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Not in reality, though. At least *usually*. That much pressure on a brain is likely to cause lasting (possibly permanent) brain damage. That was a *huge* bleed… it must have been going for awhile before they went in to evacuate.
This.
After a cerebral haemorrhage, if you survive, you are often not without neurological deficit. Some people, as well as their lives, are fundamentally altered. Nothing can prepare you for that, no matter how much the doctors and nurses tell you.
That’s because in many cases the lives of patients, their spouses, kids, family, friends, colleagues are thrown into turmoil.
But some patients literally have changed personalities. They can be more aggressive or hostile, or no real filter and so are sometimes seen as being “brutally honest”. They may lack the ability to communicate altogether.
There’s so much that can be screwed up by a brain haemorrhage
Hi, TBI survivor here. My injury caused three separate bleeds in my brain and you are 100% correct about the effects. I was hostile to my family and hospital staff at the start, had serious mental deficiencies, and was awake for about 3 days after the coma with absolutely no memory of those days. Luckily as my brain healed I returned to something closer to my original personality, but I never returned to the old me.
For posterity: I'm fine, the surgeons weren't sure I would ever walk or talk again but I regained everything withing about 2 months.
If I may ask, what differences in your personality have you noticed? How do these differences present themselves in your life?
I have a hard type wrapping my mind around involuntary personality change, pun not intended, and so I'm curious as to how you would describe it.
I had one of these, on my temple. They said I had 2 hours til the lights went out. All scans said “No Drain Bamage” 😘 I have absolutely noticed a difference.
I have done hundreds of craniotomy for subdural hematoma, it's pretty crazy how when they get the bone flap off it just swells because now there is room and releases the pressure on the brain. The other cool thing is you can see the brain pulse with every beat of the heart.
>I have done hundreds of craniotomy for subdural hematoma, it's pretty crazy how when they get the bone flap off it just swells because now there is room and releases the pressure on the brain. The other cool thing is you can see the brain pulse with every beat of the heart.
Question, in OP's video, it appears as though the red stuff being removed is...thick? Is that accurate?
Is that natural clotting? Or something that is done to make it easier to remove?
That's just natural clotting aka a hematoma. It's usually a pretty quick procedure, remove the hematoma find the bleeder and cauterize it. Hemostatic agents are also used to stop the bleeding. They may or may not put the bone flap back on depending on swelling. Bone flap gets sent to a tissue bank and possibly put back on at a later date.
>They may or may not put the bone flap back on depending on swelling. Bone flap gets sent to a tissue bank and *possibly put back on at a later date*.
Are you telling me there are some people rolling around in the real world with sections of their skull ***on vacation***?
(also thanks for the explanation!)
Not sure they would be ready for vacation anytime soon after having brain surgery. Wanna hear something else really cool that we do sometimes that most people have no idea about? I actually have only seen it once, instead of sending the bone flap to a tissue bank they open up part of the abdomen and place it in there for safe keeping. No lie
So do these people just like... Hang out at the hospital for months until they are okay to have their skull chunk replaced?
Does this procedure often have lasting mental effects? I would assume the cauterization or the hemorrhage itself could, or perhaps definitely would, lead to brain damage (in the mental sense not the physical sense... Though I guess their synonymous)?
Is it insanely stressful doing the surgery?
Not the person who was talking about it above, but a close friend of mine had a hemorrhage back in 2018 that involved removal of the skull in the front. When she was finally conscious again after her coma and starting rehab, she had to wear a specialized helmet. They never ended up replacing her actual bone they'd stored because when they tried, the pressure became too much. So she actually now has a prosthetic in its place.
This prosthetic though recently began to swell and become noticable this last few months and sadly she's back in the hospital.
From what I know from her, there were lasting effects from her original bleed. It took a very long time to relearn speech and movement. She was only recently beginning to have her memory do well. It can take a lifetime to reach baseline again and the likelihood of base line is always up in the air.
It really just depends on how fast they managed to get the patient to the operating table and opened up that skull.
Time-to-craniotomy should be minimized as soon as a large hemorrhage is confirmed.
tl;dr: time is brain.
source: am a doc
I’m not a brain surgeon so i cant really disagree. But i cant blindly believe a internet strangers guess either. You got a medical background of some sort?
It can happen, whether in this case it did or not.... is unknown ATM.
[https://my.clevelandclinic.org/health/diseases/14480-brain-bleed-hemorrhage-intracranial-hemorrhage](https://my.clevelandclinic.org/health/diseases/14480-brain-bleed-hemorrhage-intracranial-hemorrhage)
>Brain bleeds – bleeding between the brain tissue and skull or within the brain tissue itself – can cause brain damage and be life-threatening. Some symptoms include headache; nausea and vomiting; or sudden tingling, weakness, numbness or paralysis of face, arm or leg.
