Gordon Johnson: Doctor, we’ve talked about specific divisions of the brain but the reality is that the brain is connected throughout the brain and there are networks and there are basic communication methodologies that the brain uses. The core to that is the neuron, is that right? Dr. Erin Bigler: That’s correct. Gordon Johnson: What’s(…)
Gordon Johnson: You have two arms. Dr. Erin Bigler: Yes. Gordon Johnson: And, we had a hard time getting – my elbow would be much more difficult to get in a position than yours. There are a few more neurons than that in the human brain. Dr. Erin Bigler: Well some of the best studies,(…)
Gordon Johnson: Doctor, we talked about the neuron using your arm and fingers as a gross model of it and I want to now turn to what I consider, still another gross of model it, which is the diagram on your computer screen. Show us the same parts that you showed us with your hand(…)
Gordon Johnson: We have a graphic that actually shows the axonal tracts within the brain, is that correct? Dr. Erin Bigler: Yes, we have various tools now from the imaging standpoint that actually allow us to look at what we have to call aggregate tracks. So it’s not the individual tract, it’s uh, a series(…)
Gordon Johnson: Doctor, I want to talk generally about two concepts that are fairly important in the general overview understanding of the brain. The first is the two different hemispheres that there are of the brain, and the second would be the difference between gray matter and white matter. I think on our diagram we(…)
Gordon Johnson: Doctor, we were talking about the interface between the gray matter and the white matter and the distinction between gray matter and white matter in the brain. Is this white matter that we’re looking at now? Dr. Erin Bigler: This is white matter. Gordon Johnson: Can you explain what it is we’re seeing?(…)
Gordon Johnson: There are a number of major fiber tract areas but the one that is most often talked about is the corpus callosum, is that right? Dr. Erin Bigler: Well, it’s the largest and it’s the part of the brain that’s easiest to separate out. Gordon Johnson: And we can see it clearly in(…)
Gordon Johnson: Doctor, I took a few notes on a break of the fasciculus. And I probably said that wrong. But the word is fasciculus, correct? Dr. Erin Bigler: Fasciculus. Gordon Johnson: Fasic, fasis – Dr. Erin Bigler: Fasciculus. Gordon Johnson: Fasciculus. And I won’t say it again. But we have the uncinate fasciculus. Dr.(…)
Gordon Johnson: Doctor, we’ve been talking about the importance of the communication network within the brain, and we talked about the specific fasciculi on our last slide. What we have now is an actual three-dimensional movie of all of those axonal tracts put together. Can you play that movie for us, and kind of explain(…)
Gordon Johnson: Doctor, I’d now like to talk, begin the discussion about, neuropathology. We’re still looking at the DTI image. And perhaps ,as I want to start with severe brain injury and then we’ll go on to mild. perhaps we should change our images or at least our conversation to discussions that are specific to(…)
Gordon Johnson: Let’s talk a minute about the volume of the skull. We go back to the skull. And I always have a challenge putting these back together. There is a certain amount of volume of fluids that can held inside this skull, is that right? Dr. Erin Bigler: That is correct. Gordon Johnson: And(…)
Gordon Johnson: Let’s see if we can take one of our brain models and sort of demonstrate the concept of first of the epidural bleed. Perhaps if we take one of the, the still intact brains. Dr. Erin Bigler: So now this brain doesn’t have a cerebellum, but so an epidural hematoma is occurring on(…)
Gordon Johnson: Now in contrast to that, what we can see of the epidural bleed there can also be a subdural bleed, is that right? Dr. Erin Bigler: That’s correct. Gordon Johnson: Any I images of that you can show us? Dr. Erin Bigler: Well, what, what occurred here though, this was the first scan,(…)
Gordon Johnson: Often times we think about a head injury as beginning with skull fracture. On our image we do have a skull fracture. But skull fracture is not necessarily a catastrophic injury. Dr. Erin Bigler: No. Gordon Johnson: Talk to me about skull fracture. Dr. Erin Bigler: Well, skull fracture may actually absorb some(…)
Gordon Johnson: Doctor, I now would like to talk about what happens with brain swelling, hematomas and the increase of pressure associated with these severe brain injury events. Dr. Erin Bigler: Well, if we look at this case again, this patient has some severe intracranial pressure that’s occurring here, and this was a very significant(…)
Gordon Johnson: Doctor, in order to understand the concepts of what’s really going on with brain swelling and the damage that occurs as a result of increased pressure in the brain, I think it’s helpful if we talk about blood flow in and out of the skull. To do that we’ve got a new model(…)
Gordon Johnson: When there’s a bleed, and if we’re talking about just on the internal brain aspect of it, that blood, basically gets stuck there. There’s no more oxygen, and ultimately that becomes a toxin, is that right? Dr. Erin Bigler: That’s correct. Gordon Johnson: Also, it starts to pool and create one of these(…)
Gordon Johnson: Let’s talk about the realistic objectives and goals of neurosurgery. What is the surgeon able to do to reverse hemorrhages, hematomas, brain swelling? Dr. Erin Bigler: Well neurosurgical advances in my lifetime have completely revolutionized the ability to care for acute brain injury. When I finished my Ph.D., a large majority of those(…)
