Can we crank the bipolar up to 35, please? … microscissors … let’s get some irrigation in here!

These are a couple of phrases that you may hear should you ever find yourself in the operating room. They are commands used by surgeons, regardless of specialty, many, many times each day. The “bipolar” is an instrument that delivers an electric current from one metal tip to another. It allows a surgeon to burn and cut through tissue, fat, etc. It also minimizes blood loss as it cauterizes the blood vessels as they are being cut. Microscissors are just that…micro scissors. The scissors portion of the instrument are smaller than a paper clip, but they are really useful for making precise cuts under a microscope. Finally, irrigation refers to a saline solution that surgeons utilize to wash out the wound should it get full of blood or fluid.

I saw my first brain surgery a few weeks ago! It was AMAZING! It was truly awe inspiring when I stopped and thought about what all the brain controls. I mean the brain controls breathing, memory, speech, walking, personality, and pretty much everything else about us! And neurosurgeons have the responsibility of operating in this complicated control center of our bodies! They have to get in, do what needs to be done, and get out without causing neurological deficits to the patient. That is no small task. It is nerve-racking, but mostly it is really exciting. Spending time in the Cedars-Sinai OR, working with the neurosurgeons and residents, seeing brain tumor resections, watching the brain pulse along with the heartbeat, examining facial nerves, and more, have convinced me that I want to become a neurosurgeon!

Just to give you an idea of a few cases that a neurosurgeon may have to deal with on any given day, I am going to briefly describe trigeminal neuralgia (TN) and ependymomas.

Trigeminal neuralgia is a disorder characterized by intense facial pain. It typically is caused by a blood vessel putting pressure on the left or the right trigeminal nerve. The trigeminal nerve controls a multitude of functions. It transmits signals from the face to the brain, it controls jaw muscle movement, and it involves a person’s ears, eyes, nose, forehead, teeth, tongue, and more. A patient who has TN may experience intense pain in any or all of the above areas, typically on one side of the face, many times throughout the day. Attacks can be triggered by something as simple as brushing one's teeth or a cool breeze. It is a debilitating disease that gets worse over time. A neurosurgeon can correct the problem through microvascular decompression. He/she can make an incision behind the ear, cut open the skull, move the brain to expose the trigeminal nerve, separate the nerve from the blood vessel, and place a Teflon pad between the nerve and vessel to insure that the blood vessel can no longer put pressure on the nerve. The patient should recover well with little to no pain or facial numbness.

An ependymoma is a tumor that develops from ependymal tissue of the central nervous system. Most often it develops in the fourth ventricle, but it is also common in the spinal cord. Symptoms, if they arise, are typically due to an obstruction in the flow of cerebrospinal fluid. A subependymoma is a less common type of ependymoma that is typically benign and more often found in men. Ependymomas may be treated through radiation or surgical resection. The fourth ventricle, as it is situated directly over the top of the brain stem can be a tricky place to operate. Neurosurgeons have to be extremely careful when operating near the brain stem as there are only a few layers of cells that protect it. The surgeon has to tease the tumor away from the healthy brain tissue and remove it piece by piece, while continuously monitoring the brain stem evoked responses and the heart rate. It is a long, but interesting process in which the surgeon looks for visual clues that distinguish tumor from brain, such as vascularity, color, and texture.