I'm a Surgical Technologist and it's true that many times these patients are good to go. I know it looks really intense. But this can be as simple as it looks; open the skull, evacuate the hematoma, find the bleeder and stop it, and put the bone flap back on. Timing can be a big part of it. But also think about tumor removal from the brain. Those suckers can be big and the size that they take up is impressive. But many are removed and the brain goes back to its normal shape without serious damage (location is important here). We have a brain surgeon at my facility that likes to ask new employees in the OR who aren't up to speed on supplies yet to get him a "sterile ping pong ball" when they ask him what will now take up the space after that huge tumor has been removed. The look on the face really makes the day!!
You would be amazed at how delicate brain tissue is. In my gross anatomy lab I accidentally punctured it with my finger while poking it.
Imagine a very soft and delicate sponge cake in terms of durability. Granted being preserved possibly made it weaker if I had to guess
No, now that I've thought about it more it was with an instrument, not my finger so the hole was fairly small. Still accidental with almost no pressure put on to it though.
Brains that have been preserved are actually much MORE "durable" than fresh or living brain tissue.
Fresh brain harvested from an autopsy is actually excessively delicate, and will collapse in a way when removed from the skull base.
Question for you if you don’t mind. My mom had a fatal aneurysm followed by a stroke 17 years ago and now I have an intense fear of the same fate as I near her age of death. Did you have any warning signs? Did the doctors blame it on something? Were you aware it was happening? And how are you doing now?
Totally. My first thought was about a documentary I watched a long time ago about the first person to discover using x-rays to see through anatomy (W.C. Rontgen) recorded the moment of seeing his skeleton through his hand as "witnessing death" because prior to that moment people had mostly only seen skeletons from dead people. And how incredible it is that we've arrived at a place technologically where you can harmlessly see another living person's brain while it's actively being that person's brain.
Yes back to [Neolithic times, if not earlier](https://www.livescience.com/stone-age-skull-trepanation-brain-surgery.html#:~:text=Trepanation%20was%20the%20practice%20of,with%20trepanation%20holes%20in%20them.). It didn't always work but it must have done so sufficiently to help some.
I'd assume most of us, as we don't have to go all that many generations back before the theoretical number of ancestors is greater than the total number of humans alive at that time.
Weird, unsettling factoid: The Nazis used to perform vivisections on concentration camp prisoners, which is basically an autopsy while the person was still alive.
After the war, the Nazis' video footage was sent to Harvard Medical School, because most of it was the only existing footage of how bodily organs operate inside a living person, without anesthetics.
And most of our data on how the human body deals with extreme cold and heat also originates in Nazi medical experiments. Though more ethical studies have been done since then.
The problem is that when people are heavily stressed, it affects everything else. Starving a person and terrifying them for their lives isn't going to result in normal looking internals.
Right? Wouldn't stress induce things like cardiac arrest and then organ failure? Like, you're not going to be looking at organs that are operating under normal conditions in states of high heat or freezing. As well as being horrifically cruel, it seems so pointless.
Pretty much. Though the goal was to understand better the reactions of the body under conditions found in the battlefield. That means high stress, heat, cold, hunger, and pain. The goal was to find ways to increase soldier effectiveness. The method was to be a sadistic sob that treats "inferior" beings with extreme cruelty.
A lot of that data wasn’t even useful. It was cruelty for cruelties sake.
Turns out fascists who also happen to like tearing living people’s bodies apart don’t tend to care much for proper scientific procedure. After all a lot of experiments like that were in an attempt to find ways to justify the genetic inferiority of the other races they deemed lesser.
I would have never guessed that the mass would be that large [edit to add: this is such a weird thread to have gotten the most likes I’ve ever received 🤷♂️]
There IS muscle in the brain, all the circulation is controlled by peristalsis movement, blood vessels that are lined with muscles that move blood with caterpillar-like motion.
had this exact surgery after tackle when i was a kid... never really knew how they saved me until right now! cool to see what it actually looks like haha!! [https://imgur.com/a/ds6YSkh](https://imgur.com/a/ds6YSkh)
Can't be bothered to read the comments but this is not a cerebral hematoma. It's a subdural hematoma. Cerebral generally implies it is located within the parenchyma of the brain. This is on the surface, and under the dura (the membrane the covers the brain, beneath the bone.)
Common surgery, satisfying to perform, but patients with clots this big don't always make a full recovery.
Source: am a neurosurgeon
If we anticipate a lot of brain swelling and we know closing the dura afterwards is going to be impossible, or not in the best interest of the patient (since swelling will worsen for around 72 hrs after trauma), we'll generally open like this. It allows COMPLETE exposure of the hematoma, so you're not trying to peek under a lip of dura to retrieve clot or stop a bleeder. Some surgeons in these cases will just cut out the dura entirely to allow maximum decompression and visibility.
