Dr. Jayadev Panchwag brainandspinesurgery60@gmail.com

Making treatment or surgery easier and more effective is a sign of progress in medicine, but what are the risks?

Any kind of surgery, a change in body composition according to the laws of nature. Humans have been performing such surgeries since time immemorial. Of course, there are always dangers in exposing the body to interventions in nature and in certain diseases. Just as a horned, multi-horned cow does not, there is no risk of surgery in the world. That is, there is danger in everything a man does. Is there no danger in even the most mundane task like walking down the street?

Understanding the dangers of surgery is difficult not only for the general public but also for the highly educated.

Over the years, the likelihood of an accident during a particular surgery has been changing. As I wrote in a previous article, in the early years of the last century, brain tumor removal surgery was more than fifty percent risky. Although that situation has changed today, ‘Zero Risk’ surgery is almost impossible.

I remember an incident that happened on this occasion. One evening a middle-aged man came to the OPD with his wife’s MRI. It was clear that there was a tumor inside the brain. This tumor is called ‘colloid cyst’ in scientific language. The tumor is located almost in the center of the brain and although it is not cancerous, many important centers are attached to the tumor, so it is difficult to safely remove. However, if left untreated, this tumor can cause a sudden increase in blood pressure to the brain, which can be fatal. That is, surgery is mandatory; But it’s a bit difficult. During the last ten to fifteen years many changes have taken place in the field of neurosurgery to reduce the risks caused by this surgery. For example, in many cases, these nodules can be inserted into the brain by an endoscope. Computer assistance can be sought for guidance if required.

Despite all this, there is no zero percent risk to life in such a difficult surgery. Wife of an infected homeowner .. ‘Doctor, is there any risk in this surgery? In fact, we do not like to do this operation without 100 percent guarantee!

For the most part, this is not the case, but in general, the statement that comes closest to this meaning is heard in the OPD of neurosurgery. Such persevering statements sometimes create in one’s mind the feeling that ‘this disease is our own creation and we have a mental, physical and emotional responsibility to cure it’. The fun part aside, one question that remains is, ‘How easy and risk-free is brain surgery really?’

Any surgical risk is expressed in percentages. For example, the statement “there is a five percent risk in this surgery” does not exceed a certain limit. There is danger, so what is risk? Life is in danger, why is an organ in danger? There are a lot of similar questions. Therefore, the statement simply means, ‘According to international experience, 95% of patients are not at risk’. 25 percent risk is difficult, one percent risk is easy.

In fact it is important to understand that in the case of patients at risk it is 100 per cent, not one or five per cent. If it explains correctly, ‘Doctor, you said only one percent risk, now look what happened!’ No such sentences are heard. When statistics say there is a one percent risk, is the guarantee of ‘you don’t fit this one percent’ low? This assurance is given by our own mind. Anyway. The risks involved in brain surgery are higher than in other organs. There are many reasons for this. The first reason is that the brain is a very sensitive organ. At normal body temperature, this is usually the concentration of butter. So he can be easily injured. Another reason is that once brain cells are destroyed, new ones do not form. Bowel, skin, bone and muscle cells may regenerate. Also, from the deepest abilities of thought, emotion, language, reasoning, etc., to the regulation of movement, respiration, heart function and other hormones, the most important functions are concentrated in a small space. There is a possibility of damage to important centers. Fourth, the immune system (white) cells reach all parts of the body through the bloodstream. However, there is a barrier between nature and the blood vessels of the brain. This is called the Blood Brain Barrier. Nature has devised this plan to prevent these sensitive organs from being affected by toxic blood components. But even if the germs spread through the brain or spinal cord, the immune system does not reach them quickly. For example, if an infection occurs during a stomach operation, the body’s immune system responds quickly; It kills them as the germs grow. However, when the brain or spinal cord is infected, the immune system does not reach as fast. That is why brain and spinal surgery are more prone to infection.

A variety of complications can occur during or after brain and spinal surgery. When a shock hits a vital part of the brain, it stops working and weakens. Or a sudden increase in brain pressure during surgery. The third risk is swelling or increased pressure in the brain after the operation. Fourth, excessive bleeding from the blood vessels in the brain during the operation, problems with the function of other organs that left the brain during or after the operation. For example heart, urinary tract, liver etc. High blood pressure, diabetes, etc. are possible. As well as the spread of germs. During the operation the germs in the air, the germs in the patient’s body, the glands on the skin circulate in the blood. This can lead to infection, as well as if the equipment needed for the operation is not properly disinfected. As we have already seen, the immune system in the brain and spinal cord is weaker than in other organs. In addition, it is difficult to disinfect from the outside. In short, germs are difficult to treat. During this time the disease spreads. Bleeding in the brain within a few hours or days after the operation. There is water around the brain and spinal cord called cerebro-spinal-fluid-csf. Every day about half a liter of CSF is produced in the brain and it returns to the blood vessels. In rare cases after the operation, this water may come out through the skin, nose or ear (csf leak) pores. Doctors and hospitals are taking care of all these problems as much as possible without getting into the head. In fact, they expect to take it. The hospital has as many facilities as there are facilities. But with all precautions, these kinds of problems can arise in the best places in the world. Estimates are made based on worldwide experience on how much risk is involved in the operation, what the risk is, how much, and so on.

If one to three percent of the risk in one operation is hundreds of people having surgery, experience from different centers around the world can cause problems for one to three people.

In short, any surgery carries some risk with it. The risk is higher in the case of the brain and spinal cord. Before any surgery, it is important for the patient and his relatives to understand the potential risks. The statement, based on worldwide experience of the percentage of this risk, is not an estimate made in the case of a specific patient; Important to understand!

Author Brain and Spinal Surgeon.