I seriously started major progress in my project with Dr. Souweidane from this week. I had frequent meetings with a medical student, Peter Morgenstern, to talk about the current techniques related to endoscopically guided third ventriculostomy with regard to prepontine space. I also had meetings with a visiting physician from Greece, Jonathan Roth, who helped me so much with how to use MRI stations and read the images to retrieve the specific information I want. Initially Dr. Souweidane and I had brainstormed many ways to prove his hypothesis. His experience with endoscopic third ventriculostomy hinted him that the entry site of endoscope on the skull relative to the suture shifts depending on age. The results from the study, if proven true, could provide with a more specific guideline for starting physician on what would be the generally accepted endoscopic entry site for the patients. However, this turns out to be a very difficult task as most of patients come with different symptoms such as swollen cortex and ventricles, there is no solid standards of references for measurement. We even had a brief meeting with Dr. Michael Kaplitt who provided some ideas with how to go about measuring the differences that we would see between patients of different age groups. He showed us how to reconstruct a three-dimensional brain structures from plane images and argued that the measurements should not be distances from suture but rather an angle to the target site from the entry site as patients have different skull sizes and slight shifts in the brain anatomy.
Despite all the trouble and difficulties we faced in deciding what the measurement should be, I started organizing the list of patients who underwent endoscopic third ventriculostomy. In the end we had about 70 patients with decent medical records and documentations that I could work on. The range of age at the day of surgery seemed pretty diverse, ranging from 1 day old to the 70s. The etiology of the surgery and results also varied a lot as some patients even had shunts at young age and some other patients had to revise to shunt after an unsuccessful result from the endoscopic third venstriculostomy. Would it be the nature of research in medical practice? The diverse list of patients seemed almost overwhelming for me to do a well controlled analysis.