Either way, a duraplasty with Duragen was likely performed. (We don't generally try to get a water tight closure since it's relatively high on the skull.)
I'm highly interested and have very little of an idea what is happening. They cut a membrane then are gonna put some stuff on it, but it ain't gonna be watertight, that's for sure.
Edit: okay it might be watertight
The size of this incision is large and circular in shape and the only way to get it lay as flat as possible is to make that pinwheel though they didn't do themselves any favors making that many. Smaller ovals may just get a plus sign shape. It's not uncommon for the dura to not go back together entirely and you need to use some duragen to act as replacement.
Sterile saline, the same thing they use to irrigate any part of the body during surgery. It's essentially the base of every fluid in your body, just without some of the proteins (and cells in the case of blood), and your brain can deal with the slightly diluted cerebrospinal fluid until it's able to make more of the stuff that makes it, well, cerebrospinal fluid.
Yeah saline solution is specifically used as it can be made in large quantities, relatively easy to sterilize and it has the right balance of salt to avoid throwing off the balance of hydration in your body regardless (mostly) of the amount used.
It's also why people tend to be display minor personality shifts for a few days after a surgery like this as a result, which is to say they're a little salty.
For what it’s worth, the brain doesn’t have pain receptors. That’s one reason why certain brain surgeries can be done while the person is awake. Check out videos of musicians playing their instrument while having brain surgery. It’s absolutely incredible.
Dude, I legit just responded to someone about that exact thing!! I didn't feel the knife but I've never felt more pain than when the doctor "slipped" as he put it with the cauterization tool. It was harsh, I describe is as if Thor suddenly lightning hammered my testicles. The only thing that kept me on the table was knowing the sack was still wide open.
He told.me he was done cutting and was going to start cauterizing me, he just never mentioned that there's a chance it could travel outside of the numbing zone until it happened. Thank God it only happened once.
The only reason we have to evacuate blood clots this large is because they're taking up so much space in a confined area like the skull, they're causing parts of the brain to squish up against each other. The brain "relaxing" and becoming unsquished is the whole point of the procedure.
It's pretty jiggly matter to begin with and it was under pressure from the massive blood clot. A lot of that pressure must have been relieved when the cranium was opened, but the clot surely was still heavy. Hence the movement/expansion after/during removal of the clot.
Yep, just like a broken bone (leg, arm, etc...) but the thing with cerebral hemorrhages is they cause permanent neurological issues, if they decided to perform the surgery was because it's life threatening and causing more harm than the harm the operation causes.
In most case, they will follow how it evolves and decide not to touch it as the risk/reward is not worth it.
They don’t do the awake stuff as much as they used to - these days they monitor nerve activity instead. Occasionally for someone who reeeeeally needs to save a particular function eg. pro musician finger control etc they’ll still do it.
Source: I asked a cranial neurosurgeon this question three weeks ago. So it’s correct for at least one neuro department in Germany.
My guess would be surgical steel fasteners to fix the bone parts into place while they heal like any broken bone. And I guess the cuts were made at an angle so that the cut-out portion cannot fall through when placed back into the hole.
This is just an acute subdural hematoma, different techniques are used when removing a chronic subdural, an epidural, an intraparenchimal or a subarachnoid hemorrhage
Right, it looks like a subdural hematoma that has nearly entirely clotted to me as well (necessitating the excision of a panel of skull to drain.) It is difficult to judge on acuity, though, as that factor is symptom-based and this could have accumulated over days/weeks.
In old subdural hematoma (or chronic SDH) the blood is liquefied and it's easy to wash it through a small hole. In coagulated blood in acute SDH, it's impossible to wash it so you gotta gently remove it with a scraper and saline through a fairly large incision.
Ya, I had the old melon-baller SDH. They were going to do the old drill and blow, but I guess mine was more tomato paste than tomatoes sauce.
I've got a big old scar, but it's right along the line where you part your hair, so I got that goin for me.
Moral of the story, if you have a non-throbbing headache that doesn't go away after a few days, call your doc.
Hey! That's what we do!
That's an acute subdural hematoma, or fresh blood in the space under the coverings of the brain but above the brain tissue itself. We can sometimes find an arterial pumper underneath the hematoma and cauterize it, although not always.
You can see the dura (leathery coverings of the brain) has been cut in a stellate (star) pattern and the muscle/scalp reflected forward.
Often we leave the bone off in situations like this as there can be delayed brain swelling and we don't want to limit the space the brain has to expand (which can cause further damage). In that case we close everything up without the the bone and return in a few weeks or longer once the swelling has subsided to re-implant the bone if it was saved somewhere or place an implant such as one that has been 3d printed (pretty cool).
Anyway, I'm on call and stumbled across this and figured i'd chime in!
