Neurosurgery

[TheDBird90]

My A&P teacher said that during some neurosurgeries the surgeons have to keep the patient awake and keep talking so, for example, to make sure they didn't hit any important speech areas of the brain. That sounds insane to go through that. Do any neurosurgery residents have any info on this? Surely you're asleep when they cut through your skull, right?

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[pioneer22]

@neusu

 

[Lawpy]

My A&P teacher said that during some neurosurgeries the surgeons have to keep the patient awake and keep talking so, for example, to make sure they didn't hit any important speech areas of the brain. That sounds insane to go through that. Do any neurosurgery residents have any info on this? Surely you're asleep when they cut through your skull, right?

Tagging in @neusu @mmmcdowe @WedgeDawg for thorough responses

 

[HarryPotterLostInNarnia]

they even have a person playing violin during the surgery!

 

[neusu]

My A&P teacher said that during some neurosurgeries the surgeons have to keep the patient awake and keep talking so, for example, to make sure they didn't hit any important speech areas of the brain. That sounds insane to go through that. Do any neurosurgery residents have any info on this? Surely you're asleep when they cut through your skull, right?

It depends on the indication and the surgery, but we routinely operate on the brain with people wide awake. There are no pain receptors inside the dura. As someone else mentioned, some surgeons prefer to have the patient asleep for the exposure and then awake for the critical portion, others though have the patient awake the whole time

 

[WedgeDawg]

My A&P teacher said that during some neurosurgeries the surgeons have to keep the patient awake and keep talking so, for example, to make sure they didn't hit any important speech areas of the brain. That sounds insane to go through that. Do any neurosurgery residents have any info on this? Surely you're asleep when they cut through your skull, right?

For some functional neurosurgeries, such as DBS for Parkinson's, the patient is kept awake under local anesthesia so that the stimulator can be turned on to make sure it's in the right spot. If it is, the patient's hand tremor will stop as soon as it is turned on! It's an astounding thing to witness for sure.

 

[mwsapphire]

For some functional neurosurgeries, such as DBS for Parkinson's, the patient is kept awake under local anesthesia so that the stimulator can be turned on to make sure it's in the right spot. If it is, the patient's hand tremor will stop as soon as it is turned on! It's an astounding thing to witness for sure.

Both of my grandfathers died of Parkinson's , I audibly gasped at this.

 

[JB50]

It depends on the indication and the surgery, but we routinely operate on the brain with people wide awake. There are no pain receptors inside the dura. As someone else mentioned, some surgeons prefer to have the patient asleep for the exposure and then awake for the critical portion, others though have the patient awake the whole time

Why do we get headaches if there's no pain receptors in the brain?

 

[NecrotizingFasciitis]

Why do we get headaches if there's no pain receptors in the brain?

I know caffeine headaches are caused from an adaptation your body makes after long-term caffeine usage.

Caffein causes vasoconstriction in the cephalic vasculature (opposite of the dilating effects seen elsewhere in the body; periphery) and eventually your body compensates to keep the vasculature at a normal diameter; the diameter the vasculature would normally be without caffeine; it sends less constriction signals to the vasculature.) When the caffeine is abruptly taken out of the diet, the body continues to send less constriction signals than normal to those veins (b/c "reverse adaption" takes time), and as a result, they are more dilated than normal in the absence of caffeine. The vasculature is now more dilated than normal and presses up against surrounding nerves in the area, sending pain signals to the brain. This is why drinking caffeine will make caffeine headaches go away too.

This is how it was explained to me anyways.

I don't know the specific anatomical location of this process... I just know it's up there in the head somewhere, lol.

 

[JB50]

I know caffeine headaches are caused from an adaptation your body makes after long-term caffeine usage.

