Haoyang Du - Dr. Theodore Schwartz - Week8

 This week, I went in to the OR on Monday and watched a surgery in which they implant stereotacatic depth electrodes in to the patient's brain to map out seizure focus. First, they had the machine moved around patient's head to register locations with the Rosa robot. One the patient's head is registered and is at the correct locations, the robot arm, with a laser guide, will move to locations predesignated for electrode implants. The arm of the robot consists of a laser pointer and a stereotactic guiding device. Once the arm moved to a implantation spot, the surgeon will opens up the skin in that locations, and drill through the skull following the stereotactic guiding device. After drilling through the skull, the surgeon ill put in a holder in to the skull. The surgeon will then put a electric wire through the guiding device, throguh the holder and in to the brain. The wire acts like a monopolar, which will heat up due to the current going through and burn the dura and the cortex as it goes in. It thus create a space for the electrode implant to fit in while cauterize all the blood vessels on the way to prevent bleeding during implantation. The surgeon then put a lead nut on the holder. The actual functional electrode will be put in the holder, in to the brain, through the channel created by the electric monopolar device. The surgeon then tightened up the lead nut to hold the electrode wire in place while also pulling it in further in to the brain. As the electrode is already inside the brain, the surgeon will take out the wire from the sterotax and cap the lead nuts/wire with a rubber cap. On Wednesday I went to OR again and watched a endoscopic surgery for a skull base tumor removal, it was a relatively large tumor.

On Tuesday I went to the shadow a clinic day. When looking at a case with large meningioma, we noticed that the previous surgery still left part of the tumor in the brain. The fellow told us that we cannot do much for tumors invaded in to the sinus, we need to leave a part of the tumor as it would be really hard to close up the sinus if we take everything out. I have noticed that there's a general difference in the patient's view and surgeon's view of the surgery. While patients hope that the tumor surgery will solve their problem in one sitting and they do not need to come in ever again, it was rarely the case that they will be completely cured. Sometime they will have a small part of the tumor left and thus will need to monitor it regularly. In other cases, even the tumor got removed completely through surgery and nothing showed up on MRI, there's still a possibility that the tumor will grow back, which make the monitoring still necessary. Moreover, my experiences on the clinical side of the clinic have given me a feeling that there is a business component of running a clinic, including the marketing of yourself and patient leaving good review of their experience.