Haoyang Du - Dr. Theodore Schwartz - Week6

 This week, I have tried to shift my focus more towards research while maintaining the amount of OR and clinic experience. I went to OR and clinic to shadow surgery and patient seeing for the first half of the day, and then went to lab to do experiments for the second half. On Wednesday, I was able to see a ventriculoperitoneal shunt replacement followed by a right endoscopic craniopharyngioma resection. On Thursday morning, I went in to Dr. Schwartz surgery in which they were doing a right endoscopic intraventricular tumor biopsy. As the tumor is in the ventricle, the surgeon needed to go though the cortex to access the tumor. While only a tiny hole is made on the skull and the cortex for the endoscope to go in and for it to be less invasive, there were a really limited field of view and a limited room for operation. Surgeons were able to locate the tumor and get a few samples from it. However, a blood vessel near the tumor site ruptures and leads to bleeding into the ventricle space. As they were not able to stop the bleeding, Dr. Schwartz decided to do a full craniotomy on the patient to opens up the skull to provides more access to the brain. The watching crew was removed from the OR as they would need more space for the operation. I thus went in to the OR nearby which have a left awake craniotomy tumor resection. I was really excited that it was my very first away surgery observed. I walked in while they were still opening up the skull and the dura, so the patient was still anesthetized. Soon the attending surgeon asked us to remain silent as they are going to wake up the patient. As the tumor is below the cortical regions that provides important functionality, they need to have the patient awake to perform different cognitive tests and behavior evaluation to make sure they are not hurting the important cortical regions during the tumor resection. The surgeon started to do the mapping of the cortex, during which he use a electrode to gently touch the cortex and stimulate that region. In the meantime of the stimulation, the nurse in the room will ask many different questions to the patient, ask him to report any feeling that's abnormal, and also evaluate any possible facial motion that's unintentional. The nurses asked the patient to count in both English and Spanish, as it is possible that the stimulation only affect one of the languages if that is learned later in the life time. The patient said he has been speaking Spanish for 30 years, but it is really interesting that how different can the native and non-native languages be encoded in the brain that actually leads to clinical differences. The nurses changed task really often, from counting to picture identification, question answering, and sentence completion. All the task was performed in English and Spanish. The process is repeated until all the regions has been stimulated at least 3 times. Spots that's been identified as "critical" mas marked by a piece of sterile paper. Surgeon then proceed to tumor resection.