Caffein causes vasoconstriction in the cephalic vasculature (opposite of the dilating effects seen elsewhere in the body; periphery) and eventually your body compensates to keep the vasculature at a normal diameter; the diameter the vasculature would normally be without caffeine; it sends less constriction signals to the vasculature.) When the caffeine is abruptly taken out of the diet, the body continues to send less constriction signals than normal to those veins (b/c "reverse adaption" takes time), and as a result, they are more dilated than normal in the absence of caffeine. The vasculature is now more dilated than normal and presses up against surrounding nerves in the area, sending pain signals to the brain. This is why drinking caffeine will make caffeine headaches go away too.

This is how it was explained to me anyways.

I don't know the specific anatomical location of this process... I just know it's up there in the head somewhere, lol.

Can't be true mane

 

[tiedyeddog]

Why do we get headaches if there's no pain receptors in the brain?

Depends on the type of headache. There is sensation in the dura and associated protective layers so some headaches, such as hangover headaches, are thought to be due to meningeal irritation.

 

[tiedyeddog]

Can't be true mane

Migraines and headaches are a very complex thing. The idea posted above about vasculature changes is actually a real proposed pathway for some headaches. Thus why B-blockers and triptans are thought to modulate migraines. Im sure the actual reason these drugs work are much more complex than this but the what poster above is saying isn't wrong.

 

[JB50]

Migraines and headaches are a very complex thing. The idea posted above about vasculature changes is actually a real proposed pathway for some headaches. Thus why B-blockers and triptans are thought to modulate migraines. Im sure the actual reason these drugs work are much more complex than this but the what poster above is saying isn't wrong.

I know headaches and migraines are extremely complicated that's why I asked

 

[getdown]

Just as been mentioned above we do keep them awake depending on if the surgeons are at a critical point of the surgery or are close to areas that they need to make sure is not operated. A lot of times it's patient specific. If we feel that the patient is reasonable and not super anxious we can keep them awake throughout. However, many times we have them on sedation that can quickly be turned off/on as needed like precedex or propofol. Inject local around the scalp, some propofol to get them through the craniotomy portion, wake them up for the important parts and then asleep again during the closing portion. Again, a lot of this is patient, surgery and surgeon specific. Thankfully, anesthesia has lots of different drugs to address each situation.

Lots of etiologies for "headache". A lot of times the headache pain is due to the stretching of the meninges of the brain. Those have pain fibers. People with dural puncture headaches and CSF leaks are having pain because the brain shrinks and meninges are stretched, those with meningitis have pain from meningeal irritation.

 

[school is easy]

I wanna become a neurosurgeon.






just saying

 

[Matthew9Thirtyfive]

I wanna become a neurosurgeon.






just saying

These things sound super cool in theory, but I'll still take not standing in the same place for 10 hours without eating or going to the bathroom. God bless neurosurgeons, because someone's gotta do it.

 

[AnatomyGrey12]

I wanna become a neurosurgeon.






just saying

Lol

 

[aldol16]

I have friends who have shadowed during neurosurgeons and can confirm that they sometimes do indeed wake patients up in the middle of neurosurgery to make sure that they are in the right place/removing the right stuff.

 

[Dox4lyfe]

I have friends who have shadowed during neurosurgeons and can confirm that they sometimes do indeed wake patients up in the middle of neurosurgery to make sure that they are in the right place/removing the right stuff.

+1 did observe an awake patient during a neurosurgery. Just keep in mind though, they usually do neck/spine stuff (which is what I saw 99% of the time), and so these surgeries are relatively rare.

 

[jqueb29]

Can confirm, I've seen numerous awake cranies. At my institution, we heavily sedate the patient for the exposure portion, then back off once it's time to do the testing (we never actually put the patient asleep, just varying depths of conscious sedation). There are electrodes on the patient's head and some person runs them through various tests (name these animals, do this math problem, etc). When a specific task requires use of a specific area of the brain, the electrodes detect the brain activity and we have a screen that lights up which areas are primarily being used. Basically we are testing to visually see which areas of this patient's brain are needed for speech, calculation, spatial orientation, etc so we know which areas are important to ensure the neurosurgeon does not resect any of those areas.