I keep on fallin' in & out...

I am always tempted by the surgical specialties. Neurosurgery just has so many cool procedures, it would be awesome to do it. It's just the training is so rigorous...typically, these guys are working at least 14 hours, if you add 1 hour for commuting that leaves you with 9 hours to fit the rest of your life in. And I haven't even included call (or sleep) into that schedule...

Didn't get a chance to wrap up yesterday's events, lot of stuff went on. The patient that came in for the vertebroplasty, secondary to a compression fracture at L3, also had moyamoya syndrome, which is a situation when you have progressive bilateral stenosis/occlusion of the carotid system, usually quite proximal at the ICAs but it can be further up. In response to the decreased flow, you get tufts of arterial collateralization (usually lenticulostriate vessels off MCA) that look like puffs of smoke (moyamoya is Japanese term for that) on angio.

Here is an example, from Yoon et al that was published in AJR 2000; 174 (195-200) on what moyamoya vessels look like (arrows are pointing to them). Etiology of moyamoya disease is unclear, but it seems to have higher incidence in Asians and is often associated with other conditions. I don't think there is concensus on treatment, but EDAS (encephaloduroarteriosynangiosis) is one option, where you basically take the superficial temporal artery and lay it on the brain tissue to induce collateral formation to feed the brain. EDAM is similar except you lay part of the temporalis muscle on the brain to do the same thing.

We had another patient yesterday who came in for a followup cerebral angio that had EDAS, EDAM and burr holes secondary to severe moyamoya disease. It's amazing to think she is talking and raising children when the major supply to her brain are just collateral vessels...

On top of all that we had a bunch of traumas come in yesterday. One of them was a UIC religion professor who had blunt trauma to the head and was brought to Loyola where he was pronounced dead leaving behind a wife and 1.5 year-old daughter. Tragic story that made the local news: http://www.chicagotribune.com/news/local/chi-050623professor,1,1122218.story?coll=chi-news-hed

Today we removed a tumor, most likely a hemangioblastoma, in the posterior fossa roughly between the SCA and PCA on the right. I got to watch the neurointerventional radiologist embolize the tumor's blood supply yesterday, so it was neat to see it get taken out today by the neurosurgeon. The patient looked good after the surgery, we'll see how he is in the morning...