r/interestingasfuck Jan 22 '22 Wholesome 22 Wearing is Caring 1 Today I Learned 1 Silver 15 Gold 1 Helpful 39

How a craniectomy is performed to remove a tumor from the brain. /r/ALL

72.5k Upvotes

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2.6k

u/Blujeanstraveler Jan 22 '22 Masterpiece

A craniectomy is a surgical procedure that is very similar to a craniotomy, but with one key difference. After a craniectomy, the bone fragment is not immediately put back into place.

This approach may be taken if there is significant swelling in the brain and a surgeon deems it necessary to relieve pressure within the skull.

The bone fragment is typically kept so that it can be put back into place during a future surgery, although it may also be discarded in favor of a future reconstruction using an artificial bone.

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u/JamesthePuppy Jan 22 '22

Amongst the many inaccuracies in this video, the craniotomy/craniectomy one bothered me most. I’m glad someone pointed it out.

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u/wokeupquick2 Jan 23 '22

To be fair, that was an inaccuracy in OPs title, not the video.

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u/JamesthePuppy Jan 23 '22

This is very fair, true. The video has many other issues in itself, but I wrongly assumed OP was responsible for the content of the post (title and video) as a whole

158

u/Recovid Jan 23 '22 Helpful

Ok now you need to say the inaccuracies of the video so I don't look like an idiot if I ever perform a craniotomy

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u/JamesthePuppy Jan 23 '22 edited Jan 23 '22

Re-COVID? I dunno if I want you anywhere near my brain at this point in the pandemic…

I complained elsewhere about how even encapsulated tumours don’t usually just slip out cleanly like that (vascular attachment, adhesions, necrosis). Why was the whole left cerebellum marked as a tumour? What sort of midline shift would excision cause, then? How was the incision site in the cortex determined without EMG or evoked potentials? The surgeon didn’t suture the dura before applying the patch, the bone flap needs to be reattached with plates and screws, where is the transverse sinus in this video and how is it okay to cut through it, and why was a laminectomy done when the brain shouldn’t herniate downwards?

Edit: sagittal confluens, sagittal sinus, and transverse sinus. I’m very open to being told I’m wrong or missed things. I’m definitely far from an expert in these things

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u/[deleted] Jan 22 '22

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u/JamesthePuppy Jan 22 '22

You still have the option of a seeded scaffold autograft, which can get around the possibility of bone flap necrosis and infection. I’m sorry about the extended recovery and repeat surgeries – chiari malformations are challenging

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u/[deleted] Jan 22 '22

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u/JamesthePuppy Jan 22 '22

I’m really glad the incision recovered without infection :) I hope the headaches have resolved in turn too. Sometimes tight sutures can make it feel inflamed and lumpy. Dissolvable sutures can also encourage keloids that feel lumpy

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u/[deleted] Jan 22 '22

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u/Duffy189 Jan 22 '22 Helpful Wholesome

What about the bone they cut that goes horizontal?

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u/TheCaIifornian Jan 22 '22 Silver Gold Helpful Wholesome All-Seeing Upvote Starry Big Brain Time Shocked Bless Up (Pro)

That’s the Lamina of C1 (The Atlas). It’s okay for it to be removed and not replaced. We often remove the lamina (Laminectomy) to create more space for the spinal cord when there is a narrowing (stenosis) of the spinal canal which is causing issues with the spinal cord (think how your arm or leg falls asleep if you constrict it - but with your spinal cord). This can be done at any level of the spine - and is often accompanied by a fusion where we use screws, and rods to maintain the integrity of the spine - but a fusion is not always necessary. We could even use that piece of bone that is removed, and place it back with little plates, and screws (Lamioplasty), but it’s not always necessary. In this situation it can be beneficial to keep that C1 lamina off in case there is brain swelling from the surgery.

2.1k

u/end-o-t-w Jan 22 '22

Thank you for your answer

Interesting how you have to scroll through dozens of "funny" joke comments and yet this one has so few upvotes even though its a perfect explanation to the original question

438

u/Any_Mulberry_2435 Jan 22 '22

It barely has more votes than "fuck that bone in particular". O reddit sometimes you scare me

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u/blackjebus100 Jan 22 '22

It didn't used to be like this. Years ago whenever something obscure or unique was posted, almost always the top comment was somebody with knowledge on the matter explaining what it was (i.e. Unidan for those of you who remember him), and now this place is just a shell of itself.

