Far lateral approach neurosurgery: the fourth stage

Our brain surgery live tweet took place 16.11.12 in Astana, Kazakhstan. Neurosurgeon Dr. Evaldas Cesnulis guides us through the operation he led to remove a brain tumour from a 17-year old girl.
Dr. Evaldas Cesnulis is a world-class neurosurgeon based in Zürich, Switzerland. In November 2012, he spent a week in Astana, Kazakhstan with a team of Swiss doctors on a not-for-profit mentoring mission at the top teaching hospital in Kazakhstan. One of the operations he carried out was tweeted on a live Twitter stream: here, you can find a record of the event.

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1. Cystic tumour part is removed

Dr Cesnulis can now approach the cystic part of the tumour: this means it contains liquid and some blood clots. The large fluid-filled part of the tumour is emptied. Once the large fluid filled sack is empty, the brain will relax and will become very slack.

2. Removing the tumour

The edges of the tumour are cut away further, while healthy brain tissue is covered by cotton micropaddies for protection.

The tumour has to be removed in tiny pieces or the brain will be damaged during the removal process. In the pictures above, you can see that part of the tumour has now come free, and this part is removed.

Dr Cesnulis then removes as much of the remaining solid tumour as possible, using an ultrasound suction device to disintegrate it.

This special microsurgery device is actually a machine that emits ultrasound waves from its tip to disintegrate the tissue, as well as providing the suction and also irrigation. This machine allows the surgeon to gently manage the removal of tumour tissue but stops when it reaches the healthy brain.

3. A cavity is left

Above, you can see a picture of the huge cavity that has been left, with some remaining parts of the tumour. The rest of the tumour is now dissected with microsurgical tools, mobilised and removed from the healthy brain tissue.

4. Debulking and double check

The rest of the tumour tissue is moved out the way while healthy brain tissue can be seen underneath. The last tumour tissues are cut away from the healthy brain tissue completely, and the surgeon uses microscissors to remove the blood vessels that feed the tumour.

The healthy motor zone is stripped of any remnants of the tumour and the operation site is double checked for any lingering remains of the tumour. The surgeon can inspect the cavity from various angles using microsurgical mirrors similar to those a dentist would use.

Find out more

This is a summary of our live-tweet operation, which took place on Nov 16th 2012. Click below to learn about the next stage of the operation and to find the answers to some common questions about the procedure or let us know what you think on Twitter @premium_medical
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