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I never quite fully grasped the purpose of having patients stay engaged during brain operations. Is it possible to undo a brain incision? If not, what good is i

I never quite fully grasped the purpose of having patients stay engaged during brain operations. Is it possible to undo a brain incision? If not, what good is it to know a patient's abilities are degraded after having made a cut? Is it just to mitigate compounding unexpected damage?

roflc0ptic 4y ago
You don’t make more cuts there
ceejayoz 4y ago
It’s not binary. You go slowly, and stop if it’s starting to impact the behavior you’re observing.
SamoyedFurFluff 4y ago
What’s the alternative, knowing that you’re working with a system with unknown specific architecture and whose only way you can get feedback about how you’re doing is via the patient? You can stimulate parts of the brain without damaging it btw. The surgeon just needs to know what that part is specifically.
jac241 4y ago
You electrically stimulate around the spot with a probe where you’re planning to resect. If the patient can’t perform whatever task you’re evaluating then you know you can’t resect in that area. Generally looking for a 1cm margin between tissue you’re going to resect and a positive stim site. Can’t undo brain cuts. CNS neurons don’t repair themselves like peripheral neurons or your skin. Generally not cutting glioma brain tumors out per se more likely to use ultrasonic aspiration to suck the tumor out piecemeal. Depends on the tumor though.
- SeanAnderson 4y ago
  Oh, that makes sense. Cool that we can "dry run" explore with electric pulses! Thanks for explaining :)
  - infogulch 4y ago
    "dry run" is a great analogy!
- elteto 4y ago
  Fascinating! What is ultrasonic aspiration and how does it work?
- amelius 4y ago
  How do you know what task to evaluate? And what if this was not a saxophone player, but a tennis player? Or both?
  - Firmwarrior 4y ago
    The worst is when you're performing brain surgery on a brain surgeon. The operating theater can get really crowded.
    - cfu28 4y ago
      Operating theater overflow :)
    - guynamedloren 4y ago
      Okay, this was a good one!
    - rurban 4y ago
      With our brain surgery robot the brain surgeon can definitely perform brain surgery on himself. Or invite a fellow brain surgeon over the phone, well a tablet might work better. Or better VR 3d glasses.
- ayewo 4y ago
  You seem knowledgeable about the topic. I'm also curious as to the answer to this question [1]. Why does left-handedness make brain surgery slightly more complicated? 1: https://news.ycombinator.com/item?id=33215614 https://news.ycombinator.com/item?id=33215614
vanattab 4y ago
Well you can definitely stop cutting deeper if you know something is up!
locallost 4y ago
Others have explained, but what I've heard from a brain surgeon on TV: it's extremely delicate and they don't always know how deep they can go, so they probe bit by bit and when they notice it's having an effect they stop. The surgeon I listened to was also a gifted storyteller, it was very very impressive and inspiring. That's really a hell of a job.

roflc0ptic 4y ago

You don’t make more cuts there

ceejayoz 4y ago

It’s not binary. You go slowly, and stop if it’s starting to impact the behavior you’re observing.

SamoyedFurFluff 4y ago

What’s the alternative, knowing that you’re working with a system with unknown specific architecture and whose only way you can get feedback about how you’re doing is via the patient? You can stimulate parts of the brain without damaging it btw. The surgeon just needs to know what that part is specifically.

jac241 4y ago

You electrically stimulate around the spot with a probe where you’re planning to resect. If the patient can’t perform whatever task you’re evaluating then you know you can’t resect in that area. Generally looking for a 1cm margin between tissue you’re going to resect and a positive stim site. Can’t undo brain cuts. CNS neurons don’t repair themselves like peripheral neurons or your skin. Generally not cutting glioma brain tumors out per se more likely to use ultrasonic aspiration to suck the tumor out piecemeal. Depends on the tumor though.

SeanAnderson 4y ago
Oh, that makes sense. Cool that we can "dry run" explore with electric pulses! Thanks for explaining :)
- infogulch 4y ago
  "dry run" is a great analogy!
elteto 4y ago
Fascinating! What is ultrasonic aspiration and how does it work?
amelius 4y ago
How do you know what task to evaluate? And what if this was not a saxophone player, but a tennis player? Or both?
- Firmwarrior 4y ago
  The worst is when you're performing brain surgery on a brain surgeon. The operating theater can get really crowded.
  - cfu28 4y ago
    Operating theater overflow :)
  - guynamedloren 4y ago
    Okay, this was a good one!
  - rurban 4y ago
    With our brain surgery robot the brain surgeon can definitely perform brain surgery on himself. Or invite a fellow brain surgeon over the phone, well a tablet might work better. Or better VR 3d glasses.
ayewo 4y ago
You seem knowledgeable about the topic. I'm also curious as to the answer to this question [1]. Why does left-handedness make brain surgery slightly more complicated? 1: https://news.ycombinator.com/item?id=33215614 https://news.ycombinator.com/item?id=33215614

vanattab 4y ago

Well you can definitely stop cutting deeper if you know something is up!

locallost 4y ago

Others have explained, but what I've heard from a brain surgeon on TV: it's extremely delicate and they don't always know how deep they can go, so they probe bit by bit and when they notice it's having an effect they stop. The surgeon I listened to was also a gifted storyteller, it was very very impressive and inspiring. That's really a hell of a job.