nerd alert

so this isn't really a big surprise- i am a big fat nerd.  i have always been a good student- spending a great deal of time with my head in textbooks, browsing the internet, going out of my way to get as many hands-on experiences related to my field as i possibly can.

so, when this opportunity presented itself, i was more than thrilled.

i am spending my summer doing an internship at an otoneurologist's office in ogden at mckay dee hospital.  i spent the majority of my time working with the audiologist in the office doing hearing and balance testing, but also spend a great deal of time being taught by the dr.  he absolutely loves students and goes out of his way to show me his unusual cases (which seems to be most of them) and teach me from an otoneurologist's point of view.  i have learned so much more at this off-site than i could have ever imagined.

so one day i was talking to the doctor while looking at mri scans and different case studies, and i mentioned to him how awesome i thought his job was.  he is a neuro-surgeon (and an exceptional one at that) who has been practicing for over 40 years.... he has performed hundreds of surgeries and improved his patients' quality of life... and he loves his work.  i told how awesome i thought surgery was and would love more than anything to see him in action.  

so, bless his cute little old-man heart, he told me he would go out of his way to get me into one of his surgeries.  it would take a lot of hoops to jump through and paperwork to fill out, but he wanted me to have the experience.  

this was such an exciting, once-in-a-lifetime thing for me to watch (and an absolute high-light of my graduate school training), that i thought i'd share it with all my blogging friends.  i'll warn you beforehand... it's a long one!

he picked a patient for me who's case was multi-faceted.  she was an older lady, had a variety of health problems, had dizziness/vertigo issues due to a tumor growing on her auditory nerve called an acoustic neuroma.

we went over what the surgery would entail the day before.  technically, it was called a right temporal bone craniotomy for the removal of an acoustic neuroma.  sounds crazy, right?

the day of the surgery we got to the operating room.  the patient was nervous for the surgery but knew it would be the only thing that would cause her dizzy symptoms to go away.  the anesthesiologist came in and put her to sleep and it was time for us (haha, by us i mean the doctor), to get to work!  the doctor got her head in place, shaved all the hair on the right side of her head around her ear, and marked where his incision would be.

i initially thought me being in the operating room would mean that i would stand in the corner and watch the surgery from afar.  but the doctor had other plans for me.  he had me dress head to toe in scrubs, had me "scrub in" just like he did, and had me sit on a chair right next to him throughout the entire surgery.  he said i needed to experience the full thing and needed to see everything he was doing.  every few minutes he would move over and have me look through his microscope.  he would show me landmarks, muscles, bones, etc.  it was the most hands-on, personalized lesson i have ever had.

the surgery was a long one- it lasted about 8 hours.  but this is what we (he) did:

this may be a little tmi for some people, but for us audiology folk, it is fascinating

1. cut the incision behind the ear and flapped it over.

2. performed a mastoidectomy.

(definition of mastoidectomy: surgery to remove cells in the hollow, air-filled spaces in the skull behind the ear.  these cells are called mastoid air cells).  

this procedure involved a lot of drilling!

3. exposed the middle ear tendons and bones (remember from your health classes the malleus, incus, and stapes?) and removed the incus.  no hearing is saved when this surgery is performed.

4. he showed me each of the components of the vestibular system- the semicircular canals, the saccule,  utricle, endolymphatic sac, and facial nerve (i'm sure only my audiology friends really care about this)

5. performed a labyrinthectomy

(definition of labryrinthectomy: the inner ear balance organ (the labyrinth) is exposed and the semicircular canals are carefully drilled away, exposing the nerve of balance which is completely removed.)

it was crazy watching him just drill away the semicircular canals and pull the saccule out with a little tweezer tool.

at this point i saw the brainstem!  it was pulsing with her heart beat and i also saw some cerebral spinal fluid that also pulsed with her heartbeat.

6. at this point, the tumor was visible.  it was growing right on the 8th cranial nerve (vestibulocochlear nerve) and right up against the 7th cranial nerve (the facial nerve).  aside from all of the drilling, this was the most time-consuming part of the surgery.  the facial nerve controls the muscles of facial expression, taste, and supplies the fibers to the head and neck.  damaging the facial nerve could leave her with facial weakness or even paralysis (definitely not something anyone would want).  so, the doctor was extremely careful pulling the tumor off of the nerve and making sure the facial nerve was untouched.

7. the tumor was removed and looked like a small piece of chicken fat.  it was only about 10 cm long but the doctor said it was a fairly good-sized acoustic neuroma.  the tumor was saved and was sent to the pathologists, but the doctor told me it is extremely rare for these tumors to be cancerous.  most are benign but cause such terrible dizziness and vertigo issues that surgery to remove them are often necessary.

8. now that the tumor was removed, she had a huge hole in the side of her head.  the doctor cut a small piece of muscle tissue from her temporal bone and placed it over the brainstem and the area where the tumor was.  he then cut some fat out of her stomach and stuffed the fat into the large open space.  nothing wrong with a little tummy fat removal if you're already under anesthesia :)

9. the muscular fascia of the temporal bone was then stitched together. 

10.  then it was time to close  up the incision.  it took a whole lot of internal and external stitches to close everything up!

11.  wrapped her head up in a huge turbon-like bandage.

the patient was then taken to the icu.  surgeries like this require about a 3-7 day stay in the hospital.  the doctor told me when the anesthesia wears off, this lady was going to experience some crazy vertigo (and some intense nystagmus, auds).  since she no longer has a hearing or balance system on her right ear, it's going to take her some time for her body to get used to the changes.

so, that was my fabulous day in surgery.  i am so grateful that i had to opportunity to watch it.  we spend so much time reading about these medical conditions and looking at pictures and diagrams in books, but i'm a hands-on gal and it all makes a whole lot more sense when i see it in person.  this day in surgery confirmed to me that i love what i'm studying and while i won't be doing the surgeries myself, i will be working with those who do and i need to know my stuff!