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u/dirtywater83 Jan 22 '22

If it makes you feel better, I’m popping into the comments for the first time and this is the top one!

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u/Loudergood Jan 22 '22

The first voters and commenters are special.

You’ve got to remember that these are just simple redditors. These are people of the land. The common clay of the new Web. You know… morons.

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u/charlietoday Jan 22 '22 Silver Starry Narwhal Salute

I got halfway through you comment before checking that you weren't u/shittymorph.

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u/TheCaIifornian Jan 22 '22 Silver Gold All-Seeing Upvote Starry Narwhal Salute Bravo Grande!

Haha, I’ll take that as a compliment - I’ve been doing neurosurgery for quite a while, but I can only imagine the kind of damage a spine took when in nineteen ninety eight the undertaker threw mankind off hеll in a cell, and plummeted sixteen feet through an announcer's table.

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u/[deleted] Jan 22 '22

Lmao. Just the other day I was thinking about how I hadn’t seen that on Reddit in awhile.

What do you do? Surgeon, PA, nurse, …?

132

u/TheCaIifornian Jan 22 '22 Starry

Surgeon, and I always enjoy catching a Shittymorph in the wild.

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u/beesgrilledchz Jan 22 '22 Take My Energy Heartwarming

u/shittymorph, get in here. Even neurosurgeons love your work.

That guy’s awesome. Loved his troll and Scooby posts back in the day and his current abandoned dog rescue posts.

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u/Klutzinsky Jan 22 '22

If I may ask: how do you maintain a high enough visibility to operate? Between the different layers of tissu, the small opening, blood spewing all over, your hands in the way and brain parts that look about the same in all area, I can't grasp how you can just do it.

Especially compared to most people having a hard time to move color labeled cables under a desk.

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u/TheCaIifornian Jan 22 '22

We use a microscope.

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u/ImSpacemanSpiff Jan 22 '22

I had a laminectomy of the L4, L5, and S1 a year and change ago due to a few severely herniated discs. Doctor said if I didn't have it done, I'd be paralyzed from the waist down. I've always kinda wondered how much less protection my spinal cord has down there now that those three chunks of bone are gone.

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u/TheCaIifornian Jan 22 '22

The human body is pretty amazing, the bone grows back - just don’t let anyone stab you there.

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u/morning_cup_of_NO Jan 22 '22

I had this exact procedure done on the same disks last week and am sitting here recovering reading your comment. Crazy. Hope you have recovered nicely.

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u/ImSpacemanSpiff Jan 22 '22

Recovery went well! The first month or so stairs were a chore. For a couple/few months bending over and grabbing things from the floor was difficult, but a grabber tool is very worth the $12 on Amazon.

I'm now completely back at full strength and range of motion.

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u/y0family Jan 22 '22

I fucking love reddit. Thank you u/TheCaIifornian

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u/tycr0 Jan 22 '22

Stupid nature.

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u/TheCaIifornian Jan 22 '22 edited Jan 23 '22

Unfortunately, us as humans decided to stand upright a couple of million years before evolution made our spines ready for it.

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u/cedar_of_lebanon Jan 22 '22

What about the drill holes in the skull. Do they get "corked up" ? Lol

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u/redsensei777 Jan 22 '22

I liked that band-aid looking thing right after the tumor was removed. That should make it all better.

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u/Yiptice Jan 22 '22 Silver

as long as its a paw patrol band-aid

162

u/cloversclo Jan 22 '22

I can't buy those any more because my kids find them and put them everywhere, they start adding up after awhile.

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u/kariea1 Jan 22 '22

My kid found my 100 roll of forever stamps. They now decorate her fisher price slide-n-play. I could probably ship it anywhere.

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u/No_Tea5014 Jan 22 '22

OMG. Thank you for the laugh. Former working single mother of three.

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u/tired_gangstrr Jan 22 '22

I feel your pain.

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u/DeeSnow97 Jan 22 '22

Would you like a band-aid on that?

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u/2sedated Jan 22 '22

Only if it’s paw patrol

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u/SparkyMctavish Jan 22 '22

Rubble on the double.

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u/bmp35 Jan 22 '22

Chase is on the case

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u/dabunny21689 Jan 22 '22

No job is too big, no pup is too small.

