All That Moves Us

Jay Wellons

pediatric neurosurgeon, author

Father wanted to leave business career to become a doctor

He couldn’t do it so his parents put that dream onto him

Became interested in cardiology at first

a bobbing uvula

You can diagnose aortic regurgitation with _____

Alopecia totalis

condition with no hair anywhere

Dr. Miller

pediatric general surgeon

Kept coins he removed from children

His daughter became Jay’s best friend

amyotrophic lateral sclerosis

ALS meaning

amyotrophic lateral sclerosis (ALS)

neurodegenerative disease that leads to paralysis and death

Sleep deficit

when fatigue from no sleep builds up over time

Pluripotent

used to describe stem cells that can turn into any cell

Tim George

pediatric neurosurgeon

Jay worked on a project on brain imaging with him

250

___ pediatric neurosurgeons across North America

20%

___ of neurosurgeons are women

Sophia

12 year old with a ruptured brain arteriovenous malformation (AVM)

Large blood clot on left frontal lobe

Was successfully removed and she went to a rehabilitation center

Drilling hole into skull

done to reduce pressure from hemorrhage, trauma, brain tumor, draining

high pressure

Blood has ____ from the heart to the brain, then reduces pressure through the rest of the body

Capillary bed

thousands of tiny vessels to dissipate pressure evenly

Arteriovenous malformation (AVM)

____ disrupts high/low pressure and oxygenated/deoxygenated blood

Arteriovenous malformation

AVM meaning

Dalayla

8 year old with acute blindness, headache, and large tumor on the left side of her brain

Took out the tumor and she could see again

Tumor was malignant, glioblastoma multiforme (GBM)

Tumor came back to the dura (rare) and even the bone (unheard of)

Terminal

Glioblastoma (GBM)

grade 4/4 tumor, highly malignant, never fully curable

Life expectancy of child is 1-2 years

dura

tough membrane enclosing the brain

melissa

Jay’s wife, endocrinologist

sulci

crevices of the brain

gyri

hills of brain

motor strip

area of the brain that controls movement

bipolar

delicate bayoneted forceps, has electrical current

cerebrum

2 hemispheres divided into lobes

gray matter

where most cells bodies of neurons reside

white matter

millions of axons

Hannah

teenager with tremor in her hand

Tumor in her basal ganglia

Vessel feeding the tumor that they cut also fed the basal ganglia

Couldn’t move her right side

Basal ganglia

deep nuclei of the brain responsible for coordinated movement

Cerebellum

back of the brain, coordination

children

Tumors in cerebellum more common in _________

Hydrocephalus

blocked normal flow of cerebrospinal fluid to the brain, increased brain pressure

Ventriculoperitoneal shunt

tube device under skin that diverts cerebrospinal fluid to abdomen

Megan

8 year old with sudden headache

rapid hydrocephalus from blood clot

Coordination was affected but recovered

Diffuse intrinsic pontine glioma (DIPG)

deadliest tumor in children

Symptoms: eye/facial movement issues, weakness

Tumor is interwoven into pons

1 year survival at best

Arachnoid membrane

underneath the dura, fine plastic wrap like, contains cerebrospinal fluid

pia

final membrane covering of the brain

Trabecular bone

contains blood in skull bone

Quadriplegia

arms, trunk, and legs paralyzed (cervical spine injured)

Paraplegia

legs and pelvis paralyzed (thoracic and lumbar spine injured)

Brachial plexus

5 main nerves innervate the main muscle of the arm

Lumbosacral plexus

leg and pelvic nerves

9 y/o in car crash

subdural hematoma on right side of brain

Helicopter used to get her to hospital in time

dialate

Pupils ____ with increased brain pressure

Posturing

movement pattern from brain damage

KJ

3 y/o with bullet through skull, skull and scalp bleeding

Successful surgery

trauma blood

stockpiled O- blood for emergencies

sagittal sinus

drains blood of brain

bone wax

sterilized wax that can be pressed into bone to stop bleeding

Sterile methyl methacrylate

bone cement

capital purchase

one time big purchase for hospital

Retained foreign body

leaving something inside a patient after surgery

Cheyenne

subdural empyema, left 2 rubber bands

Subdural empyema

Infection on surface of brain with pressure

Intrauterine surgery for a myelomeningocele closure

surgery on fetus for a maldeveloped spinal cord

Spina bifida

not enough folate, doesn’t allow spinal cord to close in the womb

Management of Myelomeningocele Study

random assignment of fetal or postnatal surgery for trials of surgery

Team for australia fetal surgery

Kelly Bennett: maternal fetal surgeon

Stephane Braun: plastic surgery

Ray Paschall: anaesthesiology

Ann Kavanaugh McHugh: pediatric cardiologist

Alicia Crum: fetal ultrasounds

Melissa Broyles: scrub nurse

Allie

2 y/o in PICU, bleed in pons, went away then came back, developed hydrocephalus

4th ventricle

important brainstem nuclei and tracts

electrical currents

surgeons use _______ to tell where to cut in brain

Endoscopic third ventriculostomy

bypasses CSF blockage in lieu of shunt

shunt

hole or a small passage that moves, or allows movement of, fluid from one part of the body to another

Carotid endarterectomy

restores blood flow to brain to prevent stroke

Tim George

duke mentor of Jay, helped Black people get into neurology

Ryan

14 y/o, intracranial aneurysm

Died of brain death

Intracranial aneurysm

blood vessel wall thinning until it bursts, much more common in adults

Caused by high blood pressure, high cholesterol, and being male

Subarachnoid space

anatomical layer typically 1 millimeter in depth below the plastic wrap-like arachnoid membrane

Neuroendovascular surgery

“coil it”, placing soft wire fragments through the blood vessels to promote clot to prevent future aneurysm

suture box

room at ER where students close lacerations, has all the suture materials you would need

Harvey Cushing

founder of neurosurgery

Red

Ax Man, ax hit carotid during fight with cousin

carotid

main artery to the brain

Luke Nolan

12 y/o, dirt bike accident, successful surgery

Split thickness bone graft

using one of the 3 layers of the patient's own skull to replace another part of the skull

alyssa

 teenager, attempted suicide due to bullying

Fake story was that it was a shooting in her car but on right side of head, not left

Bullet went through optic nerve

survived

Seymore

11 y/o, weakness and pain in both legs

Got surgery in legs for spacity then pain started

sciatic nerve was cut instead of tendon

sued original doctor

spacity

muscle tightness

sciatic nerve

nerve as thick as the thumb in the back of adults upper legs

Neuropathic pain

pain from nerve damage

sural nerve

long thin nerve, perfect for nerve grafts

Hayden

18 y/o, cerebral cavernoma on outside and inside of cerebellum and lateral brainstem

kept returning to surgery

sucessful

RTOR

metrics to measure how often patients have to go back to the operating room

7th cranial nerve

facial function

External auditory meatus

outer ear canal

LOS

length of stay, quality metric

Leonard

8 y/o, arm nerves messed up from space heater explosion

same

Brachial plexus nerves are the ____ pattern in everyone

Ulnar and median nerve

wrist flexion nerves

Neurotization

nerve transfer