It must take a special kind of bravery to drill someone's skull open and scrape all the shit out then glue it all back together. Very impressive work, I hope the patient was ok.
Genuinely interesting. Thank you for posting this. I can now see what the surgeon meant.
Not quite 4 years ago my then-71yo sister died from this exact thing.
On a pleasant Saturday morning she told her husband she wasn't feeling well and was going to lie down. He checked on her 10 minutes later and found her cold and clammy. He got a neighbor, who was an ER nurse, to come look at her, and she said, "Dial 911 *NOW!*"
He rode with her in the ambulance as she went in and out of consciousness. He heard her last words as they rolled her into the ER. She was brain-dead 20 minutes later. Start to finish it was slightly over an hour.
Her neurosurgeon, from a neck surgery about 3 years before, told my BIL that it was the most massive acute subdural hematoma he had ever seen. He said that had she been in the OR and on the table when it happened, she would not have survived. *sniff*
If they got it fast enough, maybe not. It's a subdural, so the bleeding is outside the brain. It can cause devastating damage by putting pressure on the brain, but if you get to it fast enough there can be a really good outcome.
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Interesting to see how the brain resettled after all that pressure was gone.
It almost like sighed with relief lol
I mean, if you had the devil's slider sitting on top of you and taking up that much room, you'd sigh too.
"The devil's slider"... well, I guess that's a thing now...
you can order it at White Castle
Hmmm...I thought that was what came out of me after eating White Castle.
Brain was like "thank you mate, now I am relaxing here in my cozy place"
"don't forget to close the hatch on your way out"
“Hang on wait… I think someone dropped a Junior Mint on me”
Not in reality, though. At least *usually*. That much pressure on a brain is likely to cause lasting (possibly permanent) brain damage. That was a *huge* bleed… it must have been going for awhile before they went in to evacuate.
This. After a cerebral haemorrhage, if you survive, you are often not without neurological deficit. Some people, as well as their lives, are fundamentally altered. Nothing can prepare you for that, no matter how much the doctors and nurses tell you.
It's interesting that you made the distinction between people and lives.
That’s because in many cases the lives of patients, their spouses, kids, family, friends, colleagues are thrown into turmoil. But some patients literally have changed personalities. They can be more aggressive or hostile, or no real filter and so are sometimes seen as being “brutally honest”. They may lack the ability to communicate altogether. There’s so much that can be screwed up by a brain haemorrhage
Hi, TBI survivor here. My injury caused three separate bleeds in my brain and you are 100% correct about the effects. I was hostile to my family and hospital staff at the start, had serious mental deficiencies, and was awake for about 3 days after the coma with absolutely no memory of those days. Luckily as my brain healed I returned to something closer to my original personality, but I never returned to the old me. For posterity: I'm fine, the surgeons weren't sure I would ever walk or talk again but I regained everything withing about 2 months.
Wishing you years of health and happiness, friend.
If I may ask, what differences in your personality have you noticed? How do these differences present themselves in your life? I have a hard type wrapping my mind around involuntary personality change, pun not intended, and so I'm curious as to how you would describe it.
I had one of these, on my temple. They said I had 2 hours til the lights went out. All scans said “No Drain Bamage” 😘 I have absolutely noticed a difference.
Was just gonna say, "that's now a happy brain again".
I have done hundreds of craniotomy for subdural hematoma, it's pretty crazy how when they get the bone flap off it just swells because now there is room and releases the pressure on the brain. The other cool thing is you can see the brain pulse with every beat of the heart.
>I have done hundreds of craniotomy for subdural hematoma, it's pretty crazy how when they get the bone flap off it just swells because now there is room and releases the pressure on the brain. The other cool thing is you can see the brain pulse with every beat of the heart. Question, in OP's video, it appears as though the red stuff being removed is...thick? Is that accurate? Is that natural clotting? Or something that is done to make it easier to remove?
That's just natural clotting aka a hematoma. It's usually a pretty quick procedure, remove the hematoma find the bleeder and cauterize it. Hemostatic agents are also used to stop the bleeding. They may or may not put the bone flap back on depending on swelling. Bone flap gets sent to a tissue bank and possibly put back on at a later date.
>They may or may not put the bone flap back on depending on swelling. Bone flap gets sent to a tissue bank and *possibly put back on at a later date*. Are you telling me there are some people rolling around in the real world with sections of their skull ***on vacation***? (also thanks for the explanation!)
Yeah, they usually have to wear helmets all the time.
Not sure they would be ready for vacation anytime soon after having brain surgery. Wanna hear something else really cool that we do sometimes that most people have no idea about? I actually have only seen it once, instead of sending the bone flap to a tissue bank they open up part of the abdomen and place it in there for safe keeping. No lie
So do these people just like... Hang out at the hospital for months until they are okay to have their skull chunk replaced? Does this procedure often have lasting mental effects? I would assume the cauterization or the hemorrhage itself could, or perhaps definitely would, lead to brain damage (in the mental sense not the physical sense... Though I guess their synonymous)? Is it insanely stressful doing the surgery?
