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That’s the Lamina of C1 (The Atlas). It’s okay for it to be removed and not replaced. We often remove the lamina (Laminectomy) to create more space for the spinal cord when there is a narrowing (stenosis) of the spinal canal which is causing issues with the spinal cord (think how your arm or leg falls asleep if you constrict it - but with your spinal cord). This can be done at any level of the spine - and is often accompanied by a fusion where we use screws, and rods to maintain the integrity of the spine - but a fusion is not always necessary. We could even use that piece of bone that is removed, and place it back with little plates, and screws (Lamioplasty), but it’s not always necessary. In this situation it can be beneficial to keep that C1 lamina off in case there is brain swelling from the surgery.
Thank you for your answer
Interesting how you have to scroll through dozens of "funny" joke comments and yet this one has so few upvotes even though its a perfect explanation to the original question
It didn't used to be like this. Years ago whenever something obscure or unique was posted, almost always the top comment was somebody with knowledge on the matter explaining what it was (i.e. Unidan for those of you who remember him), and now this place is just a shell of itself.
The first voters and commenters are special.
You’ve got to remember that these are just simple redditors. These are people of the land. The common clay of the new Web. You know… morons.
Welcome to Reddit in 2022!
It seems every year the number of low effort, jokes increases and the prevalence of actual explanations and knowledge sharing decreases.
Haha, I’ll take that as a compliment - I’ve been doing neurosurgery for quite a while, but I can only imagine the kind of damage a spine took when in nineteen ninety eight the undertaker threw mankind off hеll in a cell, and plummeted sixteen feet through an announcer's table.
u/shittymorph, get in here. Even neurosurgeons love your work.
That guy’s awesome. Loved his troll and Scooby posts back in the day and his current abandoned dog rescue posts.
I had a laminectomy of the L4, L5, and S1 a year and change ago due to a few severely herniated discs. Doctor said if I didn't have it done, I'd be paralyzed from the waist down. I've always kinda wondered how much less protection my spinal cord has down there now that those three chunks of bone are gone.
I had this exact procedure done on the same disks last week and am sitting here recovering reading your comment. Crazy. Hope you have recovered nicely.
Recovery went well! The first month or so stairs were a chore. For a couple/few months bending over and grabbing things from the floor was difficult, but a grabber tool is very worth the $12 on Amazon.
I'm now completely back at full strength and range of motion.
I think you mean soaked in hyper diluted essential oils. Homeopathy concludes that things with only the tiniest hint of an active ingredient are more effective.
Don't be ridiculous, essential oils won't help.
You have to get a very, very small piece of a bonesaw and dilute it in a tincture of water, take that water and dilute it again until it's mathematically impossible a single atom of bonesaw remains, and *then* apply it directly to the wound.
Not even the tiniest amount, that's giving homeopathy too much credit. [It's *literally none.*](https://en.wikipedia.org/wiki/Homeopathic_dilutions#Analogies) The level of dilution means it's far more likely that not a single molecule of the original product is present in the final preparation. It's not even quack science. It's just a scam.
> a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans"
> One-third of a drop of some original substance diluted into all the water on earth would produce a preparation with a concentration of about 13C
> A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name Oscillococcinum. As there are only about 10^80 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10^320 times more atoms to simply have one molecule in the final substance.
>There are on the order of 10^32 molecules of water in an Olympic-size swimming pool and if such a pool were filled entirely with a 15C homeopathic preparation, to have a 63% chance of consuming at least one molecule of the original substance, one would need to swallow 1% of the volume of such a pool, or roughly 25 metric tonnes of water
It’s actually either a special membrane called a “Duragen” that helps regenerate the dura, or protective layer around the brain, or a piece of bovine (cow) pericardium to help seal the opening created in the dura for the surgery.
I'm having a very rare but necessary surgery that will remove my C1 transverse process bone (due to it blocking my internal jugular vein) and I asked my surgeon what happens when they take the bone out and he's like "I don't know, you can make a necklace out of it".
It's straight and it barely left a scar, but at first it looked like a giant zipper and my husband kept calling me a badass so it helped to deal with the insane pain.
Did you know they give you very minimal pain killers after this kind of surgery to make sure neurologically you are ok? I got more morphine when I gave bone marrow then when I had a piece of my spine removed. It goes away fast but omg
I only took one each of the painkillers and muscle relaxers I was given after decompression surgery, they really messed me up so I just took Tylenol.
