dr.ahmedjamil

Craniotomy

Neuro-monitoring

Posterior fossa lesion

I was lost
And I’m still lost
But I feel so much better
You can travel the world
But you can’t run away
From the person you are in your heart
You can be who you want to be
Make us believe in you
Keep all your light in the dark
If you’re searching for truth
You must look in the mirror
And make sense of what you can’t see
Just be

They say learning to love yourself
Is the first step
That you take what you want to be real
But flying on planes to exotic locations
Won’t teach you how you really feel
Face up to the fact
That you are who you are
And nothing can change that belief
Just be

Cause now I know
It’s not so far
To where I go
The hardest part
It’s inside me
I need
To just be

Medical errors contribute to an alarming number of deaths each
year, and neurosurgery is not exempt from this. However, it
is not enough for the surgeon to improve his or her technical
skills, striving for perfection; nearly three-quarters of neurosur-
gical errors are due to factors involving the health care system at large. Systems thinking is essential to enhancing patient safety.
To improve patient safety, we must first document where errors
and adverse events arise, through registries, incident reports, and global trigger tools, and then develop systems-level solutions to help prevent errors and mitigate them as they inevitably occur.
As has been acknowledged in numerous other safety-conscious industries, humans will make mistakes. Blaming and shaming such practitioners does little to prevent these errors from recurring. Solutions must come from the system itself, targeting the entire organizational span of surgical practice, to truly improve patient safety.

The modern patient safety movement arguably coalesced in the
wake of the 2000 publication of To Err Is Human (taken from
Seneca’s Latin phrase errare humanum est) by the National
Academy of Medicine (formerly the Institute of Medicine).
This decidedly influential report drew on the 1991 Harvard Medical Practice Study and estimated that between 44,000 and 98,000 Americans were killed yearly by medical errors.
This shockingly high figure spawned the evocative “jumbo jet” analogy—deaths caused by medical errors were numerically equivalent to one passenger jet crashing daily.
More recent studies have adjusted the estimate of
those killed by errors even higher, at 210,000 to 440,000.

The linchpin of targeted therapy for CNS tumors is sampling,
and this responsibility falls on the shoulders of neurosurgeons.
Regardless of the neurosurgical pathologic condition, neurosurgeons are often responsible for the sampling that enables downstream analyses and discoveries.
Safety remains the primary concern, but if the surgeon feels
it is safe, one may consider a secondary priority in tumor resection to collect enough specimen for sequencing, preferably from multiple sites to account for tumor heterogeneity.Similarly, in needle biopsy, it is recommended that the surgeon obtain at least two different biopsy samples using the same needle tract at different tumor depths within a bur hole.
After the material is collected, either a neuropathologist or a team member should be available to make sure samples are both immediately snap frozen and placed under sterile conditions with media for culture.
Immediate analysis is critical because many tumors are rapidly evolving.
Additionally, when considering metastases, even though the primary cancer may already have been profiled, there may be significant differences between the primary and metastatic tumor, including differences in drivers.

successful microneurosurgery is based on six solid foundations: (1) anatomic knowledge; (2) capability of
understanding the information provided by imaging and cor-
relate it with anatomy; (3) capability of planning the surgical
strategy based on the anatomic and radiologic correlation; (4)
capability of bringing together the anatomy, imaging, and pre-
surgical planning into the surgery; (5) fine surgical skill devel-
oped through extensive training (probably the best way to refine surgical skill is to perform frequent microsurgeries); and (6) a good anesthesiologist, adequate instruments, and when necessary, intraoperative neurophysiologic monitoring and imaging guidance system.

Iin 1888, Victor Horsley (1857–1916) performed the first removal of a spinal cord tumor that had been diagnosed and localized by William R. Gowers (1845–1915).
Horsley performed a laminectomy on Gowers’s patient,
Captain Golby. Golby was slowly losing function in his legs as
the result of a spinal cord tumor. Gowers localized the tumor
by examination and suggested to Horsley where to operate; the
tumor was successfully removed.

Judgment in distinguishing, and ability in treating diseases, are not to be attained by a transient cursory view of them; merely running round an Hospital for a few months, or reading a general system of surgery, will not form a compleat practitioner: the man, who aims at that character, must take notice of many little things, which the inattentive pass over, and which cannot be remarked by writers; he must accustom himself to see, and to think for himself; and must regard the rules laid down by authors, as the outlines only of a piece,
which he is to fill up and finish: books may give general ideas, but practice, and medication, must make him adroit and discerning; without these, his reading may possibly keep him clear of very gross blunders, but he will still remain injudicious, and inexpert.

