Week 1 - Goose

My first week was short but fast paced. As soon as I met my mentor, Dr. Souweidane, he briefly introduced me to his crew and suggested that I see patients with him. He usually spends his Mondays in clinics meeting new patients and others for follow ups.

Dr. Souweidane is a neurosurgeon who specializes in using an endoscope for minimally invasive surgeries. Hydrocephalous was the usual conditions that patients came in with the first day. Hydrocephalous is a condition in which the brain has trouble draining cerebrospinal fluid out of its cerebral ventricles. The condition can lead to chronic headaches accompanied with vomiting and eventually can cause damage on the neural tissues as well as the optical neurons or even death if left untreated. The conventional treatment for this condition is the installment of a cerebral shunt, an artificial one way valve passage, to facilitate the drainage of the spinal fluid into the belly. Shunts are permanently installed to connect the cerebrospinal fluid through the brain, the skull, then through the back of the neck, and into the belly. Shunts stay underneath the skin and have coils at one end to specially compensate the growing bodies in young patients. However, many problems are involved including bacterial infections in the brain which can cause patients to experience even worse headaches or faint. The cerebral ventricle is positioned at the center of a brain which makes it very difficult to treat as the surgical procedure may involve opening of the patients brain, craniotomy. The installment of an artificial device in the brain and the body not only affect patients physically but also psychologically.

Dr. Souweidane's approach to the condition is the use of an endoscope to reach to the center of the brain, cerebral ventricle, and make an extra opening for fluid drainage from the third ventricle to the subarachnoid space. Hydrocephalous may be caused by intraventricular brain tumors which blocks the passage for the cerebrospinal fluid and this is removed with the use of an endoscope.

Tuesdays are my chances for observing surgeries at the OR. I luckily had a chance to have a peek in the OR before I left to Korea for my sister's wedding in spite of all the daunting paper work I had to figure out just to go through the entrance. The patient was a 12 year old African American with intraventricular brain tumor which fortunately did not block the ventricle but somehow had improper draining of cerebrospinal fluid. The surgeons made a 15mm hole on the skull and inserted the endoscope. One of the first impressions I had while watching the procedure was that imaging has evolved to be an essential and parallel parts of a surgical procedure. The surgeons installed a small device near the patient's head which served as a reference for the computers to read the position of the brain and synchronize and match with the MRI images. This way the surgeons could find the exact location of the tumor, determine from where and in what angle to insert the endoscope to reach to the ventricle and avoid any loss of cognitive or motor functions. The surgery did not last longer than an hour and a half. The surgeons took a biopsy of the tumor and made an opening at the third ventricle--it was an amazingly efficient procedure.

As an engineer, though I have never been involved in any research for medical devices, I could already see small improvements in the use of an endoscope. The surgeons of course have to depend on what is seen on the screen through the endoscope and it is important that they communicate well to each other for the whereabouts and directions of the endoscope and where to cut and destroy. I noticed that the screen merely shows what is seen through the endoscopic camera. I thought what if the engineers can simply include angular reference as well as various choices for grids on the screen? Then the surgeons don't have to say things like "Would you turn the endoscope counterclockwise? A little bit more. Just a bit more. Cut the upper region of the circular part you see on the right side..." But instead they could become more specific with angular reference and grids and say "Let's turn the endoscope to 55 degree and start cutting the edge of the tumor from G6."