It was a pleasure to host @elonmusk at @BarrowNeuro recently. We look forward to our continued partnership with @neuralink to advance brain-computer interface technology for our patients…
Michael T. Lawton, MD
3,874 posts
Michael T. Lawton, MD
@mtlawton
Neurosurgeon. Innovator. Author. Teacher. President & CEO @BarrowNeuro. Spetzler Chair of Neurosurgery. Co-Founder @MissionBrainOrg.
- Important tip: contralateral transcallosal-contralateral transchoroidal approach is the way to medial thalamic cavernomas but travels under fornix & requires forniceal retraction; Contralateral transcallosal-ipsilateral transchoroidal travels over fornix & avoids this retraction
00:00 - In neurosurgery, there’s nothing like dissecting the Sylvian fissure – it’s outside of brain tissue, amongst a spectacular arterial landscape, clean & precise. And w/ Sylvian arteriovenous malformations, there’s the challenge of deciphering abnormal vessels & preserving normal
00:00 - I recently reached a significant spinal cavernous malformation milestone: #100 resected microsurgically. These are the most common vascular malformation in my practice & teach so much about zones of entry into cord tissue, safe resection techniques, and handling of cord tracts…
00:00 - Most of what we do in neurosurgery is deconstructive – taking things down and removing them. Bypass surgery is constructive – building something beneficial that did not previously exist. That’s why these moyamoya patients are among my favorite. Tips: handle intima carefully; use
00:00 - We like to be there when trouble strikes, as with this carotid injury during nasal polyp removal @ outside office. After control w/Foley balloon catheter in the nose, we performed bypass/carotid sacrifice, which treated the carotid-cavernous fistula and enabled safe removal of
00:00 - Sewing a bypass is almost a battle against one’s physiology & limitations of equipment. Even w/ microscope’s magnification & light dialed to their max, eyes strain to define transparent tissues. Muscles tighten w/the pressure of ischemia time & precision of micromovement, but
00:00 - Usually I go into interpeduncular fossa over the P1 PCA shoulder, but this time I went under P1 axilla to reach a large midbrain cavernoma. Also used contralateral transsylvian approach for cross-court reach behind right corticospinal tract. Note how this extends back to tectum…
00:00 - From #SevenBypasses: “Infinitesimal forces drive the needle forward and the wall backward, the needlepoint pierces the tissue with a haptic “pop” that transmits through the instruments, fires the fingertips’ sensory receptors, and stimulates the faintest of perception of a bite.
00:00 - Happy to announce the publication of my 6th book: Surgery of the Brainstem. While it took me a decade to do my first 75 brainstem cavernous malformations, my last 75 took only 2.5 years @BarrowNeuro. Hope you like the anatomy, approaches, & mgmt pearls from our contributors. . .
- “There is a thrill that comes from joining two arteries in an anastomosis with the simplest of tools: suture, a few microinstruments, and a microscope. There is a thrill that comes from applying skill, dexterity, and determination to complete a challenging bypass. There is a
00:00 - Some aneurysms require the “A-Game” because you need everything – meticulous exposure, anatomical knowledge, technical skill, attention to every detail, and a little courage – like with this ruptured superior hypophseal artery aneurysm clipping…
00:00 - The supratentorial-infraoccipital approach (STIO) is an alternative to the subtemporal approach to reach the medial temporal lobe, requiring less brain retraction, minimal cortical transgression, no risk to vein of Labbe. You just need to be willing to work at a longer distance…
00:00 - I once thought the measure of neurosurgical success was case volume + papers published, but it’s mentorship. You train residents/fellows, develop their skills, coach them, then put them in the game. When they score touchdowns, it means they will continue our legacy of excellence.
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