Welcome to the third lecture in the University of Arizona College of Science Series on "The Evolving Brain." It's Feb. 10, 2014 and we're in Centennial Hall on the campus of the UA where the lecture will begin at 7:00 p.m.
Tonight we'll hear from G. Michael Lemole, Jr., MD, Chief of the Division of Neurosurgery and Professor of Surgery at the UA College of Medicine. Lemole's topic is "The Evolution of Modern Neurosurgery: A History of Trial and Error, Success and Failure."
Interesting facts about the speaker:
Dr. Lemole's medical specialities include complex cranial surgery, skull base surgery, minimally-invasive endonasal approaches (to the brain), cerebrovascular surgery and radiosurgery.
Dr. Lemole is board certified by the American Board of Neurological Surgery. In 2002, Lemole was a resident at the Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz.
It's 6:42 p.m., and quite a crowd is gathering. It looks like it could be a full house tonight. The audience is waiting to hear G. Michael Lemole, Jr., MD speak about the science and art of neurosurgery.
Much of what we know about functional brain anatomy is apparently derived from the study of disease states and brain injuries. Dr. Lemole will speak about the science and art of neurosurgery which, according to the program announcement for tonight's lecture, "is firmly grounded in a paradigm of surgical trial and error."
In 2011, Dr. Lemole was recognized as Physician of the Year by the Pima County Medical Society. He is also Honorary Commander of the 355th Medical Group, Davis-Monthan Air Force Base.
In about 7 minutes the program will begin. This will be the third lecture in the series "The Evolving Brain." The topic is "The Evolution of Modern Neurosurgery: A History of Trial and Error, Success and Failure." While we're waiting, a series of slides about the human brain appears on the screen at the front of the auditorium.
The adult human brain weighs an average of about three pounds. The brain has two hemispheres, the left and right. They are broadly similar in shape, and most cortical areas are replicated on each side. Some functions are located on only one side of the brain.
The four brain lobes of the cerebral cortex are the frontal, parietal, occipital and temporal lobes.
Cerebellum is Latin for "little brain." The cerebellum contains more neurons that the rest of the brain.
The lights are dimming, and we're ready to go. A full house it is.
Dr. Lemole is being introduced. His field is "cutting edge" (no pun intended) neurosurgery. Please welcome our speaker...Dr. Lemole.
Most of us know Dr. Lemole from the Tucson Tragedy--the shooting of Congresswoman Gabrielle Giffords.
Dr. Lemole is playing a clip of a television neurosurgeon bragging about his profession--a little light humor for the audience. The TV neurosurgeon meets a rocket scientist, and the contest between the two makes the crowd laugh.
Dr. Lemole starts with a true story. A patient suffered a pneumatic nail gun injury to the head. The nail passed through an important blood supply. "You can't just yank that out, can you," says Dr. Lemole. Dr. Lemole discusses the team of surgeons, all with an important subspecialty, required to repair the injury. Meanwhile, a video of the surgery appears on the screen. The brain is a "pulsing, living organ," says Lemole. Dr. Lemole shows a photograph of himself with a set of pliers and the nail. The patient survived and left the hospital.
As far back as Pre-Columbian Peru, brain surgery was performed. It appears that 50% of the Pre-Columbian brain surgery patients survived. This could be determined because healing was observed in the skulls.
In early Egypt, the brain was disregarded. It was only later that the importance of the brain was realized. Aristotle had a cardiocentric (heart-centric) view. This view lasted through the Middle Ages.
The concept of dissection became more prevalent in the 13th century. Frederick II (of the Holy Roman Empire) mandated the study of anatomy and permitted public cadaver dissections
The art of Leonardo da Vinci was realistic because he did dissections.
Rene Descarte talked about the mind-body problem. Thomas Willis refocused neuroscience without controversy about the seat of the soul.
By the 19th century we had developed antisepsis and anesthesia.
The concept of localization--different brain regions with specific functions was first mentioned by Emmanuel Swedenberg (1688-1772) a Swedish scientist.