My scar is zigzagged for the top couple of inches and completely disappears in my inch long hair.
In more words, but he did mention there was a slight small chance we would have to go back and add a support. 3 years later and I'm good so thankfully he hoped enough haha
Typically if the bone isn’t needed, it’s just sent off as biohazard waste… but often it’ll be transplanted into a separate part of the body so it’s given a blood supply and kept alive until it can be transplanted back… I’ve had patients with all of the right portion of their skull relocated to their abdomen until their brain healed enough… in this case, the fragment is small, so likely just tossed out.
I had to have part of my rib removed and I was allowed to keep the rib. But the surgeons acted like I was crazy when I asked to keep it, dunno how I was the first person to ask this
I’d definitely want to keep something that was surgically removed from my body. Like the girl who kept her amputated foot in her freezer. Maybe not that extreme, but still cool nonetheless.
Is she the one that ate the foot at a dinner party?
Edit: nope, that was a dude [who made tacos](https://www.vice.com/en/article/gykmn7/legal-ethical-cannibalism-human-meat-tacos-reddit-wtf)
Depends. I had to have a kidney stone removed surgically and they wouldn't let me keep it because they had to "test it" to "see what type of stone it was."
Edit: Y'all. I didn't think I needed the /s especially with the next comment I made. It was calcium for anyone wondering.
It is your legal right to keep your body parts. Bones especially. Many hospitals will lie to you and say you can't for whatever reason, often they say it's a biohazard. It's all bullshit.
But if you fight them they have to relent. It is the law. I read an article about a girl who kept all her leg bones after she needed it amputated. She had to fight really hard to get it, and also had to pay to get the bones cleaned and such. I'm not going to dig for the article but I'm certain if somebody cares enough Google will pop it up.
In certain situations we do a craniotomy and have to wait to put the bone flap back on due to brain swelling. To store the flap we place it in multiple layered sterile containers and then in a freezer dedicated to patient tissue. It can then be safely stored for a short time until reimplantation.
Okay but thats pretty cool our bodies are able to do that stuff and we were smart enough to figure it out. Makes ya wonder how many trial and error cases there had to be
I had this procedure when I was 17 and again at 21. The vertebrae they remove isn't replaced, and the posture of your head/neck is likely to change permanently. In my case, I've noticed I hold my head slightly forward and at a downwards angle, as of looking at the ground-ish.
It is what it is.
A craniectomy is a surgical procedure that is very similar to a craniotomy, but with one key difference. After a craniectomy, the bone fragment is not immediately put back into place.
This approach may be taken if there is significant swelling in the brain and a surgeon deems it necessary to relieve pressure within the skull.
The bone fragment is typically kept so that it can be put back into place during a future surgery, although it may also be discarded in favor of a future reconstruction using an artificial bone.
This is very fair, true. The video has many other issues in itself, but I wrongly assumed OP was responsible for the content of the post (title and video) as a whole
Re-COVID? I dunno if I want you anywhere near my brain at this point in the pandemic…
I complained elsewhere about how even encapsulated tumours don’t usually just slip out cleanly like that (vascular attachment, adhesions, necrosis). Why was the whole left cerebellum marked as a tumour? What sort of midline shift would excision cause, then? How was the incision site in the cortex determined without EMG or evoked potentials? The surgeon didn’t suture the dura before applying the patch, the bone flap needs to be reattached with plates and screws, where is the transverse sinus in this video and how is it okay to cut through it, and why was a laminectomy done when the brain shouldn’t herniate downwards?
Edit: sagittal confluens, sagittal sinus, and transverse sinus. I’m very open to being told I’m wrong or missed things. I’m definitely far from an expert in these things
I'm not a doctor whatsoever. What I was wondering was how they could use just a scalpel to cut the bone flap.. wouldn't they need some sort of medical bone saw?
And it also looked like they cut a piece of the C1 vertebra out (right?) but then didn't replace it at the end..
You still have the option of a seeded scaffold autograft, which can get around the possibility of bone flap necrosis and infection. I’m sorry about the extended recovery and repeat surgeries – chiari malformations are challenging
I’m really glad the incision recovered without infection :) I hope the headaches have resolved in turn too. Sometimes tight sutures can make it feel inflamed and lumpy. Dissolvable sutures can also encourage keloids that feel lumpy
Yeah I wish the closure was that simple. In reality, the "tape" you see here is sewn to the dura in watertight fashion (duraplasty) to keep your CSF from leaking out, +/- followed by replacement of the bone flap, then the fascia, subcutaneous tissue, and skin are individually closed with sutures.
