this is week our 2nd week in neurosurgery. as far as it goes, i kinda enjoy neurosurgery! its more interesting than neurology (honestly i find surgery very exciting!)
so yesterday, my group and I were scheduled to be in the OT in Mansoura University Hospital. We're so lucky i tell u!!!
here's the story. (it might be too complicated for preclinicals to understand this, but i'll try to make it simple to understand)
Last week, we met a patient named Miss XXX age 25. I cant remember her complaint, but she came to the hospital, and mentioned that she was unable to close her eye completely, and we noticed that half of her face is paralyzed. Is 'paralyzed' the right word to describe it? Like when we did the cranial nerve examination, the angle of her mouth dropped, she cant kerutkan her forehead. so my colleague asked her some more questions and she also mentioned that one side of her hearing is not that good.
so we suspected that something's compressing her 7th and 8th cranial nerve.
muscle of the face (like smiling, raising your eyebrow, closing your eyes) are supplied by the 7th nerve (facial nerve)
hearing is supplied by vestibulococchlear nerve (8th nerve)
so now we have to determine whether its an upper motor neuron lesion or lower motor neuron lesion. (UMNL/LMNL)
why? cuz nak tau mana site defect tu~ if UMNL, its somewhere from the origin of the nerve to the brain. if its LMNL, its from the nerve to the muscles supplied by it. you get what i mean? hehe. takpe, tak faham, nanti belajar~ keke
alright, for facial nerve, senang je nak tau its an UMNL or LMNL. if only the lower half of the muscle of the face is affected, then its UMNL. if the whole face is affected, then its LMNL.
So from the examination, we concluded that its a LMNL!!!
Therefore the doctor showed us the MRI of that patient~
nampak tak lesion tu? clue : its whitish in color a.k.a hyperdense~
so the lesion is at the cerebellopontine angle. which explains the 7th and 8th cranial nerve affection.
i was confused at first, why is it LMNL ? then my groupmate explained, he said
"the tumor is arising from the vestibular nerve itself, not from the brain. so that is why its LMNL, not UMNL."
then i recalled our morning lecture, and asked him "is it a Schwannoma??" (nasib baik baru belajar~)
"yes bizzob mariooomaaaa!!" (ok he didnt actually say marioma, its just that they always call me with that name..sounds like a benign tumor ha...)
Schwanomma is a nerve sheath tumor. its a slowly growing tumor of the Schwann cells, surrounding cranial nerve roots (usually the vestibular part of the 8th nerve)
so when it grows big enough, it could compress its adjacent structure, which includes the 7th nerve!
So when we came to the OT yesterday, we were lucky enough to watch the surgery of that patient~ Doctor did an operation, approaching from behind the mastoid process, he opened up the skull, using a HUGE microscope, he elevate the cerebellum to have a good view on the tumor and scrape the tumor shuwayya shuwayya~ in cases of brain tumors, u cant just take the whole thing out or make a safety margin, cuz its the brain for God's sake!! anything you take out, you'll interfere with the brain's function~~~~
the microscope! told u its big!
so tiny. thats why he needs the big microscope.
exposing the cerebellum~
Neurosurgeons need delicate hands and extra patience.. the whole surgery will take 8 hours to complete (thats what he said that day) gila, i didn't wait til it finish of course~ i got class to attend to!! i met the doctor the next day, he finished it in 4 hours @___@pretty cool case. honestly it took me quite a while to understand the whole case.
kehkeh~ i forgot to mention, there was a fly that accidentally flew in the OT. A man sprayed ridsect in the OT! it was so funny! cant imagine what will happen if the fly mistaken the brain as food and landed on the exposed brain~ kehkehkeh~
hooray to the guy who killed the fly!
well thats the end of this post.
sorry if susah nak faham~ heeee.
i still think neurosurgery is awesome!
til next time!
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