This week was certainly just as enlightening as the first week. This week I got to see more patients with Dr. Gauthier and observe neurosurgeries with Dr. Kaplitt and Dr. Greenfield.
With Dr. Gauthier I got to see a new side of multiple sclerosis (MS). There is a wide range of responses that people can have to the same disease. Since MS is a chronic disease many of the patients that come to Dr. Gauthier’s office have had the disease for a very long time. The exact form of the disease varies for each patient; patients can feel subtly different effects during a relapse of MS which may or may not be reflected in the MRI scans showing where new lesions form in the CNS (central nervous system). But rarely for some patients the nature of the disease seems to become less predictable; the disease can become aggressive and lesions appear in the MRI that are not usually typical of MS. Dr. Gauthier has had such patients before that have required likewise more aggressive treatment, such as the same chemotherapy treatments that are given to cancer patients since these treatments aggressively suppress the immune system. In cases with such drastic changes from the usual form of the disease it is also necessary to look for diseases that can sometimes mimic MS like symptoms. It is with this kind of case that I could see how doctors investigate diseases that have no specific test to confirm whether or not the disease is present, like MS; which seems to be something like solving a medical mystery. Dr. Gauthier described this process as looking for the typical markers of disease which ranged from getting a spinal tap and blood tests to more MRI images. This new information allows doctors to rule out other diseases like certain infections that can have neurological symptoms to other autoimmune diseases of the nervous system.
With Dr. Kaplitt and Dr. Greenfield I was certainly dazzled by the technology present in neurological surgery. Dr. Kaplitt does, among other types of surgery, work with deep brain stimulators and spinal stimulators for various maladies. In these such cases Dr. Kaplitt would implant an electrode array to stimulate a specific part of the nervous system to alleviate the patient’s symptoms. Though I have not yet seen either type of device implanted within a patient I did observe how some of the electronic components, the battery pack, are replaced and readjusted for the patient. This was my first experience with technology that is physically implanted within a patient; even though it was still surgery it seemed relatively simple and quick for the surgeon to perform. After the surgery the newly implanted components were adjusted wirelessly. The second surgery I observed with Dr. Greenfield was much more complicated. It was a craniotomy for a suboccipital tumor resection; the removal of a tumor from the back of the brain. Without advances in imaging technology there is simply no way that I could see that this operation could have been performed. Not only were MRI images integral to detecting the tumor and planning the surgery, but the same images were also central to the tracking technology that essentially tracked the position of a surgical probe that was in the brain of the patient during the surgery, this technology was called BrainLAB. From my stand point there seemed to be a few critical questions during the surgery; identifying tumor tissue from normal healthy tissue and knowing when the entire tumor has been removed. Answers to these questions were aided by the BrainLAB technology. The position of the surgical probe within the brain was mapped, with BrainLAB, to the MRI scans of the patient before the procedure which allowed the surgeons to get an estimate of how far they have gone into the tumor and what might remain during the procedure. The whole procedure was completed in about 5 hours through which I also learned a lot about the anatomy of the brain.
It has been an interesting week and I look forward to next weeks’ adventures.