Neurosurgeon Answers Brain Surgery Questions From Twitter | Tech Support | WIRED

I'm Dr Brian kopel neurosurgeon today I'll be answering questions from Twitter this is brain surgery support [Music] if fianel asks what does the brain feel like to the touch if tofu and Jello had a baby that's how the brain feels there's a a give to it as a patient breathes or the heart pumps blood the brain pulsates accordingly at Stony P asks did you all know that you gotta be awake for brain surgery when you're operating on areas especially related to language we literally ask them questions some patients have played instruments to demonstrate that they are doing okay I have had a patient play a guitar in my operating room we want to see when we're trying to do a surgery for Tremor which is a rhythmic oscillation of the hands or the feet the patient be able to drink from a cup or sign their name which are things that they were not able to do if you stimulate and the patient's still able to respond they can repeat a question they can repeat a phrase that tells us that it's safe to go forward I aren't they screaming in pain the answer is no the brain in of itself has no pain receptors at Blake and band asks what is harder rocket science or brain surgery well that's an easy one to answer brain surgery is harder consider that there are a hundred billion neurons in the brain the amount of connections between those hundred billion neurons are greater than all of the stars estimated in the universe that's why it's harder at lightning Anthony asks do brain surgeons practice on fake rubber brains before having a crack at the real thing no we learn on the job the very first time I walked into an operating room I was struck by the smell we use electric quartery that is electricity in order to control bleeding in the brain in essence what you're doing is cooking flesh and well human beings have a very particular smell when they are being cooked that is a pretty eye-opening or nose opening experience the first time you go into an operating room it would be very hard to replicate it even the best simulation technology isn't quite the same at least currently than the operating room itself at lechem V asks just watch the resection of a brain tumor bro how do neurosurgeons do it and it was done perfectly the skill must be crazy Nature has inconveniently placed the brain inside a box called your skull and trying to get into that skull is like pulling off a heist you have to get into the brain not cause any damage remove the tumor and get out leaving the patient no worse than you found them depending on the tumor it can look very very similar to normal and healthy brain and it takes an experienced eye and some new technologies for us to see in the operating room where tumor ends and where normal brain begins sometimes because the tumor is particularly soft we would take it out piecemeal by suction a suction is essentially a metal instrument that's a straw that also has ultrasonic Energy Applied to its tip that helps the suction along once all the bleeding is stopped we essentially then close the covering on the brain which is called the dura fix the bone flap back to the skull let me close the scalp and we get lunch at Lydia bohaya asks what happens if you need to sneeze during awake brain surgery or do they give you something so you don't sneeze sneezing is often accompanied by something called a valsalva maneuver where the pressure inside the brain temporarily spikes and then goes down again I do deep brain stimulation there's a relatively small hole that's made in the skull about the size of a dime sometimes when a patient sneezes or coughs you can actually see the brain pulsate up a little bit that can potentially be a problem but it's pretty rare at willmium asks how do they fill the hole in your skull after brain surgery the most common way that we fill that hole is with the patient's own skull we usually affix that piece of skull called a bone flap back to the rest of the skull with titanium mini plates sometimes we have to remove a piece of skull permanently very often this can be in the setting of trauma we used to do this with titanium mesh so we would get a essentially like a screen door bend it into place and affix it to the rest of the skull to cover the hole more recently we can get a CAT scan of a patient and computers can design a perfect plastic replacement for what we removed that looks just about as good as the real thing at darkwise asks why do most brain tumors trigger food smells are brain tumors delicious sometimes tumors can create seizures in the brain and depending on where the seizures arise from can involve smell Associated oil faction Associated areas of the brain very often these smells are actually bad smells so it is a very very unusual to elicit a hallucination that is a good smell but it can happen at Kazu Dingus asks if I was doing brain surgery I would Swirl My Finger through the guy's brain just to see what happens I mean dear Lord really running a finger over the surface of the brain if you're very very gentle will do very little if there is pathology near the surface the brain surface can be friable where just the nearest touch can cause bleeding but a healthy brain can be touched with very little recourse at zeldovitz Lauren asks why