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Two Millimeters
The human stories behind brain surgery beyond the scalpel
Dr. Rob Miller, a young neurosurgeon in training, found himself operating late at night. He was doing delicate brain surgery to repair an anomaly in the brainstem, which is located at the brain’s base and controls key activities like breathing and heart rhythm. Despite the late hour and complexity of the operation, Rob was secure in his actions. He painstakingly peeled layers of tissue to uncover a yellowish lump deep within the brainstem. The dreaded tumor.
Suddenly, the attending surgeon, the most experienced doctor in the operating room, interrupted Rob in the middle of the process. “Dr. Miller,” he asked, pointing to a specific area, “what would happen if we made an incision just two millimeters deeper here?”
Rob’s mind raced. “Double vision?” he asked.
The attending surgeon shook his head. “No,” he replied firmly. “Locked-in syndrome.” He explained that a cut two millimeters deeper could entirely paralyze the patient, leaving just the ability to blink.
Two millimeters. The difference between tragedy and full recovery. A two millimeter error in judgment of the structure of the brain.
The first scientific studies of the structure of the brain are accredited to Herophilus and Erasistratus; both from the Graeco-Roman city of Alexandria. The reason these breakthroughs came about in Alexandria was that, for a brief period, and apparently for the first time in history, the dissection of human bodies was permitted.
Such is the nature of the most complex object in the universe: the brain. As soon as scientists believe they’ve figured it out, some new data emerges.
One of the current challenges is mental health and its devastating impact on society.
Keeping the mind awake
Neurosurgeons usually do procedures while the patient is conscious. The structure of the brain and the area to be operated on are precisely planned and mapped out. The operating area, for example, would be named Site 19. Any neighboring regions that may be dangerous or where different reactions can be tested are likewise labeled.
