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Two Brains are Better than Oneby Graciela Gutierrrez  Youssef G. Comair, M.D. As the patient was wheeled into the operating room, he spoke clearly and sounded not a bit nervous. This, despite the fact that in a little over an hour, someone would be drilling into his head and inserting tiny electrodes into his brain, all while he was conscious. But he knew it wouldn't be just anybody picking up that drill. It would be a neurosurgeon. For Youssef G. Comair, M.D., Professor and Vice Chair of Neurosurgery at Baylor College of Medicine, as well as Chief of Service at St. Luke's Episcopal Hospital, the deep brain stimulation procedure was just another day at the office. The surgery lasted a little over five hours, but Comair wasn't alone. A young doctor training in the specialization of neurosurgery assisted in the procedure as did a team of nurses, x-ray technicians, anesthesiologist, and other health care professionals. Because the brain is such a complex organ, group effort is an important part of what makes up the complex field of neurosurgery.  Shankar Gopinath, M.D. "Neurosurgery used to be considered a very isolated specialty, but the surgery aspect is really just a small piece of the pie," said Shankar Gopinath, M.D., Assistant Professor of Neurosurgery at BCM. "I can go into the brain and find a tumor or damaged area, but without the pathologist, the internist, and so on, I wouldn't fully know how it is affecting the body, what the best way to treat it is, or how treatment will affect other aspects of the body's functions." Gopinath added that some with the same illness or injury might begin to heal on their own, while others might need surgery, or just medication. That's where neurologists, neuroradiologists, neuropathologists, neurosurgical intensive care specialists, and others come into play. Since the brain is the control center, the entire body can show signs of what is injured or damaged. These other specialists help to analyze what is going on in the patient's body and then consult with neurosurgeons to discuss the best line of treatment. Since no two patients are exactly the same, gathering these data through a complex set of monitoring systems is a delicate procedure used for all disorders involving the brain. The four main issues neurosurgeons treat are movement disorders, trauma, tumors and developmental or vascular problems.
Gopinath, who is also Chief of Service at Ben Taub General Hospital, mainly treats trauma victims. He works closely with a neurosurgery intensive care specialist when new patients are brought in. For example, the first examination of an accident victim would most likely be a CT scan of the brain, which will only show structural changes such as swelling. Since that might not require surgery right away, a neurosurgery intensive care specialist will monitor blood pressure. This indicates whether the brain is getting enough oxygen or if there is pressure in the brain. These results will determine the next step in treatment. "Each person can react slightly different to the same type of injury, or to the same type of treatment," said Claudia Robertson, M.D., Professor of Neurosurgery at BCM and Director of the Center for Neurosurgical Intensive Care at Ben Taub General Hospital. "It is important to take into account how each person is reacting to find the right treatment. There really is no cookie cutter answer." Researchers are now focusing on personalized medicine, how a person's genetic makeup will affect recovery from brain injuries or disorders. "It's not necessarily the injury that is affected by genetics, it's how the body reacts to it," Robertson said. "Genetic information could change how we treat trauma patients. Neurosurgery has changed so much over the years, this is the next step." With neurosurgery growing, Gopinath said there is a need for more doctors. The residency training period, which lasts seven years, is usually the deal breaker when it comes to students choosing their specialty, he said. "Many students tell me they are worried that they will not be able to have a family, or the idea of seven years in training is too daunting," Gopinath said. "I know many with families, and as for the years in residency, you are in surgery, working and learning. Really we are always still learning new ideas, techniques and treatments." Gopinath and Robertson said those obstacles are the very reasons they chose neurosurgery and neurosurgery intensive care. They and others in the field seek the challenge and the research that goes along with treating brain injuries and disorders. "What was done 10 years ago is not being done today," Gopinath said. "I wanted to be a part of that." "It was the idea of how the brain and body interact, how one affects the other," Robertson said. "I'm fascinated that the brain is the only organ we can put probes into and monitor, we can learn so much from that and really grow from where we are now." To those not in the medical field, the idea of brain surgery, whether as a result of injury or illness, sounds intimidating. In the deep brain stimulation performed by Comair, a small portion of the patient's brain was visible. The patient continued to talk and answer questions from the doctor and those who assisted in the procedure. While this situation is normal for those specializing in neurosurgery, it might leave others asking where the courage of those involved comes from. "You slowly learn the craft, you gain courage through skill, you understand why you are doing this, who you are helping," Gopinath said. "You know before you go into it if it is worth doing, nerves are out of the question." |
FeaturesTreatments on the Horizon: Chapter and Verse on a Brain Killer Two Brains are Better than One SpotlightCaring for Community at Home and Abroad Injecting a Little Scientist in Every Doctor Designing a Building in the Eyes of a Researcher Laser Treatments Best Left up to Doctors BriefsFalls in Elderly Indicate Illness Findings may Increase Survival after Injuries Some Like it Hot! Structure of Receptor for Chili Pepper and Pain Revealed Beware of Drinking Margaritas in the Sun Development/AlumniBCM Family Participates in Fundraising Campaign BCM Alums take D.C. Fellowships Seed Funding Leads to Breakthroughs Father, Daughter Team up for Health Care
Steps to Discovery and Innovation
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Volume 4, Issue 2, Summer 2008 |
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| Last modified: October 7, 2008 |