"Along the way we had some bumps," said Dr. Lemole. Phrenology suggested that the shape of the cranium (the bumps on the skull) reflected the underlying brain. Johann Spurzheim (1776-1832) coined the term "phrenology."
A patient came to Paul Broca with a serious brain injury. The patient's speech was impaired. After the patient's death, the brain was dissected and the injured area of the brain, which was involved in speech, was identified and named after Broca. Phineas Gage was another patient whose brain injury was studied.
William Macewan (1827-1913) localized tumors and abscesses in brains based upon the function which was impaired and operated on the brain, often successfully.
Rickman Godlee (1849-1925) and Victor Horsley (1857-1916) also performed neurosurgery.
Harvey Cushing is the Father of American Neurosurgery. Cushing developed electrocautery and surgical silver clips. Cushing's innovations drastically reduced mortality in patients with brain injuries.
Important technological developments in neurosurgery include improvements in: anesthesia, sterile technique, pneumatic drills and electrocautery. Other advancements include clips and coils which are used to repair aneurisms. Clips squeeze the neck of the aneurism. Coiling fills the aneurism keeping it from bursting.
Microscopes are used quite effectively in neurosurgery, enabling a three-dimensional view of the brain. Endoscopes enhance visualizing orifices. Neuroimaging is one of the most important modern innovations in brain surgery.
For three-dimensional localization, early neurosurgeons use encephalometers to pinpoint areas of the brain. Then came stereotaxic devices that were screwed into the skull. Now there are more modern devices to navigate the brain.
How do we put this all together? We have a basis in science, adequate tools, a will to try and a prepared mind. The treatment of epilepsy is an example of putting this together. Epilepsy is a "short-circuit" in the brain which can spread to other areas. William P. van Wageman, MD developed a technique for cutting the corpus callosum, a band of tissue that connects the two brain hemispheres, in such a way as to prevent epilepsy
A fortunate mistake: In 1952, Irving S. Cooper, MD accidentally cut an artery in a patient with tremors. Cooper aborted the surgery, but the patient's condition had improved. Cooper discovered that making a lesion in the Globus Pallidus of the brain, which replicated the result of his surgical mistake, Cooper was able to abate tremors in patients.
Science amok? Walter Freeman and James Watt promoted the frontal leukotomy, commonly known as a lobotomy. Psychosurgery was not necessarily a bad thing initially, as there were few options for psychiatric patients. The most serious failure of psychosurgery was that some surgeons continued to use the technique after less invasive treatments like medication, were available.
Dr. Lemole uses lessons from the past to inform his practice.
The future of neurosurgery, according to Dr. Lemole, includes minimally invasive neurosurgery, with maximum results. "You don't help your patient if you leave a small scar, but the tumor comes back," says Lemole.
Dr. Lemole discusses more examples illustrating the future of neurosurgery. Endonasal skull base surgery involves accessing the brain through the nasal cavity. This avoids opening the brain case.
The old way of learning uses books. Now students use simulators. "This is the future," says Lemole. Using simulators can help surgeons avoid mistakes. "The art (neurosurgery) persists, but the life (of the neurosurgeon) is short," represents Lemole's philosophy of surgery. He also says, "Our patients are our best teachers."
Failures are inevitable, but if surgeons are introspective, they can learn from failures. Lemole cites his experience of applying clips to an aneurism. The aneurism had a plaque which complicated the surgery, and the patient had a stroke. In the days that followed, Lemole went over and over what his choices had been. "An arrow is an arrow, whether or not it hits its target," said Lemole's mentor. Lemole took this to mean that perseverance was what mattered, persevering in the face of failure. "You cannot minimize the pain and suffering that comes with a failure, but you must persevere," says Dr. Lemole. "We owe it to our patients to examine our successes and our failures."
The lecture is over. Thank you Dr. Lemole. The next lecture in the series will be held in Centennial Hall on Feb. 17, 2014. This next lecture is titled "The Literate Brain," and will be presented by Pelagie M. Beeson, PhD, Professor and Head of Speech, Language and Hearing Science.
Good evening. This is Susan E. Swanberg signing off.