A distinctive scholar of this period in the early understanding
of the brain was Thomas Willis (1621–1675), an early describer
of the eponymous circle of Willis, familiar to every physician.
Willis was educated at Oxford and became a fashionable London physician

One of the greatest physicians in the history of surgery
remains Ambroise Paré (1510–1590), a poorly educated, humble Huguenot, an individual whom many historians have considered the father of modern surgery. After extensive military surgical experience, Paré was able to organize and publish a great deal of practical knowledge, along with innovative instrument designs.

Any discussion of Renaissance surgery and anatomy has to
begin with Leonardo da Vinci (1452–1519). Multitalented, recognized as an artist, an anatomist, and a scientist. From his studies, da Vinci is now recognized as the founder of iconographic and physiologic anatomy.
He provided the earliest, albeit crude, diagrams of the cranial
nerves, the optic chiasm, and the brachial and lumbar plexi. He
developed a wax casting technique that allowed him to work
out and understand the anatomy of the ventricular system.

To…be the perfect surgeon, you must always bear in mind these eight notations.
The first task…to become a good surgeon should be to use his eyes….
Second, you must accompany and observe the qualified
physician, seeing him work before you yourself practice….
Third, you must command the most gentle touch in operating
and treating lest you cause pain to the patient….
Fourth, you must insure that your instruments be sharp and
unrusted whenever you cut anywhere….
Fifth, you must be courageous in operating and cutting but
timid to cut in the vicinity of nerves, sinews and arteries, and, so as not to commit error, you should study anatomy, which is the motherof this art…perform your surgery cleverly and never operate on human flesh as if you were working on wood or leather….
Sixth, you must be kind and sympathetic to the poor, for piety
and humility greatly augment your reputation and the sick will
more freely commit themselves to your care.
Seventh, you must never refuse anything brought you as a fee,
for the sick will respect you more.
Eighth, you must never argue about fees with the sick, or indeed demand anything unless it be previously agreed upon, for avarice is the most ignoble of vices and should you be so inflicted, you will never achieve the reputation of a good doctor.
Leonardo of Bertapaglia (ca. 1380–1460)

At the School of Salerno, an early leader in developing medical
scholasticism was Constantinus Africanus (1020–1087),magister orientis et occidentis.
Constantine provided an important bridge in medicine by introducing the scholarship of Islamic/Arabic medicine at Salerno and eventually to all of Europe.
Constantine received his medical education in Baghdad.

The dominant period for Islamic scholarship in medicine was
the 10th through 12th centuries.
Avicenna (980–1037), Rhazes (865–925), Avenzoar (d. 1162),
Albucasis (1013–1106), and Averroës (1126–1198).
One of the most beneficial teaching methods, and quite modern, did arise during the Islamic/Arabic period: the concept
of bedside medical care and teaching.

Those which are Masters and Professors chosen to performe the like operation, ought indeede to have a Lyons heart, a Ladies hand, and a Haukes eye, for that it is a worke of no small importance.

Rare colored trephination plate from Hans von Gersdorff’s 1517
manual on surgery. The victim has clear evidence of a third nerve palsy caused by a depressed skull fracture.

A skull from Peru with a left frontal trephination accomplished by means of the “scraping” technique.
The surgeon would use the two hand-held Peruvian tumis, positioned in front of the skull.
These tumis, made of a copper/bronze mix, date from the period ce 800–1100.
The patient survived the procedure, as indicated by evidence of healed bone regeneration at the site.

It is a privilege to be a neurosurgeon, as all the extraordinary
technology and science we employ is in the service of our patients.
It is at times a painful privilege as we are often condemned to
failure despite the accumulated experience and understanding to
be found in these volumes, but, as Einstein said, only a life in the
service of others is a life worthwhile.

The learning curve is influenced by a variety of factors, including the nature of the procedure being performed, surgical workload, choice of surgical instruments and technologies, training programme and the innate ability of the individual surgeon. Patient factors such as case-mix and anatomy can also influence the learning curve and should not be overlooked . In addition to the manual skills of operating, it is known that non-technical skills such as informed decision-making and the ability to make pressured intraoperative decisions also contribute to the learning curve.

Art in neurosurgery has been a critical part of the discipline for centuries. Numerous cultures, such as ancient India, China, and Egypt, and more contemporary scientists, such as Leonardo da Vinci, Max Brödel, and Norman Dott, have significantly contributed to medical illustration.