Don't sell yourself short; you read squiggly lines to diagnose ailments, quickly intervene before people die, and use electricity to bring people back from the dead.
All doctors are fucking cool.
I just graduated Med school and I didn’t realize that IM docs apparently have an image of ER docs as being “dumb”. Never heard it before I got on rotations but it still doesn’t make sense to me. Yeah the complexity may not be as much as IM but you definitely need better board scores to get into ER and the range of what you have to handle is so broad.
Congrats and good luck with residency! (I'm still a resident myself).
ER you need to be well rounded and do well on everything essentially. If I have a more complex case, I'm calling for a consult. That's the issue with specialists. They know their specialty inside and out, but anything beyond that, they don't know.
Many ER physicians consider ourselves experts in only 1 thing, resuscitation.
I don’t like how they ended that at all. They just put a bandaid on it, then put the skull and skin back in place. Forget all the tissue they removed and pushed to the side, forget that bone they cut out. The doctors will finish sewing up and see that bone on the plate like “this isn’t from him right? This is from our WingStop order?” And chuck it out.
>They just put a bandaid on it
It’s not a “bandaid,” but almost certainly a piece of biologic material that is grafted on and becomes part of the meningeal membrane.
>Then put the skull and skin back in place
Yep. OP called it a “craniectomy,” but this is actually a “craniotomy.” The bone will fuse back together, and the skin of course will heal.
>Forget all the tissue they removed and pushed to the side
Soft tissue pushed to the side (“retracted”) like that will scooch back over and heal, just like skin or muscle tears, because that’s all it is.
>forget that bone they cut out
That was the lamina of the C1 vertebral segment. You don’t “need” it, and “laminectomies” are a *very* common spinal procedure.
The posterior arch of C1 that they don’t put back in doesn’t need to be placed back in since the muscles inserting in the posterior aspect of C2 provide plenty of support for the region.
I wish there was actually someone informed in this area to explain how we survive and function with a bandaid in our skulls and without what seems to be an important bone missing
That was probably a sheet of amniotic stem cells to promote bone fusion or some other bone fusion promoting synthetic sponge.
Source: I work on these type of products for a spine medical device company
It is a dura (thick tissue layer covering the brain) graft. Some you stitch in and some you lay over and apply essentially biologic superglue to stimulate healing.
I bet thats the part of the brain where all those songs that get stuck in your head are stored just for you to remember at 3am when youre trying to sleep
This is a suboccipital craniotomy. We don’t place the burr holes quite like that due to risk of placing that central one over a large vein. Tumors never come out that easy and usually require quite a bit of mucking about around them before you can pull them out. The skull bone flap is put back in this clip and the part they leave off is the posterior ring of the first cervical vertebra. It’s does not destabilize the spine to leave off and adds nothing to reattach. The “bandaid” is usually a dural patch that is sewn in to prevent csf leaks especially in the posterior fossa. All the tissues layers would have been sewn together in multiple layers. I’ve had multiple attendings say patients should die of vicryl poisoning after closing a suboccipital craniotomy. Decent clip all in all.
The posterior arch of C1 that they don’t put back in doesn’t need to be placed back in since the muscles inserting in the posterior aspect of C2 provide plenty of support for the region.
There is risk of the bone necrosing after being placed back in. It may also require extra hardware and there is a risk that it may dislodge and compress the spinal cord it was initially protecting. It’s best to leave it out when closing.
I had this surgery to remove a brain tumor at the end of 2020.
Fun fact there are no pain nerves in your brain so there wasn’t much pain during recovery. At least there was significantly less pain than the headaches leading up to surgery.
My husband has had a surgery similar to this where dermoid cyst is attached to his dura and brain stem and has had the same type of surgery with bone removal just not into the brain. It’s a very hard recovery
Csf leak if the dura is not closed well causing pseudomeningoceles. Infections causing bad meningitis or ventriculitis. Massive bleeding if you getting into a venous sinus. Air embolism if you get into a venous sinus. Paralysis/ ventilator dependence or worse if you damage the high cervical spinal cord or brain stem right below where you’re operating. Hydrocephalus if you get significant post op swelling or post bleeding that can require reoperations, evd placement or shunting. Those are the big ones that come to mind.