were lobotomies ever a thing lobotomies were not only a thing they are the only instance where neurosurgery ever won the Nobel Prize in the early days of the 20th century psychiatric care was extremely rudimentary there were many many patients institutionalized it was a huge burden for families John Fulton a physiologist at Yale discovered that the frontal lobe was really important in creating the manifestations that we associate with psychiatric disease egas Monet speculated that if we were to interrupt certain fibers inside that frontal lobe that we could in fact help patients an instrument called a leukotome is inserted into the brain and then a hole was made inside the Deep portions of the frontal lobe once Thorazine was invented the use of lobotomy as a treatment for psychiatric disease fell out of favor but the whole process actually helped mankind really truly understand the physiology of psychiatric disease for the very first time that psychiatric disease was not a weakness in a patient's soul but a real disease like diabetes and actually led to a lot of understanding and treatment that we are using today at dibs on Debs asks hearing the term neurosurgery seems to have such a different connotation than brain surgery do they have the same meaning or are they entirely different entities the term neurosurgery encompasses brain surgery so when we all become neurosurgeons we actually learn the entire surgical technique of treating surgical conditions of the brain the spine and the peripheral nerve which is the entire nervous system brain surgery is just a segment of neurosurgery itself at go Blue tsunami asks what is a craniotomy a craniotomy is a temporary window that we make in the skull in order to allow us to access the inner contents of the brain to remove a brain tumor or to clip an aneurysm we start off by placing Burr holes or small holes around the periphery of the window that we intend to make we then take a type of Saw called the craniotome and we essentially connect the dots or the holes and we create a window called the craniotomy itself do not try this at home at Gladstone writer asks for brain surgery on the way for me this time my neurosurgeon is going to go through my nostrils it's a procedure known as endoscopic endonasal surgery so one of the areas that we encounter tumors and other types of pathologies is in the pituitary gland at the very very bottom of the brain and it sits inside this little bony pocket called the pituitary fossa at the very back of the nose sits these Pockets called air cells inside the skull itself and so by inserting a tube and a camera through the tube we can unroof this air our cell and we are right at the pituitary base and we can take out a tumor without having to disrupt normal anatomy of the skull one of the more common restrictions is limiting the use of things like straws that can develop a lot of suction inside the air cells while the the healing process is occurring and yes also don't blow your nose at Chris Conway asks what clothes do brain surgeons wear cerebral Gore-Tex hahaha I start off by wearing my surgical scrub hat I also wear my scrubs over the scrubs are the sterile layer of our Garb which involves an operative gown and a pair of surgical gloves and this whole process of gowning us up in a sterile fashion is assisted by either a scrub nurse or an or Tech once we are garbed completely we can begin the operation at Peggy Trill X did you know when they do brain surgery and need to remove part of your skull for an extended period of time they just cut an incision in your abdomen and put it in there sometimes there is so much swelling in the brain we have to give it room so that patients can survive the injury we have to remove the entire side of a patient's skull for a long period of time ultimately if you want to be able to put that skull back it's got to remain sterile and what's the most sterile place for for a patient's body part their own body what you're referencing is something that is falling out of favor but is still done neurosurgeons would make an incision in the abdomen and place the bone flap inside this temporary pocket and close it up and as long as there was no infection of the wound that bone flap remained absolutely sterile at that Ricky dude asks so I heard somewhere in random conversation and I'm not sure if it's true he was having brain surgery and the doctor poked something and he remembered being at a party many years before in Vivid detail well in fact this did happen during an operation called deep brain stimulation the electrode was going to be placed in a part of the brain called the hypothalamus the trajectory went through a structure connecting areas of the brain involving memory called the fornix a patient being awake on the table recalled a series of events from their childhood and the amount of detail was so striking to both the patient and the investigators and the surgeons they developed a technique to stimulate this particular area of the brain and have created trials looking to help patients with Alzheimer's disease at Rock Cox 64 asks you know how during brain surgery doctors will have the patient play the violin if they're violinist or whatever so that they don't up their brain do you think that they would have a gamer speedrun Super Mario 