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u/Alonzzo2 Jan 22 '22

To the lookout!

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u/healthytofu Jan 22 '22 Take My Energy

Brain leaking cerebrospinal fluid after surgery? FLEX TAPE!

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u/Echo_Oscar_Sierra Jan 22 '22

"Now that's a lot of damage!"

The other surgeons: 😧

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u/RVA804guys Jan 22 '22

Dying!!!

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u/Violoner Jan 22 '22

So is the patient

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u/mr_potrzebie Jan 22 '22

Fix a cerebral wound with this one simple trick

Surgeons HATE him!

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u/Incman Jan 22 '22

To show you the healing power of FLEX TAPE Rx, I've sawn this skull in half, and repaired it with only FLEX TAPE Rx!

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u/stunna_cal Jan 22 '22

Can confirm. Band-Aid was first soaked in essential oils for max healing

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u/Dahnlen Jan 22 '22

I think you mean soaked in hyper diluted essential oils. Homeopathy concludes that things with only the tiniest hint of an active ingredient are more effective.

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u/Nebarious Jan 22 '22

Don't be ridiculous, essential oils won't help.

You have to get a very, very small piece of a bonesaw and dilute it in a tincture of water, take that water and dilute it again until it's mathematically impossible a single atom of bonesaw remains, and then apply it directly to the wound.

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u/Dahnlen Jan 22 '22

I think we all know that as long as enough people ask God for healing there’s no need to apply anything at all

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u/GO_RAVENS Jan 22 '22 edited Jan 22 '22

Not even the tiniest amount, that's giving homeopathy too much credit. It's literally none. The level of dilution means it's far more likely that not a single molecule of the original product is present in the final preparation. It's not even quack science. It's just a scam.

a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans"

One-third of a drop of some original substance diluted into all the water on earth would produce a preparation with a concentration of about 13C

A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name Oscillococcinum. As there are only about 1080 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10320 times more atoms to simply have one molecule in the final substance.

There are on the order of 1032 molecules of water in an Olympic-size swimming pool and if such a pool were filled entirely with a 15C homeopathic preparation, to have a 63% chance of consuming at least one molecule of the original substance, one would need to swallow 1% of the volume of such a pool, or roughly 25 metric tonnes of water

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u/TheCaIifornian Jan 22 '22

It’s actually either a special membrane called a “Duragen” that helps regenerate the dura, or protective layer around the brain, or a piece of bovine (cow) pericardium to help seal the opening created in the dura for the surgery.

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u/mortuali Jan 22 '22

It's a patch made of cadaver or bovine pericardium

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u/Enology_FIRE Jan 22 '22

Instructions not clear: skull now contains bovine perineum.

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u/pranasoup Jan 22 '22

perineum lmao

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u/carolizzy81 Jan 22 '22

Not sure I like that better than a band aid. At least you're not dead.

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u/natemace Jan 22 '22

Slap some scotch tape on it

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u/cellphone_blanket Jan 22 '22

I like to think it was duct tape or something like that

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u/serencalon Jan 22 '22

Duck tape. Quacks use duck tape.

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u/greenrangerguy Jan 22 '22

Listen duck if you don't shut up I'm going to tape you to this tree with duck tape and leave you all day stuck.

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u/[deleted] Jan 22 '22

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u/penguiin_ Jan 22 '22

Look at the big man over here bragging with his brain with no tape on it oooOOooo so smert aren’t you

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u/SaltyProcrastinator Jan 22 '22

Give it a little kiss intra-op too before they close

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u/williamwchuang Jan 22 '22

Probably a synthetic graft stitched into the brain membrane.

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u/ChummusJunky Jan 22 '22

I'm having a very rare but necessary surgery that will remove my C1 transverse process bone (due to it blocking my internal jugular vein) and I asked my surgeon what happens when they take the bone out and he's like "I don't know, you can make a necklace out of it".

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u/Morning-Chub Jan 22 '22

It's kinda a necklace right now, in that it's part of your neck.

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u/forlornself Jan 22 '22

Ah yes, returning to our ancestral roots of human bone jewelery.

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u/pseudo__gamer Jan 22 '22 Helpful Wholesome

Give it to the dog

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u/coollilcoffeemug Jan 22 '22

That’s Surgical dog to you

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u/benedictjbreen Jan 22 '22

Dr Dog.