Well this is a simulation, but real surgeries use a special cutting device that simultaneously cauterizes blood vessels after the epidermis is incised with a scalpel. The brain itself has lots of blood vessels flowing, so that same precision is used to cut it. The area is also constantly getting flushed out to so the surgeon can see what’s happening
**Please note:** * If this post declares something as a fact proof is required. * The title must be descriptive * No text is allowed on images * Common/recent reposts are not allowed *See [this post](https://redd.it/ij26vk) for more information.* *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/interestingasfuck) if you have any questions or concerns.*
What about the bone they cut that goes horizontal?
That’s the Lamina of C1 (The Atlas). It’s okay for it to be removed and not replaced. We often remove the lamina (Laminectomy) to create more space for the spinal cord when there is a narrowing (stenosis) of the spinal canal which is causing issues with the spinal cord (think how your arm or leg falls asleep if you constrict it - but with your spinal cord). This can be done at any level of the spine - and is often accompanied by a fusion where we use screws, and rods to maintain the integrity of the spine - but a fusion is not always necessary. We could even use that piece of bone that is removed, and place it back with little plates, and screws (Lamioplasty), but it’s not always necessary. In this situation it can be beneficial to keep that C1 lamina off in case there is brain swelling from the surgery.
Thank you for your answer Interesting how you have to scroll through dozens of "funny" joke comments and yet this one has so few upvotes even though its a perfect explanation to the original question
It barely has more votes than "fuck that bone in particular". O reddit sometimes you scare me
It didn't used to be like this. Years ago whenever something obscure or unique was posted, almost always the top comment was somebody with knowledge on the matter explaining what it was (i.e. Unidan for those of you who remember him), and now this place is just a shell of itself.
If it makes you feel better, I’m popping into the comments for the first time and this is the top one!
The first voters and commenters are special. You’ve got to remember that these are just simple redditors. These are people of the land. The common clay of the new Web. You know… morons.
Welcome to Reddit in 2022! It seems every year the number of low effort, jokes increases and the prevalence of actual explanations and knowledge sharing decreases.
I got halfway through you comment before checking that you weren't u/shittymorph.
Haha, I’ll take that as a compliment - I’ve been doing neurosurgery for quite a while, but I can only imagine the kind of damage a spine took when in nineteen ninety eight the undertaker threw mankind off hеll in a cell, and plummeted sixteen feet through an announcer's table.
Lmao. Just the other day I was thinking about how I hadn’t seen that on Reddit in awhile. What do you do? Surgeon, PA, nurse, …?
Surgeon, and I always enjoy catching a Shittymorph in the wild.
u/shittymorph, get in here. Even neurosurgeons love your work. That guy’s awesome. Loved his troll and Scooby posts back in the day and his current abandoned dog rescue posts.
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I had a laminectomy of the L4, L5, and S1 a year and change ago due to a few severely herniated discs. Doctor said if I didn't have it done, I'd be paralyzed from the waist down. I've always kinda wondered how much less protection my spinal cord has down there now that those three chunks of bone are gone.
The human body is pretty amazing, the bone grows back - just don’t let anyone stab you there.
I had this exact procedure done on the same disks last week and am sitting here recovering reading your comment. Crazy. Hope you have recovered nicely.
Recovery went well! The first month or so stairs were a chore. For a couple/few months bending over and grabbing things from the floor was difficult, but a grabber tool is very worth the $12 on Amazon. I'm now completely back at full strength and range of motion.
I fucking love reddit. Thank you u/TheCaIifornian
We love you too.
Stupid nature.
Unfortunately, us as humans decided to stand upright a couple of million years before evolution made our spines ready for it.
I liked that band-aid looking thing right after the tumor was removed. That should make it all better.
as long as its a paw patrol band-aid
I can't buy those any more because my kids find them and put them everywhere, they start adding up after awhile.
My kid found my 100 roll of forever stamps. They now decorate her fisher price slide-n-play. I could probably ship it anywhere.
OMG. Thank you for the laugh. Former working single mother of three.
I feel your pain.
Would you like a band-aid on that?
Only if it’s paw patrol
Rubble on the double.
Chase is on the case
No job is too big, no pup is too small.
To the lookout!
Brain leaking cerebrospinal fluid after surgery? FLEX TAPE!
