Pages

Saturday, August 18, 2007

neurosurgery

I had an opportunity to attend a neurosurgery last week. The surgery was to remove a brain tumour which has caused the patient to have chronic headache in the past few years.

Prior to the operation, I changed my clothes to the surgical cloth. There were few people in the operating theatre: few surgeons and the supporting nurses. The tumour was meningioma which is a type of tumour that attaches to the surface of the brain (dura).

At the start of the operation, the patient was put under general anaesthetic. Since the tumour is located at parietal lobe, the patient's head need to be turned sideways. To ensure the head does not move during the operation, screws were attached at the front and at the back of the head. It seems painful to me to have screw put into your head, front and back for few hours and your head need to turn sideways throughout the operation. Anyway, general anaesthetic helps this situation.

To reach the tumour in the brain, the surgeons need to remove the layers of the scalp. There are five layers in scalp [Skin, Connective tissue, Aponeurosis, Loose connective tissue and Periosteum]. Each layer need to be removed separately. It was amazing to see the layer being removed carefully and you could see the brain beating according to the heart beat. Whenever the scalpel cut through blood vessels, blood spurts out and I think by the end of the operation, the amount of blood gushed out from the brain was around few cups of blood. It is not something that can be seen by someone who is haemophobia.

When all those layers and bone have been removed, we could see the tumour. It was big and it took quite a long time to remove the tumour from the brain. The surgeons need to peel off any attachment of the tumour from the brain. It requires strong concentration and stamina too. The operation lasts about 4 hours and I think only surgeons are capable to stand for more than 4 hours without moving a lot. I need to move around the operating theatre to prevent leg cramps from standing too long. I guess surgery will not be my future career :).

After the tumour has been removed, the surgeon connects the layers and the bone. The bone is connected using screws and the scalp is secured using staples. I am surprised to see the staples being used in the operation. I was thinking the surgeon will attach the skin back using sutures. I guess staples is a better option in this type of surgery.

This neurosurgery gave me an opportunity to refresh my knowledge on neuroanatomy and it was interesting yet tiring.

12 comments:

Mai said...

wah, menariknye..,
mmg perkataan scalp asalnye dari tu ke or lepas tu baru die try mnemonics kan?

tak jahit ek? just staple2 je? so tak tutup btol2 ke? sutures tu ape?

adeh saketnye kepale kene screw..

hafiz238 said...

rasanya mnemonics tu dibuat lepas nama scalp :).

takderlah tutup betul2 sangat. Sebelum tutup, mereka letak something on the brain that will stop bleeding (anti-coagulant)
.

Next, put the bone and attach it using screw. After that, put the scalp back and secure it using staples. banyak juga staples digunakan.

suture tu benang jahitan yang digunakan untuk pembedahan.

Pesakit tak rasa sakit semasa pembedahan kerana guna general anaesthetic :)

intan saleh said...

darah during c-sec lagi la.. berbaldi-baldi.

SoFie NuR said...

wah bestnye...

bile la my chance utk tgk surgery akan tibe....x sabar rasenye...ehmm

hafiz238 said...

intan: c-sec or birth delivery must be extremely bloody kan...

sofie: it will come eventually but before that, you should know your anatomy first :)

intan saleh said...

ive watched both c-sec n normal delivery masa cas kmb. normal delivery isnt that bloody.. and takes shorter time too. with c-sec lama psl nk belah layer by layer tu la. before that mmg mati2 ingat belah trus kuar baby. kwang3! sungguh jahil waktu itu.

hafiz238 said...

hmm, so c-sec is longer and more blood being spilled out...i guess i will know more later in women rotation next year...

chem said...

from my experience during o&g rotation: i think c-sec tak lama sangat, especially yang emergency c-sec. cepat jer surgeon keluarkan baby to avoid severe foetal distress.

normal delivery can reach up to 24 hour (the maximum time allowed for 1st stage of labour. if more--> proceed to c-sec). lagi2 for primigravida (1st time mother).

*sorry, banyak unfamiliar terms. nak tau, boleh tanya :) anyway, you'll be learning this eventually :)

Anonymous said...

during labour, memang bloody tak ingat dunia. paling geli tengok placenta!...tapi semuanya terubat bila nampak baby keluar+cry, and terus letak depan maknyer. sweet moments:)

moshimoshi said...

reminds me of that story yang orang hirup the monkey brain with straws and all. of course for a completely different purpose :D

hafiz238 said...

chem: thanks for the info. The only unfamiliar term to me was primigravida :)

anonymous: that is sweet. I guess I will experience the joy of delivery when I do woman rotation later.

moshimoshi: tak tahu pula story tu....must be gross then :)

intan saleh said...

chem: yeah.. i wasnt talking the time interm of stages. i meant time baby nk kuar tu.