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u/dapoorv Jan 22 '22

Dr Doggie Houser : Sorry your accident was ruff ruff. We had to cut your leg which has mysteriously gone missing ( ͡° ͜ʖ ͡°)

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u/dhstowe Jan 22 '22

Great band

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u/TacoWithFrijoles Jan 22 '22

Good Boi

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u/G33ONER Jan 22 '22

Dr Good Boi

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u/-Numaios- Jan 22 '22

We apparently don't need it. I hope.

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u/lucycolt90 Jan 22 '22

I had a brain decompression surgery for a Chiari malformation and those are the exact words the doctor told me when he removed that exact part

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u/die-squith Jan 22 '22

I'd be like... but that's MY bone. Give it back. Lol

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u/StarGraz3r84 Jan 22 '22

Yeah doc, just put it back in there for God sakes

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u/OleScootsMcGee Jan 22 '22

“Put that thing back where it came from or so help me!”

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u/Usman5432 Jan 22 '22

I remember that musical

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u/TinyTrafficCones Jan 22 '22

It’s a work in progress

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u/hereforthesnarkbb Jan 22 '22

I did too. Did they put your skull back? They didn’t put mine back

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u/Meecus570 Jan 22 '22

Were you also given the nice zigzag cut that is hidden by your hair or a straight line like this one?

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u/lucycolt90 Jan 22 '22

It's straight and it barely left a scar, but at first it looked like a giant zipper and my husband kept calling me a badass so it helped to deal with the insane pain.

Did you know they give you very minimal pain killers after this kind of surgery to make sure neurologically you are ok? I got more morphine when I gave bone marrow then when I had a piece of my spine removed. It goes away fast but omg

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u/Meecus570 Jan 22 '22

I only took one each of the painkillers and muscle relaxers I was given after decompression surgery, they really messed me up so I just took Tylenol.

My scar is zigzagged for the top couple of inches and completely disappears in my inch long hair.

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u/N0T_SURE Jan 22 '22

Did he say the "I hope" part?

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u/theplushpairing Jan 22 '22

Om nom nom… what bone?

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u/Zumbert Jan 22 '22

Perhaps A nice bone broth soup

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u/DoctorRajan Jan 22 '22

Mmmmm just like mama used to make em

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u/FishWash Jan 22 '22

You guys are killing me

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u/annabelle1378 Jan 22 '22

Typically if the bone isn’t needed, it’s just sent off as biohazard waste… but often it’ll be transplanted into a separate part of the body so it’s given a blood supply and kept alive until it can be transplanted back… I’ve had patients with all of the right portion of their skull relocated to their abdomen until their brain healed enough… in this case, the fragment is small, so likely just tossed out.

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u/quippers Jan 22 '22

If I ever need surgery, am I allowed to keep my spare parts?

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u/Condensates Jan 22 '22

I had to have part of my rib removed and I was allowed to keep the rib. But the surgeons acted like I was crazy when I asked to keep it, dunno how I was the first person to ask this

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u/Ravilaaa Jan 22 '22

I’d definitely want to keep something that was surgically removed from my body. Like the girl who kept her amputated foot in her freezer. Maybe not that extreme, but still cool nonetheless.

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u/TikiUSA Jan 22 '22

Is she the one that ate the foot at a dinner party?

Edit: nope, that was a dude who made tacos

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u/shredtilldeth Jan 22 '22

It is your legal right to keep your body parts. Bones especially. Many hospitals will lie to you and say you can't for whatever reason, often they say it's a biohazard. It's all bullshit.

But if you fight them they have to relent. It is the law. I read an article about a girl who kept all her leg bones after she needed it amputated. She had to fight really hard to get it, and also had to pay to get the bones cleaned and such. I'm not going to dig for the article but I'm certain if somebody cares enough Google will pop it up.

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u/AlkalineHound Jan 22 '22 edited Jan 22 '22

Depends. I had to have a kidney stone removed surgically and they wouldn't let me keep it because they had to "test it" to "see what type of stone it was."

Edit: Y'all. I didn't think I needed the /s especially with the next comment I made. It was calcium for anyone wondering.

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u/Cronogato Jan 22 '22

You made it sound like you don’t trust that explanation. What do you think THEY did with YOUR STONE? Damn Illuminati.