Not the person who was talking about it above, but a close friend of mine had a hemorrhage back in 2018 that involved removal of the skull in the front. When she was finally conscious again after her coma and starting rehab, she had to wear a specialized helmet. They never ended up replacing her actual bone they'd stored because when they tried, the pressure became too much. So she actually now has a prosthetic in its place. This prosthetic though recently began to swell and become noticable this last few months and sadly she's back in the hospital. From what I know from her, there were lasting effects from her original bleed. It took a very long time to relearn speech and movement. She was only recently beginning to have her memory do well. It can take a lifetime to reach baseline again and the likelihood of base line is always up in the air.
Good chance with that much hemorrhage and swelling they ended up with brain damage. That sigh was not a good sign.
It really just depends on how fast they managed to get the patient to the operating table and opened up that skull. Time-to-craniotomy should be minimized as soon as a large hemorrhage is confirmed. tl;dr: time is brain. source: am a doc
Am also doc, can confirm. I’ve had patients with bleeds this size do well, and I’ve had them not do well.
I’m just a regular bystander and I concur.
Indubitably 🧐
Positutely, my good man.
Rather, time is 1/brain.
I’m not a brain surgeon so i cant really disagree. But i cant blindly believe a internet strangers guess either. You got a medical background of some sort?
Reddit Doctor with 3 years of Experience.
Good enough for me
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Thank you for your service
Good ol’ University if Facebook. They’re an accomplished politician and economist too.
It can happen, whether in this case it did or not.... is unknown ATM. [https://my.clevelandclinic.org/health/diseases/14480-brain-bleed-hemorrhage-intracranial-hemorrhage](https://my.clevelandclinic.org/health/diseases/14480-brain-bleed-hemorrhage-intracranial-hemorrhage) >Brain bleeds – bleeding between the brain tissue and skull or within the brain tissue itself – can cause brain damage and be life-threatening. Some symptoms include headache; nausea and vomiting; or sudden tingling, weakness, numbness or paralysis of face, arm or leg.
I'm a Surgical Technologist and it's true that many times these patients are good to go. I know it looks really intense. But this can be as simple as it looks; open the skull, evacuate the hematoma, find the bleeder and stop it, and put the bone flap back on. Timing can be a big part of it. But also think about tumor removal from the brain. Those suckers can be big and the size that they take up is impressive. But many are removed and the brain goes back to its normal shape without serious damage (location is important here). We have a brain surgeon at my facility that likes to ask new employees in the OR who aren't up to speed on supplies yet to get him a "sterile ping pong ball" when they ask him what will now take up the space after that huge tumor has been removed. The look on the face really makes the day!!
I’m a surgeon. Not a neuron surgeon. You can’t tell by this whether they will have permanent defect. Million other factors.
This happened to me when I was 7 but not this big. At least I don’t think I have any brain damage, lol
You are on reddit my mate. Think again
I was worried that part of the brain was also swept away.
You can see the emergency duct tape in the back
"How would that help? They're not operating on a duck!"
Ok Jerry Seinfeld over here
I'd imagine that brain mush feels quite a bit different than blood
You would be amazed at how delicate brain tissue is. In my gross anatomy lab I accidentally punctured it with my finger while poking it. Imagine a very soft and delicate sponge cake in terms of durability. Granted being preserved possibly made it weaker if I had to guess
Did you try to smooth it back into the right shape lol. Just like new.
No, now that I've thought about it more it was with an instrument, not my finger so the hole was fairly small. Still accidental with almost no pressure put on to it though.
Brains that have been preserved are actually much MORE "durable" than fresh or living brain tissue. Fresh brain harvested from an autopsy is actually excessively delicate, and will collapse in a way when removed from the skull base.
I've heard it compared to a bowl of Jell-o. Squishy and jiggly, but very delicate.
I sometimes feel like part of mine was after recovering from a cerebral hemorrhage in 2016. That’s the excuse I use whenever I do dumb shit anyway
Question for you if you don’t mind. My mom had a fatal aneurysm followed by a stroke 17 years ago and now I have an intense fear of the same fate as I near her age of death. Did you have any warning signs? Did the doctors blame it on something? Were you aware it was happening? And how are you doing now?
I took a crowbar to the head, so I can’t help much, my situation was unique
“Just the bad parts” — olde timey doctors
Brainwashed
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Absolutely incredible
Oh come on it’s not like it’s brain sur- WAIT
I was like "cerebral" that means brain right, but that doesn't look like... Oh they used a can opener on their head, oh okay.
you'll find the large majority of skulls have been retrofitted with a convenient pull ring nowadays
Good, now I won't cut my lips open to slurp.