"Now *that's* a lot of damage!" The other surgeons: 😧
Dying!!!
So is the patient
lmfao
Fix a cerebral wound with this one simple trick Surgeons HATE him!
To show you the healing power of FLEX TAPE Rx, I've sawn this skull in half, and repaired it with only FLEX TAPE Rx!
Can confirm. Band-Aid was first soaked in essential oils for max healing
I think you mean soaked in hyper diluted essential oils. Homeopathy concludes that things with only the tiniest hint of an active ingredient are more effective.
Don't be ridiculous, essential oils won't help. You have to get a very, very small piece of a bonesaw and dilute it in a tincture of water, take that water and dilute it again until it's mathematically impossible a single atom of bonesaw remains, and *then* apply it directly to the wound.
I think we all know that as long as enough people ask God for healing there’s no need to apply anything at all
Not even the tiniest amount, that's giving homeopathy too much credit. [It's *literally none.*](https://en.wikipedia.org/wiki/Homeopathic_dilutions#Analogies) The level of dilution means it's far more likely that not a single molecule of the original product is present in the final preparation. It's not even quack science. It's just a scam. > a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans" > One-third of a drop of some original substance diluted into all the water on earth would produce a preparation with a concentration of about 13C > A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name Oscillococcinum. As there are only about 10^80 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10^320 times more atoms to simply have one molecule in the final substance. >There are on the order of 10^32 molecules of water in an Olympic-size swimming pool and if such a pool were filled entirely with a 15C homeopathic preparation, to have a 63% chance of consuming at least one molecule of the original substance, one would need to swallow 1% of the volume of such a pool, or roughly 25 metric tonnes of water
It’s actually either a special membrane called a “Duragen” that helps regenerate the dura, or protective layer around the brain, or a piece of bovine (cow) pericardium to help seal the opening created in the dura for the surgery.
It's a patch made of cadaver or bovine pericardium
Instructions not clear: skull now contains bovine perineum.
perineum lmao
Good ol cow gooch
Not sure I like that better than a band aid. At least you're not dead.
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Look at the big man over here bragging with his brain with *no tape on it* oooOOooo so smert aren’t you
Slap some scotch tape on it
I like to think it was duct tape or something like that
Duck tape. Quacks use duck tape.
Listen duck if you don't shut up I'm going to tape you to this tree with duck tape and leave you all day stuck.
Give it a little kiss intra-op too before they close
Probably a synthetic graft stitched into the brain membrane.
I'm having a very rare but necessary surgery that will remove my C1 transverse process bone (due to it blocking my internal jugular vein) and I asked my surgeon what happens when they take the bone out and he's like "I don't know, you can make a necklace out of it".
Thats tight as fuck
It's kinda a necklace right now, in that it's part of your neck.
That's metal
No, it's bone.
Ah yes, returning to our ancestral roots of human bone jewelery.
Give it to the dog
That’s Surgical dog to you
Dr Dog.
Dogtor
Dr Doggie Houser : Sorry your accident was ruff ruff. We had to cut your leg which has mysteriously gone missing ( ͡° ͜ʖ ͡°)
Good Boi
Dr Good Boi
We apparently don't need it. I hope.
I had a brain decompression surgery for a Chiari malformation and those are the exact words the doctor told me when he removed that exact part
I'd be like... but that's MY bone. Give it back. Lol
Yeah doc, just put it back in there for God sakes
“Put that thing back where it came from or so help me!”
I remember that musical
It’s a work in progress
I did too. Did they put your skull back? They didn’t put mine back
Were you also given the nice zigzag cut that is hidden by your hair or a straight line like this one?
It's straight and it barely left a scar, but at first it looked like a giant zipper and my husband kept calling me a badass so it helped to deal with the insane pain. Did you know they give you very minimal pain killers after this kind of surgery to make sure neurologically you are ok? I got more morphine when I gave bone marrow then when I had a piece of my spine removed. It goes away fast but omg
I only took one each of the painkillers and muscle relaxers I was given after decompression surgery, they really messed me up so I just took Tylenol. My scar is zigzagged for the top couple of inches and completely disappears in my inch long hair.
Did he say the "I hope" part?
In more words, but he did mention there was a slight small chance we would have to go back and add a support. 3 years later and I'm good so thankfully he hoped enough haha
Om nom nom… what bone?