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u/Steve0512 Jan 22 '22

Thanks, I pictured a filing cabinet with a Manila folder for each patient holding a sandwich bag with their skull bone in it.

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u/Several-Ad-1195 Jan 22 '22

In certain situations we do a craniotomy and have to wait to put the bone flap back on due to brain swelling. To store the flap we place it in multiple layered sterile containers and then in a freezer dedicated to patient tissue. It can then be safely stored for a short time until reimplantation.

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u/Unfair_Translator_13 Jan 22 '22

Okay but thats pretty cool our bodies are able to do that stuff and we were smart enough to figure it out. Makes ya wonder how many trial and error cases there had to be

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u/quarrelsome_napkin Jan 22 '22

I had this procedure when I was 17 and again at 21. The vertebrae they remove isn't replaced, and the posture of your head/neck is likely to change permanently. In my case, I've noticed I hold my head slightly forward and at a downwards angle, as of looking at the ground-ish. It is what it is.

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u/BigOrkWaaagh Jan 22 '22

They put it back but on the outside so you have a convenient little hook.

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u/Convergent_Series Jan 22 '22 Silver Wholesome

Yeah just tape that shit back up. We’re good to go

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u/Mono_831 Jan 22 '22

Slaps roof of car “This tape will keep any tumors or thoughts from oozing out.”

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u/Derman0524 Jan 22 '22

Gorilla tap’her up!

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u/ebolatron Jan 22 '22

Yeah I wish the closure was that simple. In reality, the "tape" you see here is sewn to the dura in watertight fashion (duraplasty) to keep your CSF from leaking out, +/- followed by replacement of the bone flap, then the fascia, subcutaneous tissue, and skin are individually closed with sutures.

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u/Pozniaky86 Jan 22 '22 Wholesome

Yea I could never be a doctor. Not that it’s disgusting, I’m just really stupid.

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u/shamaze Jan 22 '22 Silver

I'm a doctor and this is still beyond me. (I'm an ER physician). Neurosurgeons are incredible.

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u/LOMOcatVasilii Jan 22 '22

Don't sell yourself short; you read squiggly lines to diagnose ailments, quickly intervene before people die, and use electricity to bring people back from the dead.

All doctors are fucking cool.

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u/bugxbuster Jan 22 '22

and use electricity to bring people back from the dead

That was just Doctor Frankenstein you’re thinking of

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u/TheRavenSayeth Jan 22 '22

I just graduated Med school and I didn’t realize that IM docs apparently have an image of ER docs as being “dumb”. Never heard it before I got on rotations but it still doesn’t make sense to me. Yeah the complexity may not be as much as IM but you definitely need better board scores to get into ER and the range of what you have to handle is so broad.

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u/shamaze Jan 22 '22

Congrats and good luck with residency! (I'm still a resident myself).

ER you need to be well rounded and do well on everything essentially. If I have a more complex case, I'm calling for a consult. That's the issue with specialists. They know their specialty inside and out, but anything beyond that, they don't know.

Many ER physicians consider ourselves experts in only 1 thing, resuscitation.

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u/clyde2003 Jan 22 '22

How did you get through med school without watching Scrubs? They visit that whole rivalry a few times. And also Steak Night.

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u/clinicalia Jan 22 '22

yeah same, i'd get really nervous and next thing i know, i'm looking for a brain tumor in someone's foot

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u/Igituri Jan 22 '22

Doesn't look that hard, I'll give it a whirl.

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u/Igituri Jan 22 '22

Ok, they left out quite a bit, like all this red stuff...

1.5k

u/commendablenotion Jan 22 '22 Silver Helpful Wholesome

Supposed to drain the patient first. Cut the throat and hang them upside down for 4-6 hours.

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u/tacticooluser Jan 22 '22

Oh nope I think you may have just committed a crime

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u/sirpoopingtun Jan 22 '22

What crime? Curing a man of his tumour?

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u/a-d-d-y Jan 22 '22

curing him of life

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u/cellphone_blanket Jan 22 '22

can confirm the cancer has stopped spreading and the cancer cells are now dead. Cancer cured!

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u/The_Brackman Jan 22 '22

The real crime would be to not finish what we started.

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u/sirpoopingtun Jan 22 '22

Truer words have never been said! Now get on the operating table

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u/Bzykk Jan 22 '22

The real crime is the friends we made along the way.

