The Brain Surgery Experience

Into The Void

Stuff floats. The surgeon is using water to flush out some of the dermoid cyst material that has been broken loose.

Obviously, I can’t provide a firsthand account of what happened while I was under. Word on the street though, was that it took between eight and nine hours. I think a significant amount of that time was spent loading data from the brain lab into “the system.”

The plan was to perform the endoscopic surgery on the colloid cyst in the third ventricle first. I believe the bicoronal incision was made prior to the small burr hole (4-5mm I believe) for the endoscope. Normally, for endoscopic surgery a large incision isn’t necessary. That’s one of its advantages. But since they needed to do it for the craniotomy they got some of the dirty work out of the way up front.

Now the data is loaded and the endscope is in my head. The surgeon watches a screen while manipulating the endoscope and he begins to “fenestrate” the membrane of the cyst. The endoscope has a bunch of fiber optics that provide the images. (Again, I completely don’t know what I’m talking about so take my account for what it’s worth.) Then, using one of the other “channels” in the endoscope he sucks out some of the cyst’s viscous mucous-like material. For reasons that I don’t know he was only able to get about half of the cyst without putting me in too much danger. I believe this part of the surgery took about an hour, maybe two. Apparently the set up took almost an hour in addition to the actual surgery.

As you can see from the videos and images on this site it ain’t easy to see what you’re doing through the endoscope. Each of the colored dots in the images is actually one of the fiber optics.

Then came the head cracking. I’m not sure, but I think they use a small electric saw to cut through the skull. I believe as much as two thirds of my forehead skull going pretty high up was removed.

With that pesky skull out of the way the doctor could get a good look at what he had to do. He is looking through some sort of binocular set up. Though this surgery had fewer risks it took a long time, four to five hours I believe. It still amazes me that these surgeons can just go into the brain and move things around without too much havoc. The images and videos on this site tell the story best, but the cyst was wearing through the top of my brain. I asked the doctor “do they ever wear all the way through the brain?” He replied “yes, and they’re easier to find when that happens.”

The surgeon began cutting into the brain and then started removing the cyst. Some of this was done with a small suction tube. At one point, as you can see in the video on this site he also used water to flush out pieces of the dermoid cyst. As the pieces floated to the top he would pluck them out with some tweezer-like instrument.

Covering the brain with a sponge to protect the exposed area while surgery continues. The movie shows a lot of digging to remove the dermoid cyst.

This digging through my brain and removing pieces went on until he eventually went through a nasal cavity and arrived at the back of my nose. The bone there was perforated and I believe the cyst was also stubbornly attached. In the videos you can see him cutting and cauterizing with the blue-sleeved tongs as he removes the last few pieces. Then he had to seal the bone to keep fluids from just leaking out my nose. Ugh.

The part of this story I haven’t mentioned yet is that I was born with at least the dermoid cyst and probably the colloid cyst. While I was in utero, my skull plates were forming and they pinched the outer layer of my brain covering, the dura. At early age it was known that I had cyst below the surface of the bridge of my nose. I also had a large congenital pore on the tip of my nose that often released puss as a result of the cyst. When I was seven I had surgery to remove this cyst. Because puss was again coming out of the tip of nose when it was squeezed I returned to the same plastic surgeons when I was 31. They again removed the cyst, and another small piece in a follow-up soon after. They also tried to fill the dent on the tip of my nose. The pore is gone, but the dent has returned slightly.

It turns out that this cyst was just the other side of the dermoid that continued to grow in my brain. Given my history my brain surgeons were suprised that the cyst on the inside of my skull hadn’t been discovered before. From a timing standpoint in my life I’m glad everything worked out the way it has.

(The second video of the dermoid cyst removal.)