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After 120 Years, Doctors Develop New Brain Surgery Technique

Johns Hopkins surgeons report they have devised a better, safer method to replace bone removed from the skull after lifesaving brain surgery. The new technique, they say, appears to result in fewer complications than standard restoration, which has changed little since its development in the 1890s.
 
Patients who have a piece of the skull removed to accommodate a swelling brain caused by brain injury, infection, tumor or stroke typically undergo a second operation — a cranioplasty — a few months later to restore the protective covering. In the intervening weeks, the scalp often adheres to the outer layer of the brain. Traditionally, surgeons have peeled the scalp off the brain to then tuck the skull bone or custom implant back into place, a practice which puts the patient at risk of bleeding, seizure, stroke and infection. In some cases, the replaced bone or implant must again be removed.

In the new approach, described online in the journal Neurosurgery, surgeons pull back only the top three layers of the five-layer scalp, thereby sandwiching the bone or implant in between. The researchers say this innovation not only prevents brain injury, but also reduces infection risk by providing the delicate bone or implant access to blood supply in the scalp from both the top and the bottom.

“Everyone has been taught for 120 years to completely peel up the scalp,” says study leader Chad R. Gordon, D.O., a craniofacial surgeon and assistant professor of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine. “But by not disturbing the brain, we get much better outcomes. This is a safer, simpler way to do a very complex surgery.”

“This represents a tremendous advantage for our patients,” says Johns Hopkins neurosurgeon Judy Huang, M.D., a study co-author.

For the study, the research team, which included several Johns Hopkins neurosurgeons, treated 50 patients using the new technique between July 2011 and June 2013. Only one patient developed a deep infection requiring bone removal. Deep infection remains the leading major complication following secondary cranioplasty, with rates reported between 21 and 40 percent. Blood loss also was dramatically reduced, they say.

Ideally, surgeons restore the skull with the same piece of bone removed during the original operation, which is stored in a freezer between operations. In some cases, surgeons must substitute the original bone with a custom-made implant made of an organic compound called methyl methacrylate, which has been used safely since the 1960s.

Gordon says he is working with several Johns Hopkins neurosurgeons through the Multidisciplinary Adult Cranioplastic Clinic, which helps answer patient questions about two major sets of concerns: how to safely reconstruct a life-threatening skull defect following brain surgery and what type of deformity will result.

“She’s in there in the middle of the night telling patients that she has to take part of their skull off to save their lives,” Gordon says of Huang. “Meanwhile, everyone’s thinking, ‘What is it going to look like afterward?’ Working together, we can reassure our patients and their families and work together toward a positive outcome.”

Shift Happens- the world is changing at a much faster rate than is perceived, the stats you’ll see hear are mind blowing, but if you use technology often they shouldn’t come as a surprise. More and more people are becoming addicted to social networking sites such as Facebook/ twitter more, basically almost everyone in rich countries has a range of laptops computers, games consoles you name it…which is a good thing as it has the potential to create new jobs, for example more and more are needed people are required to find cures for diseases such as cancer and HIV , if you have got great ideas for new gadgets which you think will be popular amongst young people or if you have a neat idea to solve some of our current world-wide problems  then you shall love the future as you may receive large sums of money for your inventions e.g. look at the legacy left by technology-genius Steve Jobs. There might be jobs for… doctors to specialise in new diseases and health issues that we declared as “normal” before which may arise as excess baggage  from the new beautiful modern age, one thing’s for certain is that nothing ever stays the same, as long as you stay on your feet and stay updated you may come to realise that change is good but if you don’t do not worry the principles of life will stay the same, it’s only the world around you that is changing, how you respond to that is up to you.

Striving to study Medicine

So why do you want to become a doctor??? Many people have their own reasons about striving to become a doctor through studying medicine such as; having a secure job, a good source of income, having the title “Dr. N.A me”, want to wear a white coat. Some have reasons which are much more worthwhile, for example they have a keen interest in science and they would love to use that knowledge to help others’ physical and mental well-being, they truly believe that they can improve the way the health care system is run through their own input of good leadership skills acquired  from a very young age, for example, student leader, prefect and head girl or boy and they believe that they can cope realistically with the very long hours of hard-work, “picture this” you’re an A&E doctor with patients who do not want to be told to wait as you treat a seriously ill patient because they want their scab fixed “immediately”( they could have gone to the G.P instead!)…well  not maybe exactly in those terms, it’s also funny how people call the ambulance when they’re drunk because they want a lift home, when the ambulance crew could be saving someone’s life who for example is maybe unconscious on the other side of town and it wasn’t their fault.

Anyway that is just one scenario which may or may not occur often, they are many benefits which accompany life as a doctor because as I read somewhere once deciding to study medicine is like asking someone to marry you, a BIG commitment. I think working with a group of other determined individuals who are working hard to make sure that people are given the right health-care which they indirectly paid for through their taxes and some patients can be really lovely and as I have seen through my work experience in a hospice and the knowledge that you are helping someone who is patient and co-operative is thrilling. Even though it can have many ups and downs , I am sure that anyone who wants to pursue a career in medicine like me  will have a very successful career if you do enough research and think deeply if this is the job that you want to do for the rest of your life!
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