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u/olives82 Jan 22 '22

Curing a tumor of his man

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u/motownexpress Jan 22 '22

That’s one way to kill a tumor

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u/MathisDaBoss Jan 22 '22

You cracked me up :)

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u/Squibblezombie Jan 22 '22

That means you’re doing it right. Keep going and report back.

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u/cuntsaurus Jan 22 '22

For real. The tumor just floats out on its own.

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u/Yvaelle Jan 22 '22

The tumor wants to be free, you need to be ready to catch it or it will go up someone's nose and you have to start all over again.

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u/maaaatttt_Damon Jan 22 '22

It's not exactly Rocket Science, is it?

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u/Consistent_Yam_1442 Jan 22 '22

Bitch left a bone out!

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u/papa_mike2 Jan 22 '22

IKEA always gives you extra pieces, kinda like evolution.

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u/Yvaelle Jan 22 '22 edited Jan 22 '22 Silver

Thats the warranty void if removed bone.

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u/drawpril Jan 22 '22

If you eat it, it goes back to it's place.

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u/clinicalia Jan 22 '22

yeah, if it's so important and smart, it should find its way back to where it needs to be

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u/ElonMuskIsAnAlien_ Jan 22 '22

It takes skill to rebuild something with fewer pieces! I do it all the time

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u/453286971 Jan 22 '22

It’s k it’s not load bearing

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u/Quentin_Funkadelic Jan 22 '22

Neurosurgeon keeping trophies.

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u/xlmagicpants Jan 22 '22

So did the predator

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u/xerrabyte Jan 22 '22

Did they just tape the first layer closed?

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u/clinicalia Jan 22 '22

it's fine, it was gorilla tape, it'll hold

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u/moonkey2 Jan 22 '22

Just flex tape that bitch right up

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u/RevolutionaryCut5210 Jan 22 '22

I wish there was actually someone informed in this area to explain how we survive and function with a bandaid in our skulls and without what seems to be an important bone missing

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u/fxdxmd Jan 22 '22

It is a dura (thick tissue layer covering the brain) graft. Some you stitch in and some you lay over and apply essentially biologic superglue to stimulate healing.

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u/deetdadee Jan 22 '22

That was probably a sheet of amniotic stem cells to promote bone fusion or some other bone fusion promoting synthetic sponge.

Source: I work on these type of products for a spine medical device company

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u/Skorn01 Jan 22 '22

I don’t like how they ended that at all. They just put a bandaid on it, then put the skull and skin back in place. Forget all the tissue they removed and pushed to the side, forget that bone they cut out. The doctors will finish sewing up and see that bone on the plate like “this isn’t from him right? This is from our WingStop order?” And chuck it out.

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u/Angeltear757 Jan 22 '22

I didn't like how the tumor just slid out....like a brain poo.

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u/hizzure Jan 22 '22 Silver

Yeah, this is what happens when you have too much brain fart

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u/PepperbroniFrom2B Jan 22 '22

when you brain fart a little too hard and poo poo comes out!!! (of your brain!!!)

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u/WorldWarPee Jan 22 '22

I can't believe they're still sold out of brain toilet paper

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u/DearLeader420 Jan 22 '22 Helpful Eureka!

They just put a bandaid on it

It’s not a “bandaid,” but almost certainly a piece of biologic material that is grafted on and becomes part of the meningeal membrane.

Then put the skull and skin back in place

Yep. OP called it a “craniectomy,” but this is actually a “craniotomy.” The bone will fuse back together, and the skin of course will heal.

Forget all the tissue they removed and pushed to the side

Soft tissue pushed to the side (“retracted”) like that will scooch back over and heal, just like skin or muscle tears, because that’s all it is.

forget that bone they cut out

That was the lamina of the C1 vertebral segment. You don’t “need” it, and “laminectomies” are a very common spinal procedure.

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u/Formal-Advertising52 Jan 22 '22

This definitely doesn’t show how the closure happens. Closure time is half of the procedure time usually.

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u/Dzjar Jan 22 '22

Gotta take some shortcuts when the end of the shift is approaching.

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u/DocJawbone Jan 22 '22

"alright wrap it up boys, it's karaoke night"

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u/Suolamamma Jan 22 '22

They didn’t even put the skull piece back in me from my compression surgery

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u/DrADHD987 Jan 22 '22

The posterior arch of C1 that they don’t put back in doesn’t need to be placed back in since the muscles inserting in the posterior aspect of C2 provide plenty of support for the region.