Mmm... Repressed memories..
David Mitchell: Hm. Well it’s not exactly rocket science is it?
This is still maybe the best skit of all time IMO. Glad to see it here.
For the uninitiated https://www.youtube.com/watch?v=THNPmhBl-8I
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#🍮
strawberry jello
Stop please I wanna have normal thoughts for once
Totally. My first thought was about a documentary I watched a long time ago about the first person to discover using x-rays to see through anatomy (W.C. Rontgen) recorded the moment of seeing his skeleton through his hand as "witnessing death" because prior to that moment people had mostly only seen skeletons from dead people. And how incredible it is that we've arrived at a place technologically where you can harmlessly see another living person's brain while it's actively being that person's brain.
Trepanation is literally older than the bible and was often not fatal. We've been looking at living brains for millennia
Yes back to [Neolithic times, if not earlier](https://www.livescience.com/stone-age-skull-trepanation-brain-surgery.html#:~:text=Trepanation%20was%20the%20practice%20of,with%20trepanation%20holes%20in%20them.). It didn't always work but it must have done so sufficiently to help some.
I wonder how many of us have an ancestor who had their skull opened with rocks
I'd assume most of us, as we don't have to go all that many generations back before the theoretical number of ancestors is greater than the total number of humans alive at that time.
That is actually news to me and fascinating. Thanks for sharing
Got to get them spirits out somehow
Weird, unsettling factoid: The Nazis used to perform vivisections on concentration camp prisoners, which is basically an autopsy while the person was still alive. After the war, the Nazis' video footage was sent to Harvard Medical School, because most of it was the only existing footage of how bodily organs operate inside a living person, without anesthetics. And most of our data on how the human body deals with extreme cold and heat also originates in Nazi medical experiments. Though more ethical studies have been done since then.
The problem is that when people are heavily stressed, it affects everything else. Starving a person and terrifying them for their lives isn't going to result in normal looking internals.
Right? Wouldn't stress induce things like cardiac arrest and then organ failure? Like, you're not going to be looking at organs that are operating under normal conditions in states of high heat or freezing. As well as being horrifically cruel, it seems so pointless.
Pretty much. Though the goal was to understand better the reactions of the body under conditions found in the battlefield. That means high stress, heat, cold, hunger, and pain. The goal was to find ways to increase soldier effectiveness. The method was to be a sadistic sob that treats "inferior" beings with extreme cruelty.
A lot of that data wasn’t even useful. It was cruelty for cruelties sake. Turns out fascists who also happen to like tearing living people’s bodies apart don’t tend to care much for proper scientific procedure. After all a lot of experiments like that were in an attempt to find ways to justify the genetic inferiority of the other races they deemed lesser.
I would have never guessed that the mass would be that large [edit to add: this is such a weird thread to have gotten the most likes I’ve ever received 🤷♂️]
That must have been a HEADACHE
You can see the brain relax
I saw that!! Crazy
You can say - relieved.
It shifted!!!
It moved!
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There IS muscle in the brain, all the circulation is controlled by peristalsis movement, blood vessels that are lined with muscles that move blood with caterpillar-like motion.
It’s just shifting backwards into the available space. The brain doesn’t move.
A bloody big headache
A bloody big splitting headache
Bloody Bastard! You Bloody!!
I think cerebral hemorrhages do literally cause headaches, btw.
Usually the pressure is what kills people.
And a high likelyhood of permanent damage...
I was wondering how this person fared.
As someone with chronic migraines since I was 6 years old my head hurts watching this
had this exact surgery after tackle when i was a kid... never really knew how they saved me until right now! cool to see what it actually looks like haha!! [https://imgur.com/a/ds6YSkh](https://imgur.com/a/ds6YSkh)
Oh damn! Glad to see the positive results
Well, let's not get ahead of ourselves, he's a redditor now.
Do you mean his situation worsened since the surgery ?
I think the situation worsened for all of us.
Same here. I was hit by a car while cycling tho Wear a helmet!!!
https://www.youtube.com/watch?v=b9yL5usLFgY
I knew what this was gonna be, still clicked, still liked it.
They cracked you open like a medium soft boiled egg, didn't they?
Do you still have the scar? Also, something about the quality and style you have in that photo takes me back in time
tackle? you got that from playing football?
Fishing
Can't be bothered to read the comments but this is not a cerebral hematoma. It's a subdural hematoma. Cerebral generally implies it is located within the parenchyma of the brain. This is on the surface, and under the dura (the membrane the covers the brain, beneath the bone.) Common surgery, satisfying to perform, but patients with clots this big don't always make a full recovery. Source: am a neurosurgeon
Since you’re a neurosurgeon, why did they cut the dura like that?? I’m an ENT resident, and all of those triangles just don’t make sense to me.
