Neurosurgery at the Uniklinic

Last Thursday I went to the neurological clinic at the Uniklinic in Bonn, Germany for my directed studies class. It is one of the major neurosurgical facilities in Germany with consistently over 2500 surgical interventions per year; therefore they perform surgeries ranging the whole field of neurosurgery. Their particular focus is devoted to epilepsy surgery, neurovascular surgery, surgery of intrinsic brain tumors, and complex spinal procedures. Dr. Podlager met us in the first floor of the neuro-building at the Uniklinic where I was able to ask him a few questions about the daily routine of a neurosurgeon in Germany. The daily routine for neurosurgeons is mainly an 8-6 job just like any other. Mainly they have scheduled surgeries in the morning with the occasional trauma patient that needs emergency surgery, but by around 3 most scheduled surgeries are over with and paperwork is and meets are completed in the afternoon. It sounded very much like what a normal surgeon back home would go through in a day so it was interesting to learn that medical practices are mostly the same no matter where you are in the western hemisphere.

The first surgery we went to observe was a pituitary adenoma removal. The tumor had been growing on the patient’s pituitary gland and was pressing against the optical nerve thus slowly reducing the patient’s vision over time without them noticing too much. On the patients MRI I was able to see the growth being a slightly off color than the normal tissue and how it was causing the nerves to bend back on itself as the tumor grew further and further forward. It was really interesting to notice the color contrasts on the MRI after working with an image processing software like Matlab and knowing what exactly was needed to generate the end result MRI. When the surgery started the Doctor Vater, came in and took a look on the real time x-rays to make sure his approach through the sphenoid sinus was correct. Because they were constantly taking x-rays to observe where they were going we had to wear lead aprons to block the radiation that was being constantly used in the room. It was really interesting to see that once they had reached the tumor the process of removing it was less fine-tuned than I had imagined. The surgeon simply said “everything that is gray. Remove it. Everything that is white/yellow. Leave it alone!”. Maybe to my untrained eye it looked very ambiguous in regards to what he was removing but I’m sure that some white/yellow tissue was removed in the process of his scooping out of the tumor. Another thing that startled me to discover was the fact that the patient’s septum was completely removed and nothing besides sponges used to stop the bleeding were placed in the space before the doctors sowed the wound shut. Also there is now a direct hole from the patient’s nose to the bottom of his brain! The surgeons didn’t seem concerned with the possibility of a brain infection which was a little unnerving to me now that I know everything that could go wrong. The trip was great and I learned a lot about how surgeons work and that I'm not too sure I want to do that for a living.