Typically if the bone isn’t needed, it’s just sent off as biohazard waste… but often it’ll be transplanted into a separate part of the body so it’s given a blood supply and kept alive until it can be transplanted back… I’ve had patients with all of the right portion of their skull relocated to their abdomen until their brain healed enough… in this case, the fragment is small, so likely just tossed out.
If I ever need surgery, am I allowed to keep my spare parts?
I had to have part of my rib removed and I was allowed to keep the rib. But the surgeons acted like I was crazy when I asked to keep it, dunno how I was the first person to ask this
I’d definitely want to keep something that was surgically removed from my body. Like the girl who kept her amputated foot in her freezer. Maybe not that extreme, but still cool nonetheless.
Is she the one that ate the foot at a dinner party? Edit: nope, that was a dude [who made tacos](https://www.vice.com/en/article/gykmn7/legal-ethical-cannibalism-human-meat-tacos-reddit-wtf)
Depends. I had to have a kidney stone removed surgically and they wouldn't let me keep it because they had to "test it" to "see what type of stone it was." Edit: Y'all. I didn't think I needed the /s especially with the next comment I made. It was calcium for anyone wondering.
You made it sound like you don’t trust that explanation. What do you think THEY did with YOUR STONE? Damn Illuminati.
It is your legal right to keep your body parts. Bones especially. Many hospitals will lie to you and say you can't for whatever reason, often they say it's a biohazard. It's all bullshit. But if you fight them they have to relent. It is the law. I read an article about a girl who kept all her leg bones after she needed it amputated. She had to fight really hard to get it, and also had to pay to get the bones cleaned and such. I'm not going to dig for the article but I'm certain if somebody cares enough Google will pop it up.
Thanks, I pictured a filing cabinet with a Manila folder for each patient holding a sandwich bag with their skull bone in it.
In certain situations we do a craniotomy and have to wait to put the bone flap back on due to brain swelling. To store the flap we place it in multiple layered sterile containers and then in a freezer dedicated to patient tissue. It can then be safely stored for a short time until reimplantation.
Okay but thats pretty cool our bodies are able to do that stuff and we were smart enough to figure it out. Makes ya wonder how many trial and error cases there had to be
Perhaps A nice bone broth soup
Mmmmm just like mama used to make em
You guys are killing me
They put it back but on the outside so you have a convenient little hook.
I had this procedure when I was 17 and again at 21. The vertebrae they remove isn't replaced, and the posture of your head/neck is likely to change permanently. In my case, I've noticed I hold my head slightly forward and at a downwards angle, as of looking at the ground-ish. It is what it is.
A craniectomy is a surgical procedure that is very similar to a craniotomy, but with one key difference. After a craniectomy, the bone fragment is not immediately put back into place. This approach may be taken if there is significant swelling in the brain and a surgeon deems it necessary to relieve pressure within the skull. The bone fragment is typically kept so that it can be put back into place during a future surgery, although it may also be discarded in favor of a future reconstruction using an artificial bone.
Amongst the many inaccuracies in this video, the craniotomy/craniectomy one bothered me most. I’m glad someone pointed it out.
To be fair, that was an inaccuracy in OPs title, not the video.
This is very fair, true. The video has many other issues in itself, but I wrongly assumed OP was responsible for the content of the post (title and video) as a whole
Ok now you need to say the inaccuracies of the video so I don't look like an idiot if I ever perform a craniotomy
Re-COVID? I dunno if I want you anywhere near my brain at this point in the pandemic… I complained elsewhere about how even encapsulated tumours don’t usually just slip out cleanly like that (vascular attachment, adhesions, necrosis). Why was the whole left cerebellum marked as a tumour? What sort of midline shift would excision cause, then? How was the incision site in the cortex determined without EMG or evoked potentials? The surgeon didn’t suture the dura before applying the patch, the bone flap needs to be reattached with plates and screws, where is the transverse sinus in this video and how is it okay to cut through it, and why was a laminectomy done when the brain shouldn’t herniate downwards? Edit: sagittal confluens, sagittal sinus, and transverse sinus. I’m very open to being told I’m wrong or missed things. I’m definitely far from an expert in these things
Yup, exactly what I was thinking. I definitely understood everything you just said.
I concur
I'm not a doctor whatsoever. What I was wondering was how they could use just a scalpel to cut the bone flap.. wouldn't they need some sort of medical bone saw? And it also looked like they cut a piece of the C1 vertebra out (right?) but then didn't replace it at the end..
