Oh goodness - it was a long week, but a good week. Despite a couple rough moments, the last couple days have been pretty good. I got to see an encephalocele repair yesterday. It wasn't that cool to watch because it was all endoscopic (through the nose with a little camera) but it is an interesting condition. Basically it is when a piece of brain herniates through a broken or dessicated bone in the skull. The herniated part becomes necrotic (dies) and sometimes the layers surrounding the brain can have a tear and leak cerebrospinal fluid into the nose or mouth. This patient had a tear in one of her sinuses, so she was have symptoms of chronic sinusitis for months until an ENT thought to check the type of fluid coming from her nose.
Today I watched a cranioplasty, which is when they place a bone flap or mesh matrix to cover the brain where a piece of the skull has been removed. When patients have brain bleeds pressure builds up quickly within the skull compressing the brain which can lead to permanent neurological damage and even death. To treat it the neurosurgeons will often remove a flap of bone in a procedure called a craniectomy. If the bleeding is not localized to one area where it can be easily removed, the flap is left off and the scalp is closed. They do this to allow the pressure to remain low. Eventually (months to years later) they will replace the bone flap, which has been stored in a sterile freezer for the patient. So this patient had a craniectomy decades ago and had a defect in her skull where the bone flap was never replaced. Since she had no protection over a portion of her brain, she was at a high risk for traumatic brain injury from even the slightest head injury. The surgeon cut down to the brain, exposing the edges of the bone that was still present, placed the mesh and screwed it into the skull, then closed her head up. One of the coolest things about this case was that you could see her scalp pulsating where the bone was missing.
This week was better than last because I actually feel like I know a little more about what's going on and what is expected of me. Also I've been getting to know the residents a little more and they seem to be warming up to us. Two of the med students I've been working with are moving on to a 2 week neurology rotation and me and a 3rd year are continuing. I've been pretty lucky to work with some great med students. The four of us got along really well which made the long days more bearable. We should be getting a new med student Monday which will be cool.
And to top everything off, I got off before 5 today and made it home at a reasonable hour :) Now I'm going to spend some time with my favorite person in the world this weekend and try to get some things done around the house. Perhaps I'll finally make this banana bread I've been planning to make for a couple weeks...