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u/BigOrkWaaagh Jan 22 '22

I didn't see any sewing up in the video.

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u/jawnly211 Jan 22 '22

Looks easy enough….

hold my beer

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u/Uhhlaneuh Jan 22 '22

Doctors are amazing people. If you’re a doctor and you’re reading this, you are amazing.

And veterinarians too. They don’t get enough love

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u/Red_P0pRocks Jan 22 '22

I misread that as vegetarians and was very confused

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u/hows-your-mom Jan 22 '22

Pretty cool that when you open the dura matter, that tumor is just itching to come out by it self.

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u/clinicalia Jan 22 '22

it saw the kind stuff that dude was thinkin about, it didnt wanna be in there no more

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u/Glengooliebluu Jan 22 '22

I bet thats the part of the brain where all those songs that get stuck in your head are stored just for you to remember at 3am when youre trying to sleep

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u/catloverMD Jan 22 '22

This is a suboccipital craniotomy. We don’t place the burr holes quite like that due to risk of placing that central one over a large vein. Tumors never come out that easy and usually require quite a bit of mucking about around them before you can pull them out. The skull bone flap is put back in this clip and the part they leave off is the posterior ring of the first cervical vertebra. It’s does not destabilize the spine to leave off and adds nothing to reattach. The “bandaid” is usually a dural patch that is sewn in to prevent csf leaks especially in the posterior fossa. All the tissues layers would have been sewn together in multiple layers. I’ve had multiple attendings say patients should die of vicryl poisoning after closing a suboccipital craniotomy. Decent clip all in all.

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u/sbarnesvta Jan 22 '22

I had this surgery to remove a brain tumor at the end of 2020.

Fun fact there are no pain nerves in your brain so there wasn’t much pain during recovery. At least there was significantly less pain than the headaches leading up to surgery.

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u/Amphibian-Overall Jan 22 '22

r/holup for skipping that bone when the skull was put back into place.

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u/DrADHD987 Jan 22 '22

The posterior arch of C1 that they don’t put back in doesn’t need to be placed back in since the muscles inserting in the posterior aspect of C2 provide plenty of support for the region.

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u/UndeadBuggalo Jan 22 '22 edited Jan 22 '22

My husband has had a surgery similar to this where dermoid cyst is attached to his dura and brain stem and has had the same type of surgery with bone removal just not into the brain. It’s a very hard recovery

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u/coollilcoffeemug Jan 22 '22

Makes it look easy (i obvi know it’s not). What are some complications that can arise or that the surgeon can come across while performing this?

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u/catloverMD Jan 22 '22

Csf leak if the dura is not closed well causing pseudomeningoceles. Infections causing bad meningitis or ventriculitis. Massive bleeding if you getting into a venous sinus. Air embolism if you get into a venous sinus. Paralysis/ ventilator dependence or worse if you damage the high cervical spinal cord or brain stem right below where you’re operating. Hydrocephalus if you get significant post op swelling or post bleeding that can require reoperations, evd placement or shunting. Those are the big ones that come to mind.

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u/Elder_Scrolls_Nerd Jan 22 '22

The dura has the be shut properly, and the brain has lots of blood vessels in it. Not disturbing too much is tough

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u/truphen_newben Jan 22 '22

You forgot to put a piece back

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u/Whiter-White Jan 22 '22

If they forgot it then it wasn't important.

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u/hWOLFGANGs Jan 22 '22

Operation has trained me for this moment

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u/Tykauffman21 Jan 22 '22

Very considerate of the tumor to just plop out once they open that final layer. I guess it knew it was time.

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u/[deleted] Jan 22 '22

This is like that gentle birth clip from earlier.

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u/Electrical-Teaching1 Jan 22 '22

I expected more blood..

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u/Elder_Scrolls_Nerd Jan 22 '22

Well this is a simulation, but real surgeries use a special cutting device that simultaneously cauterizes blood vessels after the epidermis is incised with a scalpel. The brain itself has lots of blood vessels flowing, so that same precision is used to cut it. The area is also constantly getting flushed out to so the surgeon can see what’s happening

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u/pawprintscharles Jan 22 '22

As a neurosurgery PA….”oversimplification” does not even BEGIN to describe this video

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