Brainstem Surgery

A few days ago I could watch a famous neurosurgeon doing three followed and identic surgeries. With an audience of doctors to watch, he left a room and entered another where everything was ready for him, including the approach. He had Spent average ten minutes in each one and successfully  removed  three cavernomas of medulla oblonga (kind of tumor of veins that can lies any part of our brain and other organs). In those cases, the lesions were located in the most noble part of our body, the brainstem. Although of living in neurosurgery environment for five years, I have never seen anything similar before. While he was handling the tumor, all of us were breathing carefully and too concentrated, there was no safety margin. After finished the last one, he thanked all and left the room to continue his life.

While it was happening, there was three commom people like us, maybe a lawyer, basketball player or bus driver, that unfortunatelly was the patient in that moment and was sleeping deeply due to one of the most important discovery of the humanity, the anesthesics. If these people had a little bit knowledge from neuroanatomy of Dr. Rothon or neurophisiology I really do not know if they dare to lie down there.

Undoubtedly in surgery world, is not anyone that has skills to handle safely with this sort of lesions. Where is located the control of all our vital functions, through it passes all the sensory and motors pathways, hosts the center of control of breathing, cardiac rate, blood pressure, part of the chewing, speech, swallowing, hearing pathways, control of ocular motility, motor coordination and maintenance of wakefulness. We should thank it for we are awake, there are a structure called reticular formation that is responsible for the maintenance of our wakefulness. Once I read in an anatomy book that the brainstem is the part of central nervous system that had more neurological function concentrated in the less volume. No wonder that nature protected it surrounded by bones, among them the hardest and most solid of all, the petrous portion of temporal bone, the name came from the similarity with the firmness of a stone and so it is also known as rock .

If you propose to handle the núcleus, the core of a person, it would be courage added confidence, the conflict of the security with audacity plus knowledge with a couple of prudence and responsibility. You have to concentrate your thoughts on the technique and momentarily forget the risks and all past and future that exist around that patient. You have to put the whole weight of your body upon years of study of anatomy and physiology and don't let the fear make difference on this seesaw. Moreover, the most important when we propose to do a surgery of this size is respect for the others' lives, more than that, respect for the patient, who are naked of distrust.

Might the most ancient Greek philosophers in the fifth century before Christ know all this concentration of functions and importance within a single structure? Might it be involved in the answer of "the one big question" of what constitutes reality and existence? Overall, if I could summarize the fact of being alive in just one word undoubtely would be the brain stem, since damaged it integrity is no more reality or existence.

Bernardo de Andrada