this trade off.  He was saying that, when doing the seizure focus removal surgery or tumor removal surgery, he would think about what he would regretted not doing during the surgery.  





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