brain tumour/skull

[aheyn01]

Have a question here...

I know it might sound very vauge - but if a person has a brain tumour and has to have it removed, how does the surgeon actually get access to the brain?

What I mean is..... they would have to make more than just one cut to get any access at all - more like a square (but then how would that heal)... they couldnt make two cuts (like one right and then 90 degrees down) and then pull it up because its the skull!

How is it done?

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[mpp]

I'm not sure what your asking but I'll try to answer as best I can.

The approach to a brain tumor all depends on location and is carefully planned to disturb as little unaffected brain as possible, especially the important bits. That is to say there are parts of the brain where you can take pretty large chunks out without too big a deficit in function and there are others places that resecting even a tiny bit would have devastating consequences. Plus, there's the vascular supply to worry about as well.

The idea is to take away as much bone as is needed to get a good approach to the tumor without needing to take out too much normal brain. The bone is often taken in a flap that can then be put back (like a hatch door). For some tumors you can only take so much and just leave the rest to grow back another day.

There are some pretty cool 3D brain mapping gizmos that help with making a smart approach.

 

[aheyn01]

I'm not sure what your asking but I'll try to answer as best I can.

The approach to a brain tumor all depends on location and is carefully planned to disturb as little unaffected brain as possible, especially the important bits. That is to say there are parts of the brain where you can take pretty large chunks out without too big a deficit in function and there are others places that resecting even a tiny bit would have devastating consequences. Plus, there's the vascular supply to worry about as well.

The idea is to take away as much bone as is needed to get a good approach to the tumor without needing to take out too much normal brain. The bone is often taken in a flap that can then be put back (like a hatch door). For some tumors you can only take so much and just leave the rest to grow back another day.

There are some pretty cool 3D brain mapping gizmos that help with making a smart approach.

mpp - thanks for that, very interesting to read. Basically I was talking about how they 'cut' the hole in the skull to get to the spot. So what your saying is, once they put the bone (that is hinged up) back down - it will grow back together again ?

Also... when you say take out parts of the brain - you mean they literally cut out some of the grey/white matter ? Geez you'd hope they knew exactly what could be touched or not.

I remember a friend of a friend's who had an op to remove a brain tumour ages ago - after the op she lost her sense of smell.....

 

[Chronic Student]

You make your skin incision.

Put your Raney clips on the scalp edges.

Get hemostasis.

More dissection, take down the temporalis if you need to.

Strip the periosteum off of the skull.

You then use a device called a perforator (think large drill bit) to make an initial opening into the skull. This is spring loaded and stops rotating when resistance is removed.

You then use a Penfield to place some bonewax around the edges of your hole for hemostasis and you can also use it to release the dura around your hole.

You make several more holes like this one.

Then there are a couple of ways to "connect the dots"

Old school is to use a Gigli saw on a passer. It's basically a wire saw that is passed from one hole to another and then drawn back and forth and cuts a path from one hole to another.

The newer method is to use a ultra high speed drill like a Midas Rex or a Black Max that has a small cutting bit on it. There is also an attachment called a foot which runs paralell to the bit and then turns perpindicular past the bit and protects the dura from the drill. This bit then cuts a path between the holes.

Once all of the dots are connected, you use the Penfield to pry up your flap and strip the dura off of it.

Incise the dura and tack it back.

You then do what you came to do using as little force, manipulation, handling, retractors, etc., as is possible.

When you are done and have closed the dura then you can use a plating system like the KLS or a similar one to attach the bone flap to the surrounding skull.

The plating system are tiny little titanium plates and screws that are used to provide stability while the bone heals.

That's probably more than you wanted to know.

-Mike

 

[Blake]

Pretty accurate explanations here, but nothing beats seeing it live. Try to shadow a neurosurgeon, as hard as it may be to find someone willing to let you (presuming you're pre-med. My bad if it's not your case).

 

[seba3y2000]

thank u bbm for ur explaination and want to ask u about the new of the use of stem cell therapy to treat the brain tumours .