[HN Gopher] Surgeons Cut a Giant Tumor Out of My Head. Is There ...
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Surgeons Cut a Giant Tumor Out of My Head. Is There a Better Way?
Author : melling
Score : 123 points
Date : 2024-08-14 16:39 UTC (4 days ago)
(HTM) web link (www.bloomberg.com)
(TXT) w3m dump (www.bloomberg.com)
| xyst wrote:
| https://archive.ph/3axkV
| ChrisMarshallNY wrote:
| Back in '96, I had a pretty serious craniotomy.
|
| Took me a couple of months to learn to walk and chew gum at the
| same time, but I was pretty much 100% recovered, in five years.
|
| One of best days of my life, was when my neurosurgeon said "I
| never want to see you again."
|
| They did it the old-fashioned way. Scalpel and Black-and-Decker
| circular saw.
| adin8mon wrote:
| A family member of mine had to go through something similar,
| the old-fashioned way. I've never felt more scared for someone
| else than on that day.
| Loudergood wrote:
| Brain plasticity is amazing.
| aborsy wrote:
| So long as they are young!
| loa_in_ wrote:
| That's a myth. Brain plasticity was never properly studied
| beyond 26 years of age.
| fredgrott wrote:
| nope, neurons are fully regenerable including into old age.
| tomcam wrote:
| Wow. Genuinely grateful you got through it so well.
| ChrisMarshallNY wrote:
| So am I. It was a ... _tense_ ... time of my life.
| blackeyeblitzar wrote:
| Is it actually a black and decker? It isn't some sort of
| special FDA approved medical saw? Is that even a thing?
| bluefirebrand wrote:
| What would the difference be in your mind?
|
| As long as the blade is suitable for cutting bone and it's
| all sterilized, what would make it medical grade over
| carpenter grade?
|
| My Dad was the manager of a tool store for decades. He has
| had a lot of knee problems and he has a funny story about his
| knee surgeon coming into the store looking for a drill bit to
| drill out a stripped screw. He jokingly asked if the stripped
| screw was in someone's knee, and sure enough it was.
| robertlagrant wrote:
| > what would make it medical grade over carpenter grade?
|
| In my experience, about $50000.
| acchow wrote:
| My woodworking equipment has a certain amount of jitter and
| give. It seems to have precision to about 1-1.5mm. I
| imagine medical grade machine cutting would have higher
| precision?
| vasco wrote:
| Probably, but when you're watching these surgeries as a
| layman for the first time it's surprising how much
| fumbling around they seem to do. I have a few pieces of
| metal inside me so took more of an interest at some
| point, and even those surgeons admit their job is mostly
| carpentry on hard mode.
| wbl wrote:
| My grandfather was an orthopod and an amateur carpenter.
| The skills really do transfer.
| soared wrote:
| Next time you go under ask your surgeon to take pictures
| and videos. Very interesting to see inside your body!
| vasco wrote:
| I even kept the metal rods they had in my leg in between
| surgeries that would otherwise be thrown out!
| ChrisMarshallNY wrote:
| A friend of mine got a hip replacement, and asked for the
| old hip.
|
| They refused to give it to him. They said it was "medical
| waste," and they weren't allowed to deal with it, except
| in whatever federal manner was required.
| KMag wrote:
| As long as it survives an autoclave and doesn't leave
| behind any debris in the site, it seems fine.
| davrosthedalek wrote:
| You will have a very hard time sterilizing a carpenter
| grade saw.
| HeyLaughingBoy wrote:
| It would need to be survive an autoclave, for one thing. It
| would need to be possible to actually clean it, not shed
| bits of paint and plastic into the patient's skull,
| material compatibility with antiseptics, etc.
|
| If I thought about it for a few minutes, I'm sure I could
| create a long list of requirements for a suitable saw.
| rich_sasha wrote:
| A friend is a neurosurgeon and they use some special saw that
| stops as soon as there's no hard tissue providing resistance.
| So you press it hard into the skull, and when it's done
| chewing through the bone, it immediately stops.
|
| Apparently the scariest bit for the junior doctors to learn
| to use, somehow.
| jajko wrote:
| Same or very similar stuff is used to cut plaster casts for
| broken bones. You see that small circle rotating next to
| your veins in legs and there is suddenly some tension in
| the room. Especially when saw seems to keep stopping when
| cutting through plaster for no good reason, causing some
| confusion for the doctor and making him lean more heavily
| into it.
|
| Afterwards they realize that harder resin casing was
| layered with soft fabric by previous orthopedic surgeon in
| previous hospital, so the thing actually worked as intended
| (but if you keep pressing power button and leaning into it
| it will keep cutting). Talking about hospital equipment in
| Switzerland, 2 weeks ago after a nasty paraglider crash
| landing.