64 during brain surgery if they're a famous this video game athlete I suppose why not we could do that sure no problem that billionaire asks I just seen a billboard for gamma knife brain surgery where apparently they operate on your brain without cutting anything open the gamma knife is a type of what we call stereotactic radio surgery pinpoint beams of radiation are focused deep inside the brain and wherever these beams of radiation intersect they deposit a therapeutic dose of radiation that's in a very important tool especially in the realm of certain vascular disorders brain tumors and certain functional disorders at producer Danny ask hi yes can a brain surgeon weigh in here and tell me which part of my brain is responsible for getting the Jurassic Park theme song stuck in my head I'd like to remove it please well that would be a really bad idea because the controller of attention is called the thalamus it's a deep area of gray matter inside the brain and it actually Acts as a gate as to what is grabbing our attention from moment to moment to moment I highly recommend keeping your Thalamus at Danielle babe 26 asks is deep brain stimulation surgery worth the risk so like the heart the brain is an electrical organ everything that we do from writing a Sonata to hitting a baseball is the result of an electrical pattern of activity in the brain diseases such as Parkinson's disease or dystonia or things even like depression and obsessive-compulsive disorder are the results of abnormal electrical patterns of activity in the brain what is deep brain stimulation essentially what it is is a pacemaker for the brain we could place an electrode through a very very tiny hole at the top of the skull into deep structures of the brain what we are trying to do is take a one millimeter electrode and hit a one millimeter Target inside the brain so it's really really really super precise by regulating that electrical activity we can actually make patients symptoms much much better the scariest risk is bleeding in the brain or stroke generally around one percent I had Big Daddy on air asks a robot which can perform brain surgery was showcased at the hashtag world robot conference how good are you at your job robots are coming to take it away well believe it or not robots are already in the operating room there are some limitations one the skull itself and other areas of the body where robots are used such as the abdomen robots have a lot of access because the abdomen can be temporarily inflated with air and there's a lot of room for robots to move around skull's inconvenient there's a skull and then there's a brain not much else and so robots to really become very useful for brain surgery they're going to have to be miniaturized to a huge degree furthermore somebody's got to tell the robots where to go and that still will likely be a human process for for many years to come at fiend Mrs the brain does not feel pain as it has no pain receptors if that is the case why do we experience headaches I have severe migraines and feel like I have an ax in my brain sometimes in the case of migraines the blood cells constrict and then as the blood cells begin to relax that physical relaxation stimulates the pain receptors and causes the pain at leemerg xrl asks can a brain surgeon cut open my head and take out the pieces with ADHD please thanks there are some non-invasive brain stimulation techniques called transcranial magnetic stimulation that people have explored for ADHD but not neurosurgically as of yet at quetzal cohette asks how do you choose the area of the brain where the electrodes are implanted we place an electrode inside the brain to interact with networks of the brain and networks of the brain are distributed pockets of neurons that are all working together to create a behavior if we're talking about a network function that's related to Movement we are interested in placing these electrodes in movement Associated areas of the brain deep gray structures called the basal ganglia which can be seen over here other avenues of research are looking at placing electrodes along the surface of the brain to stimulate the network along the cortex because everything is connected even though you're stimulating locally you're affecting things globally at pristine Martian asks how far away is superhuman intelligence with a brain computer interface I think currently we are fairly close to having brain computer interfaces really help a process called neuroplasticity in the brain and neuroplasticity is the brain's normal process to learn and adapt to the outside world I think that's something that we're going to likely see within the next several years the idea of having a a Bluetooth implant in the brain that helps you Google something on the Fly we are talking decades upon decades before we would see something like that occurring so those are all the questions we have today great questions thanks for watching brain surgery support [Music]

Channel: WIRED

Views: 2,429,139

Keywords: brain surgeon tech support, brain surgery, brain surgery tech support, innovation, neurosurgeon, neurosurgeon brain support, neurosurgeon brain surgery, ott tech support, science & technology, tech support, wired

Id: S_UN4s5qlt8

Length: 17min 9sec (1029 seconds)

Published: Tue Feb 07 2023