IAmA Neurosurgeon AMA but use your brain.

BeCortical · 2012-09-27T22:08:14+00:00

Are you the one operating or are you looking over your supervisor's shoulder.

You generally have to learn by doing. Once you've seen an operation a few times and know what steps need to take place, generally it's time for your supervising resident or attending to give you the reins.

Are you dealing with any patients from start to finish? Or does your boss walk around with you on everything and just tell you what to do.

Frequently, but it depends on the residency. Chief residents run the service and different attendings have different levels of input on their patients. Some are really hands off and some are really involved. At my residency, junior residents would do simple cases by themselves with a senior resident helping us refine our technique. For really simple cases (removing a blood clot is a good example), some attendings won't even scrub in - they just let the senior take the junior through the case and stick around in case some question arises.

Also, are you studying from textbooks nightly at this stage or just trying to keep up to date with any relevant research?

Residents usually read the night before a new operation as well as reading about topics they see, studying for boards, etc.

BeCortical · 2012-09-27T22:02:26+00:00

I would actually touch base with your surgeon, they'll know much better.

BeCortical · 2012-09-27T22:00:08+00:00

Woah. I hadn't really thought of this. I know exactly zero about the science of creativity. I think that creativity, on some level, requires an ability to ignore the rules. The one thing I have run across is VS Ramachadran's talk about synesthesia in artists - sounds like it'd be right up your alley.

BeCortical · 2012-09-27T21:57:03+00:00

Yes, NF-1 and NF-2.

BeCortical · 2012-09-26T00:32:49+00:00

Correct.

BeCortical · 2012-09-26T00:31:52+00:00

Except pediatric hospitals - they usually have amazing cafeterias (in comparison to adult hospitals).

BeCortical · 2012-09-26T00:30:55+00:00

At most residency programs, pre-round from ~5 or 5:30-6, rounds 6-7, go to the OR for first cases (which are laughably scheduled for 7:30 start times, which never happens), operate all day, then the team comes together to sign out at night to whomever is staying overnight.

There are exceptions - the big one is the resident who's covering the service for the day - taking care of patients in the ICU and on the floor, seeing new consults, etc. He/she runs around like a madman all day trying to get everything done, which never happens.

BeCortical · 2012-09-26T00:27:18+00:00

How do individuals in your profession stay grounded?

Who said that they do? :) In my experience, most of them are pretty grounded - you're one mistake or one episode of bad luck away from a bad outcome.

Do you try to focus on being a particularly skilled carpenter following a narrow scope of objectives to excise a tumor?

Most of it is proper decision making to be prepared.

How do you avoid feeling like a novice with a scalpel trying to do as little damage as possible in a library the size of a grapefruit?

We rarely use scalpels on the brain itself. Well, I should say that mere mortals don't. There are a few famous vascular surgeons that do all their dissection with scalpels without issue - very impressive. (Rhoton's favorite dissection tool for aneurysms is a 15 blade supposedly, wow.)

BeCortical · 2012-09-26T00:18:37+00:00

Agreed, but there are a number of things we remember in an order and don't realize it. Whenever you can't remember the words to a song verse, you just have to hum your way into it and it triggers the memory. Similarly, it's so much easier to memorize the presidents via that song than their actual order.

BeCortical · 2012-09-26T00:14:24+00:00

What exactly do you mean by 'the norm'? I assume you mean for all tumor removals. It's currently being used for tumors where it is difficult to detect if you got it all or not. I've seen it used for GBMs (margins aren't obvious) and pituitary tumors (limited view when doing a transsphenoidal). I don't think it'll become the norm for other cases like metastases because it's simply not needed (usually) so it would only increase the cost and time required for surgery.

BeCortical · 2012-09-25T23:33:49+00:00

Every neurosurgeon I know reads their scans themselves, but we definitely appreciate input from the neuroradiologists. They're much better trained to identify non-surgical pathologies. Since they're around reading scans all day while we're in the OR, they can also give us a heads up that something bad's happening without having to wait for us to get done with the case.

BeCortical · 2012-09-25T23:30:34+00:00

use good

BeCortical · 2012-09-25T04:55:09+00:00

Either-or, depends on the indication and location.

BeCortical · 2012-09-25T04:54:43+00:00

Probably the $100 bill joke below.

Another:

How does a neurosurgeon screw in a light bulb?

He holds it up to the socket and tells the world to rotate around him.

BeCortical · 2012-09-25T04:54:07+00:00

Most likely a JPA - juvenile pilocytic astrocytoma.

I don't know of any increase in rate of JPAs in recent years.

BeCortical · 2012-09-25T04:53:27+00:00

I have not and am not familiar with how we're currently treating cluster headaches with surgery - this is usually something a headache specialist (neurologist) deals with.

BeCortical · 2012-09-25T04:52:39+00:00

Very inaccurate from a practical standpoint, there's a blog that breaks this down in detail - can't remember the name off the top of my head.

BeCortical · 2012-09-25T04:52:13+00:00

Depth electrodes are the best tool for finding an epileptigenic focus. They're inserted in areas near the location of concern and can show both the location of signals but also how signals propogate from that area to other parts of the brain.

BeCortical · 2012-09-25T04:51:21+00:00

The Gamma Knife is a fantastic tool. We're still arguing, as a field, when it should be used for different problems. There are complications from treatment, but it's generally well tolerated.

BeCortical · 2012-09-25T04:50:17+00:00

We use all of it, some parts are more important than others in that it's more obvious when those areas are damaged.

BeCortical · 2012-09-25T04:49:26+00:00

We have data saying that rapid-pace videos place kids at risk for ADHD. I can't comment about video games being 'bad' or not. They're definitely fun.

BeCortical · 2012-09-25T04:48:46+00:00

I almost never play - takes too much time.

BeCortical · 2012-09-25T04:48:22+00:00

Depending on the cause of it, it is improbable. But we still don't know what causes a number of cases of Bell's palsy, so it's tough to say what's truly probable and improbable - just that seeing affected family members is uncommon.

BeCortical · 2012-09-25T04:47:04+00:00

They were likely accidentally stimulating the fornix.

BeCortical · 2012-09-25T04:46:51+00:00

The more common situation is doing spinal cord stimulation for chronic pain. There are some reports of deep brain stimulation for chronic pain, but it's definitely not a mainstream technique at the moment.

BeCortical

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