| ZeroGravitas wrote:
| Cast saws are different, they don't affect skin as
| demonstrated by this youtuber with a high speed camera:
|
| https://youtube.com/watch?v=Bx1AiQdMQro
|
| edit: though actually I googled the skull saws which I
| wasn't familiar with and they might work on a similar
| principle, found someone talking about using them in
| autopsies anyway.
| PhasmaFelis wrote:
| That's strange. Cast saws don't need to stop like that;
| they can't cut skin even running at full speed. Your grey
| matter is not as tough as your skin and you wouldn't want
| to touch it with even a gentle power tool, though, so it
| makes sense that brain-surgery saws would be different.
|
| I'm forever grateful to the doc who actually pressed the
| running sawblade into his hand to prove that it's
| harmless, instead of just saying "don't worry, it's safe"
| while going to town on my leg with a power tool.
| jac241 wrote:
| That is known as the perforator drill bit - https://www.red
| dit.com/r/toolgifs/comments/z2zikm/cranial_pe...
|
| Used to make burr holes so that the dura can be stripped
| away from the skull using the Penfield 3 instrument.
|
| Then what's used is what's known as the B1 with footplate
| to create the bone flap - https://www.researchgate.net/publ
| ication/323134344_Exposure_...
|
| Here is an example of the drill system - Midas Rex MR8 -
| https://www.ebay.com/itm/125960633809
|
| Here's a video of a surgeon performing the pterional
| craniotomy, probably the most common craniotomy for things
| like aneurysms, -
| https://www.neurosurgicalatlas.com/volumes/cranial-
| approache...
| gumby wrote:
| You mean the bonesaw-through-the-chest scene in
| _Reanimator_ was not accurate?
| ChrisMarshallNY wrote:
| Nah... that was a joke.
|
| But their tools look surprisingly like standard hardware.
|
| Lot more pricey, though.
| OJFord wrote:
| 'x grade' stuff is usually just about testing &
| certification, it's not that it is actually necessarily any
| different from the 'standard' model.
| bearsnowstorm wrote:
| A counterpoint on focused ultrasound for essential tremor - just
| because you don't penetrate the brain with a physical object
| doesn't mean you don't have side effects - as usual, benefits
| come with risks
|
| https://jamanetwork.com/journals/jamaneurology/fullarticle/2...
| vasco wrote:
| This article isn't accessible so it's hard to see what you
| mean. Do you have a link to the full thing?
|
| Found a similar previous one
| https://movementdisorders.onlinelibrary.wiley.com/doi/10.100...
| where out of 10 patients, 7 had issues:
|
| > Tremor significantly improved in all patients. Seven
| experienced mild adverse effects, including 2 with transient
| gait impairment and a fall, 1 with dysarthria and dysphagia,
| and 1 with mild dysphagia persisting at 3 months.
|
| Also can't access the full pdf either though.
| melling wrote:
| The FDA approved histotripsy mentioned in the article to treat
| liver tumors is available at NYU Langone.
|
| https://nyulangone.org/news/nyu-langone-cancer-specialists-u...
| yarg wrote:
| Either sonic or photonic attacks from every direction at once,
| resonating at the tumour site.
|
| You'll also need to bolster the immune system to aid in recovery.
| kuhewa wrote:
| > You'll also need to bolster the immune system to aid in
| recovery.
|
| This eats the brain
| tomcam wrote:
| How?
| mschuster91 wrote:
| I guess they're referring to the brain (and, by extension,
| the eyes!) being an "immunoprivileged zone" [1]... the
| brain-blood-barrier makes a lot of "everyday" stuff for the
| rest of the body pretty complex affairs for everything CNS
| related.
|
| [1] https://en.wikipedia.org/wiki/Immune_privilege
| atlas_hugged wrote:
| Wait, what???
|
| Where on earth did you hear that?
|
| Source?
| DiscourseFan wrote:
| https://www.imdb.com/title/tt0087469/
| rishabhjain wrote:
| I wonder how is it different than radiosurgery? Machines like
| Cyberknife, Gammaknife also treat brain tumours in non invasive
| way
| suddenseizure wrote:
| I wouldn't call radiation non invasive, it ages the surrounding
| brain tissue a lot.
|
| For people with faster growing tumors like GBM the tumor will
| usually kill them before the side effects of radiation hit.
|
| But for people with slower growing tumors like
| oligodendroglioma, the side effects of radiation can force them
| to quit their job and go on disability, years before they
| actually die of the cancer.
|
| The better we get at treating these tumors and extending
| patients' lives, the more important it will be to avoid
| radiation as long as possible to ensure that extra quantity of
| life also has quality.
| OJFord wrote:
| In medicine/surgery, 'invasive' is a bit of a term of art,
| meaning that implements physically enter the body. 'keyhole
| surgery' (a small incision with a scope and tiny tooling
| pushed through) for example is often described as 'minimally
| invasive'.
| FireBeyond wrote:
| Yes. Even placing stents during cardiac catheterization
| (PCIs or angioplasty) is 'minimally invasive' because
| typically access is achieved by the femoral artery and
| snaked up (the femoral comes "direct" from the heart, for
| all intents).
