Our Summary

This research paper is about a study conducted to better understand and track how the brain changes position during epilepsy surgery. This phenomenon, known as ‘brain shift’, can affect the accuracy of image-guided neurosurgery. The researchers used a special surgical system and software to track the position of different features of the brain before and during surgery in 12 patients. They specifically looked at whether the size and orientation of the opening in the skull (craniotomy), and the direction of gravity, affected how much the brain shifted. The average brain shift was about 9.64 millimeters, but they found that this shift wasn’t related to the direction of gravity, the orientation of the craniotomy, the angle between gravity and the craniotomy, or the size of the craniotomy. The findings can help surgeons monitor changes in the position of the brain during surgery, and assess how reliable pre-surgery images are over time.

FAQs

  1. What is ‘brain shift’ and how does it affect the accuracy of neurosurgery?
  2. How did the researchers track the position of the brain during epilepsy surgery?
  3. Did the research find any correlation between the size and orientation of the craniotomy, direction of gravity, and the amount of brain shift?

Doctor’s Tip

A doctor might advise a patient undergoing brain surgery to follow all pre-operative instructions carefully, including avoiding certain medications or foods that could interfere with the surgery. They might also stress the importance of keeping an open line of communication with the surgical team, and following post-operative care instructions closely to ensure a successful recovery. Additionally, the doctor may explain that brain shift is a normal phenomenon during surgery, and reassure the patient that the surgical team is equipped to monitor and adjust for any changes in brain position during the procedure.

Suitable For

Patients who are typically recommended for brain surgery include those with:

  1. Brain tumors: Surgery is often recommended to remove tumors that are causing symptoms or are located in areas of the brain that are accessible for surgery.

  2. Epilepsy: For patients with severe epilepsy that does not respond to medication, surgery may be recommended to remove the area of the brain causing seizures.

  3. Aneurysms: Surgery may be recommended to repair aneurysms in the brain to prevent them from rupturing and causing a potentially life-threatening hemorrhage.

  4. Brain trauma: In cases of severe brain trauma, surgery may be necessary to relieve pressure on the brain and repair any damage.

  5. Hydrocephalus: Surgery may be recommended to place a shunt to drain excess cerebrospinal fluid from the brain in patients with hydrocephalus.

  6. Arteriovenous malformations (AVMs): Surgery may be recommended to remove AVMs in the brain to prevent them from causing bleeding or other complications.

  7. Chiari malformation: Surgery may be recommended to decompress the brain and spinal cord in patients with Chiari malformation causing symptoms.

  8. Movement disorders: Surgery may be recommended for patients with movement disorders such as Parkinson’s disease or essential tremor who do not respond to medication.

  9. Trigeminal neuralgia: Surgery may be recommended to relieve pain in patients with trigeminal neuralgia that does not respond to medication.

  10. Cerebral palsy: Surgery may be recommended to correct abnormalities in the brain that are causing symptoms in patients with cerebral palsy.

Overall, brain surgery is typically recommended for patients with conditions that cannot be effectively treated with medication or other non-invasive treatments, and who have a good chance of benefiting from surgical intervention.

Timeline

Before Brain Surgery:

  • Patient undergoes various medical tests and consultations to determine the need for surgery
  • Patient meets with neurosurgeon to discuss the procedure, risks, and potential outcomes
  • Patient may undergo pre-operative imaging studies such as MRI or CT scans
  • Patient may need to make lifestyle changes or take medications in preparation for surgery
  • Patient may need to fast before surgery and follow specific instructions from the medical team

During Brain Surgery:

  • Patient is taken to the operating room and given anesthesia
  • Surgeon performs the craniotomy, or opening in the skull, to access the brain
  • Surgeon uses imaging techniques such as MRI or CT scans to guide the surgery and locate the affected area
  • Surgeon removes or repairs the affected part of the brain
  • Surgeon closes the incision and patient is taken to recovery

After Brain Surgery:

  • Patient is closely monitored in the recovery room for any complications
  • Patient may need to stay in the hospital for a few days or longer depending on the type of surgery
  • Patient may need rehabilitation or physical therapy to regain function and mobility
  • Patient may need to follow up with the neurosurgeon for post-operative care and monitoring
  • Patient may experience side effects such as headaches, fatigue, memory loss, or changes in behavior

Overall, the timeline for a patient before and after brain surgery can vary depending on the type of surgery and individual factors. It is important for patients to follow the instructions of their medical team and seek support from family and friends during the recovery process.

What to Ask Your Doctor

  1. What is the purpose of the brain surgery and what are the potential risks and benefits?
  2. How will the surgery be performed and what is the expected recovery process?
  3. Will there be any long-term effects or complications from the surgery?
  4. How often do you perform this type of surgery and what is your success rate?
  5. Will I need any additional treatments or therapies after the surgery?
  6. How will you ensure the accuracy of the surgery, especially in relation to brain shift?
  7. What imaging techniques will be used before and during the surgery to guide the procedure?
  8. What are the potential factors that can affect brain shift during the surgery?
  9. How will you monitor and adjust for any brain shift that occurs during the surgery?
  10. What follow-up appointments and monitoring will be necessary after the surgery?

Reference

Authors: De Momi E, Ferrigno G, Bosoni G, Bassanini P, Blasi P, Casaceli G, Fuschillo D, Castana L, Cossu M, Lo Russo G, Cardinale F. Journal: Int J Comput Assist Radiol Surg. 2016 Mar;11(3):473-81. doi: 10.1007/s11548-015-1259-1. Epub 2015 Jul 17. PMID: 26183148