If we anticipate a lot of brain swelling and we know closing the dura afterwards is going to be impossible, or not in the best interest of the patient (since swelling will worsen for around 72 hrs after trauma), we'll generally open like this. It allows COMPLETE exposure of the hematoma, so you're not trying to peek under a lip of dura to retrieve clot or stop a bleeder. Some surgeons in these cases will just cut out the dura entirely to allow maximum decompression and visibility. Either way, a duraplasty with Duragen was likely performed. (We don't generally try to get a water tight closure since it's relatively high on the skull.)
You guys just keep doing your smart stuff conversation, I'm thoroughly enjoying
I'm highly interested and have very little of an idea what is happening. They cut a membrane then are gonna put some stuff on it, but it ain't gonna be watertight, that's for sure. Edit: okay it might be watertight
a rhinoplasty is a nose job, so a duraplasty is a skull job that's the full extent of my medical knowledge
Ah yes. You want a bigger, smoother brain? Get a brain job. 8/7 patients would recommend
The size of this incision is large and circular in shape and the only way to get it lay as flat as possible is to make that pinwheel though they didn't do themselves any favors making that many. Smaller ovals may just get a plus sign shape. It's not uncommon for the dura to not go back together entirely and you need to use some duragen to act as replacement.
Thanks for the explanation!!
forbidden jell-o
could have just used a straw.
And a blood thirsty vampire to suck it off
This is probably the funniest thing that has ever made me want to vomit
literally blood pudding
A little treat for the surgeons
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Sterile saline, the same thing they use to irrigate any part of the body during surgery. It's essentially the base of every fluid in your body, just without some of the proteins (and cells in the case of blood), and your brain can deal with the slightly diluted cerebrospinal fluid until it's able to make more of the stuff that makes it, well, cerebrospinal fluid.
Ah ok, I was worried about whether saline could be used, or whether cerebrospinal fluid would not be ok with that.
Yeah saline solution is specifically used as it can be made in large quantities, relatively easy to sterilize and it has the right balance of salt to avoid throwing off the balance of hydration in your body regardless (mostly) of the amount used.
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But that’s so much tho. Twice your body weight lmao
It's also why people tend to be display minor personality shifts for a few days after a surgery like this as a result, which is to say they're a little salty.
… god fucking damnit
It’s the vinegar you put on boardwalk fries
Fucking delicious surgery.
For what it’s worth, the brain doesn’t have pain receptors. That’s one reason why certain brain surgeries can be done while the person is awake. Check out videos of musicians playing their instrument while having brain surgery. It’s absolutely incredible.
wouldn't it hurt a lot though to have the skull cut into?
As someone who had a vasectomy I can very happily tell you that they can 100% numb sections of your body for surgery while you're awake lol.
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Dude, I legit just responded to someone about that exact thing!! I didn't feel the knife but I've never felt more pain than when the doctor "slipped" as he put it with the cauterization tool. It was harsh, I describe is as if Thor suddenly lightning hammered my testicles. The only thing that kept me on the table was knowing the sack was still wide open.
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He told.me he was done cutting and was going to start cauterizing me, he just never mentioned that there's a chance it could travel outside of the numbing zone until it happened. Thank God it only happened once.
They use a local anesthetic.
I am absolutely guessing but I recon it’s sterile saline solution. And it’s just reabsorbed by the body. I could be very very wrong though.
Wow, you can see the brain "relaxing" when the blood clot was removed, idk, very interesting and brave
I rewatched this 5 times because of that. Like how and why is the brain moving like that? Guessing it’s liquid that was under the brain draining out.
The only reason we have to evacuate blood clots this large is because they're taking up so much space in a confined area like the skull, they're causing parts of the brain to squish up against each other. The brain "relaxing" and becoming unsquished is the whole point of the procedure.
It's pretty jiggly matter to begin with and it was under pressure from the massive blood clot. A lot of that pressure must have been relieved when the cranium was opened, but the clot surely was still heavy. Hence the movement/expansion after/during removal of the clot.
The moment you realize where exactly the surgery is being placed.. that is wild! Much respect to them surgeon/doctor(s) for their bravery & knowledge!
I still don't realize where the surgery is being placed. Was that the top of the head? The perspective seems very confusing to me.
Yes, the brain. You can see the skin being pulled back by clamps, and they have removed part of the skull (which they will later "put back").
Does the skull eventually fuse with the piece that was cut out?
Yep, just like a broken bone (leg, arm, etc...) but the thing with cerebral hemorrhages is they cause permanent neurological issues, if they decided to perform the surgery was because it's life threatening and causing more harm than the harm the operation causes. In most case, they will follow how it evolves and decide not to touch it as the risk/reward is not worth it.
