Let’s talk about what Brady’s surgery actually entailed.
Bradys list of procedures are as follows:
Stealth neuro navigation
Right frontal temporal craniotomy
Intra-axial mass resection
Gleolan
Duraplast
Yup. Fiiiiive categories. And we’re going to go through each one just a little bit, to paint a picture.
To start, I’ll remind you that Brady’s mass showed up in his right temporal lobe, which you will know if you read that list, haha! If you’re picturing where your temple is, it might be hard to understand where that is, but I can tell you its right above his right ear. This shows the left, but you get it.
Now to the categories!
Stealth neuro navigation is the process of really finding your bearings, making a plan, and getting the patient set up. Brady was draped off, and his head was set up in a scary way with clamps and mayfield pins. Look that stuff up and you’ll know why he has that mark on his forehead 😬
They used something of a doppler, combined with all previous scans, located the mass with confidence, marked the incision, and got Brady all set up for the next bit.
The right frontal temporal craniotomy sounds pretty medieval if you ask me. And its exactly what you think it – removing the skull portion. As we picked through the operative report, we googled every tool name, and honestly, it was just all the standard nonthreatening pokers in varying sizes that you picture being in a doctors office. Except for the drill and the saw, lol! Brady muttered from his chair just now “the bone-do zip.” The craniotomy was performed by drilling burr holes and then connecting them with the bone-do zip. There was some talk about pinning back flaps, but we won’t get into all that. The space was opened. Thats enough.
Intra-axial mass resection. Tumour removal, basically. The report talks in depth about constant planning, and confirming the masses location using the neuronavigation. Lots and lots of microscopes. When the time came to actually dig in, they began by cauterizing all around the mass as was visible. They used ultrasonic aspiration to de-bulk the mass, consistently rechecking position, and extending the craniotomy in a couple of different directions, as needed.
Gleolan is a super cool new med that played a role in the removal of Brady’s brain mass. It was a gross contrasty orange juice/aluminum shot that Brady took the night before, and it is specifically used to illuminate malignant cells, most commonly used when investigating brain tumours/cancers. So at this point in the surgery, once the bulk of the mass was resected, they turned on their fluorescent lights to see how the gleolan reacted. It showed faint illumination throughout the surgical cavity. Don’t panic here 💜 Take a second. Not only is this method new and not 1000% reliable, but a faint glow kicks a radiant flash in the ass! We’ll take faint any day! This did show, however, that the tumour had fuzzy edges, not smooth. Fuzzy can suggest spreading, though the tumour was completely unchanged since the day we discovered it. Unfortunately, the fuzzy edges started infiltrating the white matter, meaning it wasn’t safe to scoop them all out of there. So. Not 100% perfect, but definitely still very successful!
Duraplast is last. Its even in the name. Its the closing up of the surgical cavity and putting the head back together. Yikes that sounds grosser than I imagined 😅 Everything was cleaned well, and then the packing began. Mesh was first. Dural lining was closed with nylon sutures. There was a bandaid-type of cover put over the stitches. Brady says “braindaid.” Gelfoam was also used, which is another type of braindaid covered in a solution specifically to prevent against bleeding. That one absorbs and dissolves in the weeks following surgery. After aaaaall the packing materials were in place, the bone flap *shivers* was put back in place and secured with plates and screws. How many – we don’t know, but we’re excited to find out if Brady will beep going through airport security someday.
At this point, the heavy lifting of closing up was done. A drain tube was placed alongside the bare bone and secured with a silk suture, preparing for recovery. The temporalis (layer of muscle along the skull) was laid in place and sutured down, and then secured further with the last layer of skin and *gulp* 41 staples.
Everything was washed, dried, and dressed.
Wait for it.
Doused. Dried. Dressed. Drained. Disconnected. Dilaudid.
I could keep going, but I’ll stop…
Post surgery, Brady immediately went in for an x-ray, as the number of sutures noted was off by one, but nothing was amiss on the inside, and Brady was cleared into recovery.
And now he’s OUT! Goodness this series could go on forever. I will stop soon. But not yet.