How do neurosurgeons get to the middle of someone’s brain without damaging other parts of the brain?

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How do neurosurgeons get to the middle of someone’s brain without damaging other parts of the brain?

In: Biology
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Going inside the brain is a last case scenario. In those cases the alternative to surgery is death or a great worsening of the patients QoL. So, rewards outweigh the risks in those cases. Damage does happen, and it is sometimes severe, but it’s all dependent on the result. If going inside your brain meant possible vision loss in your left eye but also meant the removal of a lethal tumor, you’d likely say yes.

Of course, brain surgeons are highly trained in what areas of the brain do what and the ways to do the least damage possible.

In short, they don’t.

Detailed imaging (pre-op MRI and intro-operative CT) are often used to create a robust surgical plan which includes trajectories, burr hole locations, and implant targets to minimize risk of bleeding, damage to important speech regions, etc. Unintended cognitive, personality, speech, and motor symptoms are not uncommon following major neurosurgery.

Source: neural engineer who studies deep brain stimulation.

Getting to ‘the middle’ is a last resort. Getting much beneath the surface is always risky, and the central part is neurologically the most complex. But the brain is composed of several different lobes, which have some natural anatomical separation. To some extent you can also follow the path of major blood vessels.

Any brain surgery is risky to some degree. But the patient and/or doctor may decide that some brain damage is an acceptable risk (or even likelihood) for a decent chance at removing a greater threat. And depending on where the problem is, the effects of those risks can be approximately calculated, something like “you may lose the ability to speak”, or “vision in your right field of view will probably be affected”.

is there something where one drills a hole into a person’s skull?

There will always be some damage. The way I saw it, is that they try to make a kind of tunnel through the brain cortex, by spreading the upper layers to the left and to the right.

They map out their route as others have said. One thing being missed is the various approaches a surgeon will use to get to different pathology locations. They will position the patient in different ways to drop or slack the brain and then lift up various “folds” of the Brian if possible.

They will drill down the orbit or take off part of the sinuses etc. Skull based surgeons do crazy shit to get to the base of the skull that’s why those cases go for 20 hours sometimes or even multiple stages.

-neurosurgery NP

They dont, it’s why some tumors and aneurysms are considered inoperable. And even if the condition can be accessed without the guarantee of severe damage or death, neurosurgery is the most fragile and dangerous type of surgery because of the high possibility of complications.