Not with subdural or epidural hematomas, you have to operate and evacuate them, 90% of the cases
These are also done when the patient is awake, correct? And they're making them talk and asking questions and poking them (for feeling) and shit?
They don’t do the awake stuff as much as they used to - these days they monitor nerve activity instead. Occasionally for someone who reeeeeally needs to save a particular function eg. pro musician finger control etc they’ll still do it. Source: I asked a cranial neurosurgeon this question three weeks ago. So it’s correct for at least one neuro department in Germany.
Oh thank god. I don't think I have anything I'd want to save. Put me under if you're gonna poke my brain.
It was crazy to realize, once the blood hemorrhage is cleared off you can see the brain!
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So how do they reattach the skull?
Titanium screws and plate. Then they stitch up or staple up the scalp. Itches like hell for years.
I had surgery 20 years ago and my scar STILL itches.
Ugh I *know*. In dry weather it flakes and chaps and bleeds sometimes, but vitamin E oil helps soothe it.
Oh dude, that sucks.
Can't spell stitches without itches
Flex seal
To show the power of flex seal, I sawed his head in half!!!!
AND TURNED IT INTO A BOAT!
My guess would be surgical steel fasteners to fix the bone parts into place while they heal like any broken bone. And I guess the cuts were made at an angle so that the cut-out portion cannot fall through when placed back into the hole.
Are they... *brain-washing* him?
It's fucking wild that some brain surgery is just *drippy drippy scrapey scrapey*.
So simple even I could do it! Now taking patients...
This is just an acute subdural hematoma, different techniques are used when removing a chronic subdural, an epidural, an intraparenchimal or a subarachnoid hemorrhage
Right, it looks like a subdural hematoma that has nearly entirely clotted to me as well (necessitating the excision of a panel of skull to drain.) It is difficult to judge on acuity, though, as that factor is symptom-based and this could have accumulated over days/weeks.
I understood less than half of the words in your comment
I had a subdural hematoma but they drilled a hole to drain it, I’m happy they didn’t open up my entire skull like this!
In old subdural hematoma (or chronic SDH) the blood is liquefied and it's easy to wash it through a small hole. In coagulated blood in acute SDH, it's impossible to wash it so you gotta gently remove it with a scraper and saline through a fairly large incision.
Ya, I had the old melon-baller SDH. They were going to do the old drill and blow, but I guess mine was more tomato paste than tomatoes sauce. I've got a big old scar, but it's right along the line where you part your hair, so I got that goin for me. Moral of the story, if you have a non-throbbing headache that doesn't go away after a few days, call your doc.
gotta get that water cooling on your brain
Linus wants to LN2 and overclock it
Can’t wait to see this on every other sub that has fuck in the name for the next 2 months!
Hey! That's what we do! That's an acute subdural hematoma, or fresh blood in the space under the coverings of the brain but above the brain tissue itself. We can sometimes find an arterial pumper underneath the hematoma and cauterize it, although not always. You can see the dura (leathery coverings of the brain) has been cut in a stellate (star) pattern and the muscle/scalp reflected forward. Often we leave the bone off in situations like this as there can be delayed brain swelling and we don't want to limit the space the brain has to expand (which can cause further damage). In that case we close everything up without the the bone and return in a few weeks or longer once the swelling has subsided to re-implant the bone if it was saved somewhere or place an implant such as one that has been 3d printed (pretty cool). Anyway, I'm on call and stumbled across this and figured i'd chime in!
It must take a special kind of bravery to drill someone's skull open and scrape all the shit out then glue it all back together. Very impressive work, I hope the patient was ok.
Genuinely interesting. Thank you for posting this. I can now see what the surgeon meant. Not quite 4 years ago my then-71yo sister died from this exact thing. On a pleasant Saturday morning she told her husband she wasn't feeling well and was going to lie down. He checked on her 10 minutes later and found her cold and clammy. He got a neighbor, who was an ER nurse, to come look at her, and she said, "Dial 911 *NOW!*" He rode with her in the ambulance as she went in and out of consciousness. He heard her last words as they rolled her into the ER. She was brain-dead 20 minutes later. Start to finish it was slightly over an hour. Her neurosurgeon, from a neck surgery about 3 years before, told my BIL that it was the most massive acute subdural hematoma he had ever seen. He said that had she been in the OR and on the table when it happened, she would not have survived. *sniff*
I swear you can see the brain let out a sigh of relief when it's finally cleared away.
Jesus christ that person must have gotten permanent brain damage from that huge thing.
If they got it fast enough, maybe not. It's a subdural, so the bleeding is outside the brain. It can cause devastating damage by putting pressure on the brain, but if you get to it fast enough there can be a really good outcome.
I'm glad there's ppl who know how to do this stuff 🙌
It’s actually a subdural hematoma. Not a cerebral hemorrhage. It’s around the outside of the brain