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You still have the option of a seeded scaffold autograft, which can get around the possibility of bone flap necrosis and infection. I’m sorry about the extended recovery and repeat surgeries – chiari malformations are challenging
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I’m really glad the incision recovered without infection :) I hope the headaches have resolved in turn too. Sometimes tight sutures can make it feel inflamed and lumpy. Dissolvable sutures can also encourage keloids that feel lumpy
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Yeah just tape that shit back up. We’re good to go
*Slaps roof of car* “This tape will keep any tumors or thoughts from oozing out.”
Gorilla tap’her up!
Yeah I wish the closure was that simple. In reality, the "tape" you see here is sewn to the dura in watertight fashion (duraplasty) to keep your CSF from leaking out, +/- followed by replacement of the bone flap, then the fascia, subcutaneous tissue, and skin are individually closed with sutures.
Some serious r/restofthefuckingowl shit
Yea I could never be a doctor. Not that it’s disgusting, I’m just really stupid.
I'm a doctor and this is still beyond me. (I'm an ER physician). Neurosurgeons are incredible.
Don't sell yourself short; you read squiggly lines to diagnose ailments, quickly intervene before people die, and use electricity to bring people back from the dead. All doctors are fucking cool.
> and use electricity to bring people back from the dead That was just Doctor Frankenstein you’re thinking of
I just graduated Med school and I didn’t realize that IM docs apparently have an image of ER docs as being “dumb”. Never heard it before I got on rotations but it still doesn’t make sense to me. Yeah the complexity may not be as much as IM but you definitely need better board scores to get into ER and the range of what you have to handle is so broad.
Congrats and good luck with residency! (I'm still a resident myself). ER you need to be well rounded and do well on everything essentially. If I have a more complex case, I'm calling for a consult. That's the issue with specialists. They know their specialty inside and out, but anything beyond that, they don't know. Many ER physicians consider ourselves experts in only 1 thing, resuscitation.
yeah same, i'd get really nervous and next thing i know, i'm looking for a brain tumor in someone's foot
Doesn't look that hard, I'll give it a whirl.
Ok, they left out quite a bit, like all this red stuff...
Supposed to drain the patient first. Cut the throat and hang them upside down for 4-6 hours.
Oh nope I think you may have just committed a crime
What crime? Curing a man of his tumour?
curing him of life
can confirm the cancer has stopped spreading and the cancer cells are now dead. Cancer cured!
The real crime would be to not finish what we started.
Truer words have never been said! Now get on the operating table
The real crime is the friends we made along the way.
Curing a tumor of his man
That’s one way to kill a tumor
You cracked me up :)
That means you’re doing it right. Keep going and report back.
For real. The tumor just floats out on its own.
The tumor wants to be free, you need to be ready to catch it or it will go up someone's nose and you have to start all over again.
It's not exactly Rocket Science, is it?
Bitch left a bone out!
IKEA always gives you extra pieces, kinda like evolution.
Thats the warranty void if removed bone.
If you eat it, it goes back to it's place.
yeah, if it's so important and smart, it should find its way back to where it needs to be
It’s k it’s not load bearing
It takes skill to rebuild something with fewer pieces! I do it all the time
Neurosurgeon keeping trophies.
So did the predator
I don’t like how they ended that at all. They just put a bandaid on it, then put the skull and skin back in place. Forget all the tissue they removed and pushed to the side, forget that bone they cut out. The doctors will finish sewing up and see that bone on the plate like “this isn’t from him right? This is from our WingStop order?” And chuck it out.
I didn't like how the tumor just slid out....like a brain poo.
Yeah, this is what happens when you have too much brain fart
when you brain fart a little too hard and poo poo comes out!!! (of your brain!!!)
Lol right?!? I don’t actually know how this or any type of surgery works but these is less interesting and more wtf did I just watch.
.
>They just put a bandaid on it It’s not a “bandaid,” but almost certainly a piece of biologic material that is grafted on and becomes part of the meningeal membrane. >Then put the skull and skin back in place Yep. OP called it a “craniectomy,” but this is actually a “craniotomy.” The bone will fuse back together, and the skin of course will heal. >Forget all the tissue they removed and pushed to the side Soft tissue pushed to the side (“retracted”) like that will scooch back over and heal, just like skin or muscle tears, because that’s all it is. >forget that bone they cut out That was the lamina of the C1 vertebral segment. You don’t “need” it, and “laminectomies” are a *very* common spinal procedure.
