Week of February 1, 1999The show begins with Dr. Elizabeth Tancred, a senior lecturer in the school of anatomy at the University of New South Wales and the co-developer of an interactive CD-ROM called Brainstorm. Brainstorm is widely used in medical schools to educate students about both the gross (visible with the naked eye) and minute features of the brain. Dr. Tancred developed the program in light of her own frustrations-- here humorously described-- working with brains in laboratory settings.
For more information about Brainstorm, you can contact Mosby, its distributor, at 1-800-426-4545. You can also learn more about Brainstorm from Stanford University, where it was developed.
Next, Dr. Goodwin hosts two prominent neurosurgeons, Dr. Leonard Cerullo and Dr. Eugene Flamm. Dr. Cerullo is the founder and medical director of the Chicago Institute of Neurosurgery and Neuroresearch, based at Columbus Hospital in Chicago. Dr. Flamm is co-chair of the department of neurosurgery at Beth Israel Medical Center in New York City.
Dr. Flamm begins by telling us that the history of brain surgery dates back to prehistoric times. Skulls have been found with man-made holes, although we don't know for what purposes the holes were made. By the time of the Renaissance in Europe, doctors knew how to remove blood clots from the brain. But it wasn't until the eighteenth century that doctors began to make the connections between external symptoms and the need for surgery.
The doctors discuss 'stereotactic radio surgery'--the name for methods of brain surgery that deliver high dosages of ionizing radiation to a very confined area in the brain. An external frame is placed on the outside of the skull and used in conjunction with scanning technology like MRI or CAT to 'zero in' on the target area within the brain.
Dr. Goodwin asks whether the surrounding tissue can be protected from radiation when, for instance, a tumor is deep in the brain. Dr. Cerullo explains that many hundreds of weak beams are used, all passing through different areas of the brain, and the beams then converge on the targeted problem area.
The doctors explain how new scanning techniques have made the process of surgery much easier. Before, they used atlases of the brain, which were essentially models drawn from autopsied brains. Now they can take account of the individual variation in size and location of structures in the brain and consequently be more confident about where they are in the brain.
Dr. Flamm talks about his own sub-specialty of 'cerebral protection'. One of the problems in doing brain surgery is that the brain can only tolerate disruptions in blood or fluid flow for so long. People who experience some paralysis or weakness on one side after brain surgery are probably responding to this kind of disruption. He's working on ways to safely get around this kind of constraint.
Dr. Goodwin asks what it is like emotionally to be a brain surgeon. Both guests agree that the challenges come in dealing with patients before and after surgery--preparing them for the invasive process, making sure they understand the risks, helping them cope with less than optimal outcomes--for example when most but not all of a cancerous tumor can be removed. Dr. Flamm comments that patients now are more aware than they used to be of what is involved in these surgeries.
Dr. Goodwin takes a call from Davvy in Chicago, whose young niece died in 1974 of a type of tumor called a brainstem glioma. She wants to know whether there has been progress since then.
Dr. Cerullo explains that it depends on the grade of the tumor. There's been progress in surgery and decompression of gliomas, but they are an under-researched area. Dr. Flamm says that are monitoring techniques have improved with this kind of tumor but concurs that we need to learn much more.
An interesting point arises when Dr. Goodwin asks broadly how the doctors decide when to recommend surgery. Dr. Flamm explains how more widespread use of MRI scans allows doctors to find problems before patients actually manifest symptoms. Then, given the risks of surgery, they must decide whether to intervene or not. It depends on the natural history of the type of problem--an aneurysm, for example, can be so potentially dangerous that surgery will probably be recommended, versus a meningioma, a type of tumor that and may sometimes be left alone for a while.
Dr. Cerullo agrees and adds that this comes up often in spinal surgery, where X-Rays often look much worse than the patient actually feels. He says he treats people, not x-rays. Sometimes it is better to be conservative and not recommend surgery if there are no symptoms.
Dr. Goodwin takes another caller--Irene from St. Louis, who has a brain tumor and has opted to forgo surgery, at least for now, because of the risks. Dr. Cerullo says that since Irene's tumor can be monitored with scans and neurological exams, her approach makes sense. Dr. Goodwin adds that, speaking as a psychiatrist, Irene's positive attitude and sense of control are important in her healing process. Both doctors say that new treatments for her type of problem are being developed nearly every day.
For more information about the Chicago Institute of Neurosurgery and Neuroresearch, you can call 1-800-411-CINN, or visit their Web site. Dr. Cerullo also recommends two books, The New Explorers by Bill Curtis and Vital Signs by Dennis Breo.
Dr. Flamm's office number is 212-870-7962. He recommends A History of Neurosurgery in its Scientific and Professional Contexts, published by the American Association of Neurological Surgery, for those who want to know more.
Next--a look inside the operating room with reporter Deirdre Kennedy. She sits in on an operation at Stanford Medical Center using a new device--the Guideline System 3000--which actually guides surgeons using the sounds of synapses firing in the brain. The surgery is similar to the stereotactic surgery discussed earlier, and you'll gain insight into the tremendous responsibilities faced by the surgeons who work with the brain.
For more information about the Guideline System 3000, you can contact Geoffrey Powell of Axon Instruments, its maker, at 650-571-9400.
Next Dr. Goodwin interviews a pioneer in the area of split-brain research, Dr. Michael Gazzaniga. Dr. Gazzaniga is the head of the Center for Cognitive Neuroscience at Dartmouth College and editor of the Journal of Cognitive Neuroscience. He has written about his work in Scientific American magazine.
Dr. Gazzaniga explains that people with 'split' brains have actually had a part of the brain--a network of fibers known as the corpus callosum, which sends signals between the right and left hemispheres of the brain--severed. This surgical procedure was and is still done to help certain people with epilepsy, when the condition cannot be controlled by anti-convulsant medication or when seizures are not originating from one particular part of the brain.
After surgery these people aren't different from anyone else in any obvious way--but there are important changes in their brains that reveal themselves when examined by researchers. For example, people who were briefly flashed images to their left side, which is controlled by the right hemisphere, said they hadn't seen anything. But they could point to the objects they had seen. The right brain had seen the pictures but the left brain, which is dominant for language and speech, didn't know about it.
Some people who are born with a similar condition learn to compensate for it--their brain essentially 'rewires' itself to make up for the lack of communication between hemispheres.
Dr. Gazzaniga distinguishes scientific discoveries from some of the popular notions of "left-brained" and "right-brained" people. In all normal people, both sides are functioning in tandem, and to call someone one or another is really just shorthand for describing their personality--are they analytical and verbal, or less so?
In general, split-brain studies are intriguing for what they reveal about the evolution of the brain. The degree of lateralization, or specialization on each side, in humans is much higher than in monkeys or apes. The two hemispheres may also control memory in different ways. Researchers now suspect that the left brain, which is repsonsible for problem-solving, also creates interpretive narratives and tries to fit things into context. Thus, it can create false memories that seem to make sense or 'ring true'. The right brain, on the other hand, while in some ways more limited, may be more reliable. It gives back the input it's fed.
Dr. Gazzaniga and Dr. Goodwin also discuss the importance of clincial medicine for generating scientific ideas and how a debt of gratitude is owed those with split brains who have voluntarily become long-term research subjects.
You can reach Dr. Gazzaniga at the Dartmouth Center for Cognitive Neuroscience, 603-646-1180, 6162 Silsby Hall, Hanover, NH 03755-3547. He is the author of several books including The Mind's Past and Nature's Mind.
Finally, MSNBC's John Hockenberry offers his thoughts on brain surgery, which he defines more broadly than do our specialists.