|
| Yes, you blow up vessels with a balloon and leave a metal
| sheath in them, but as you say, minimally invasive, because
| you didn't crack the chest to do it.
| pknomad wrote:
| I didn't realize how aggressive GBM could be until watching
| this video: https://www.youtube.com/watch?v=VSLPq010Q-o
|
| That much growth in 4 months is eye watering.
|
| > The better we get at treating these tumors and extending
| patients' lives, the more important it will be to avoid
| radiation as long as possible to ensure that extra quantity
| of life also has quality.
|
| This is a good point.
| HeadsUpHigh wrote:
| Radiosurgery has it's limits and also horrible side effects esp
| in CNS tumors. If the tumor can be accessed without damaging
| too much healthy tissue and it's a histological type that has
| clean borders you are probably better off cutting it out.
| vsuperpower2021 wrote:
| article fails to load text partway through. why are websites so
| bad at doing this?
| Muromec wrote:
| To make sure you watch ads
| Ylpertnodi wrote:
| Should have asked this question beforehand?
| vanderZwan wrote:
| > _The key is knowing exactly where to aim. While the MRI machine
| took readings, Elias ran a test at a low intensity to see if he
| could gently heat up the spot on Doby's thalamus he was
| targeting. Satisfied with the result, he then proceeded to blast
| an area millimeters wide with 6,000 joules of focused sound
| energy for a few seconds. A graph on his monitor showed the
| temperature jumping to about 60C (140F). Everything around it
| stayed at a normal 37C. Other than a brief sensation of heat
| inside his head, Doby said he didn't feel a thing. Elias repeated
| the process three more times, checking the tremor after each. By
| the fourth, it was gone._
|
| Leaving it at "knowing where to aim" is severely underselling the
| problem, because then the next step is _how_ to aim.
|
| Back in 2003 when I still studied physics I attended a talk back
| by a Dutch biomedical researcher who worked on shock wave
| lithotripsy - a procedure where ultrasound is used to break
| kidney stones. So same idea as this, except kidney stone
|
| So what he pointed out was that the human body is not a medium of
| uniform density, so the way the sound waves propagate is hard to
| calculate.
|
| Worse, the human body tends to _move_ , even when the patient is
| under anesthetics. Even if you sedate someone enough to lie
| perfectly still, the heartbeat means blood vessels grow and
| shrink, breathing causes miniscule motions that can throw off the
| ultrasound beams.
|
| Maybe this is specific to kidney stones though, maybe kidneys are
| just a lot more "floppy" organs and maybe kidney stones move a
| lot. Maybe the brain is a lot more "stable" in the skull. And I
| suppose the method of destruction is different (kidney stones
| need to be _shattered_ by ultrasound waves, whereas this method
| uses heat), so that might also be an influence.
|
| I'm not being critical of this technology btw, just trying to
| point out that the engineering problems involved are likely a lot
| more interesting than that this article is suggesting.
|
| [0] https://en.wikipedia.org/wiki/Lithotripsy
| saas_sam wrote:
| Interesting. Maybe part of the solution is better predicting
| and controlling the motion inside the human body. I could
| imagine using a method to guarantee a particular organ be at a
| certain place at a certain moment: perhaps by accelerating the
| body a certain way to shove the organ into a position for a
| moment. Or maybe by injecting microscopic machines to surround
| and hold an area still. Someone will figure it out.
| kelsey98765431 wrote:
| Science needs more cadavers! Bring out ya dead
| FiatLuxDave wrote:
| In radiation therapy, respiratory gating is a common method to
| deal with the problem of breathing movement:
| https://www.oncolink.org/cancer-treatment/radiation/support/...
|
| I was not aware of respiratory gating being used in SWL. So, I
| did a brief search and saw that the efficacy of gating had
| definitely changed over the years:
|
| https://pubmed.ncbi.nlm.nih.gov/7858616/ (1994)
|
| https://pubmed.ncbi.nlm.nih.gov/22471349/ (2012)
|
| https://pubmed.ncbi.nlm.nih.gov/38515108/ (2024)
|
| So, it looks like that engineering problem has been worked on a
| lot since that talk in 2003.
| randerson wrote:
| I once had to have a Heart MRI, which was fascinating because
| movement normally messes up an MRI. For the heart, they attach
| a pulse monitor and the MRI machine pauses its movement for a
| split second each time the heart beats.
| pknomad wrote:
| I'm a bit confused on the use of word non-invasive in this
| context.
|
| I was under the impression that non-invasive meant no cutting of
| tissue. Even if ultrasound separated the cancerous tissue from
| the healthy tissue - how would the surgeons get it out of the
| head without cutting into the skull? I also thought some surgeons
| used diluted hydrogen peroxide irrigation for removing potential
| neoplastic cancerous tissues post excision?
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