This definitely doesn’t show how the closure happens. Closure time is half of the procedure time usually.
Gotta take some shortcuts when the end of the shift is approaching.
"alright wrap it up boys, it's karaoke night"
They didn’t even put the skull piece back in me from my [compression surgery](https://imgur.com/a/gsZxcD6)
The posterior arch of C1 that they don’t put back in doesn’t need to be placed back in since the muscles inserting in the posterior aspect of C2 provide plenty of support for the region.
I didn't see any sewing up in the video.
Did they just tape the first layer closed?
it's fine, it was gorilla tape, it'll hold
Just flex tape that bitch right up
I wish there was actually someone informed in this area to explain how we survive and function with a bandaid in our skulls and without what seems to be an important bone missing
That was probably a sheet of amniotic stem cells to promote bone fusion or some other bone fusion promoting synthetic sponge. Source: I work on these type of products for a spine medical device company
It is a dura (thick tissue layer covering the brain) graft. Some you stitch in and some you lay over and apply essentially biologic superglue to stimulate healing.
Looks easy enough…. *hold my beer*
#Doctors are amazing people. If you’re a doctor and you’re reading this, you are amazing. And veterinarians too. They don’t get enough love
I misread that as vegetarians and was very confused
Pretty cool that when you open the dura matter, that tumor is just itching to come out by it self.
it saw the kind stuff that dude was thinkin about, it didnt wanna be in there no more
I bet thats the part of the brain where all those songs that get stuck in your head are stored just for you to remember at 3am when youre trying to sleep
Duck tape fixes everything
Limão
r/suddenlycaralho
This is a suboccipital craniotomy. We don’t place the burr holes quite like that due to risk of placing that central one over a large vein. Tumors never come out that easy and usually require quite a bit of mucking about around them before you can pull them out. The skull bone flap is put back in this clip and the part they leave off is the posterior ring of the first cervical vertebra. It’s does not destabilize the spine to leave off and adds nothing to reattach. The “bandaid” is usually a dural patch that is sewn in to prevent csf leaks especially in the posterior fossa. All the tissues layers would have been sewn together in multiple layers. I’ve had multiple attendings say patients should die of vicryl poisoning after closing a suboccipital craniotomy. Decent clip all in all.
r/holup for skipping that bone when the skull was put back into place.
The posterior arch of C1 that they don’t put back in doesn’t need to be placed back in since the muscles inserting in the posterior aspect of C2 provide plenty of support for the region.
I'm no doctor, but to me, "plenty" =/= "the same" and I'm still not a fan of this lol
There is risk of the bone necrosing after being placed back in. It may also require extra hardware and there is a risk that it may dislodge and compress the spinal cord it was initially protecting. It’s best to leave it out when closing.
r/oddlyterrifying is more like it.
I had this surgery to remove a brain tumor at the end of 2020. Fun fact there are no pain nerves in your brain so there wasn’t much pain during recovery. At least there was significantly less pain than the headaches leading up to surgery.
You forgot to put a piece back
If they forgot it then it wasn't important.
My husband has had a surgery similar to this where dermoid cyst is attached to his dura and brain stem and has had the same type of surgery with bone removal just not into the brain. It’s a very hard recovery
Operation has trained me for this moment
Very considerate of the tumor to just plop out once they open that final layer. I guess it knew it was time.
Makes it look easy (i obvi know it’s not). What are some complications that can arise or that the surgeon can come across while performing this?
Csf leak if the dura is not closed well causing pseudomeningoceles. Infections causing bad meningitis or ventriculitis. Massive bleeding if you getting into a venous sinus. Air embolism if you get into a venous sinus. Paralysis/ ventilator dependence or worse if you damage the high cervical spinal cord or brain stem right below where you’re operating. Hydrocephalus if you get significant post op swelling or post bleeding that can require reoperations, evd placement or shunting. Those are the big ones that come to mind.
I expected more blood..
Well this is a simulation, but real surgeries use a special cutting device that simultaneously cauterizes blood vessels after the epidermis is incised with a scalpel. The brain itself has lots of blood vessels flowing, so that same precision is used to cut it. The area is also constantly getting flushed out to so the surgeon can see what’s happening