Last week, we discussed the fantastical flexibility of the
newborn’s skull and how cultures around the world have taken advantage of its
malleability by intentionally modifying it into strange and mesmerizing shapes.
This week, however, we are exploring the opposite end of the
spectrum: what happens when your brain is locked inside a box that cannot
yield. Let me tell you up front – it ain’t good.
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plates of the skull, have vanished as the sutures joining the plates fused. Those sutures will continue to meld throughout your lifetime and if you live long enough, may completely disappear (what we in the skeletal biz call “obliterate”).
But having a network of fused plates encasing that most
essential organ, the brain, is a double-edged sword. Let’s discuss the pros and
cons of this brainy box.
The skull offers protection to the delicate tissues that
compose the brain. Without the skull, you’d most likely suffer brain damage
before lunchtime, for without the protective cover of the cranium, all it would
take is a subtle knock on the noggin to cause permanent damage. There’s a
reason all vertebrates sport a helmet at the northernmost region of their
spinal apparatus. Whether you’re a tiger or a toad, an elephant or an anteater,
protection is a must and the cranium does a pretty fair job of buffering
our brains.
But even with a skull, damage happens. A trip and a fall or
a crash on your bike is all it takes to cause a head injury and one of the
scariest injuries you can suffer is closed head trauma.
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So what’s a neurologist to do?? There are drugs to reduce the
swelling, which are usually the first line of treatment, but if the swelling
persists, they must take further action.
Rev up the bone saw; it’s time to make a window.
Rev up the bone saw; it’s time to make a window.
Craniotomy is just as daunting as it sounds. A flap of bone
is removed, which allows a bit of breathing room for the swollen brain. The
piece of bone is usually popped in the freezer so that, when the brain stops
swelling and returns to normal, the bony patch can be replaced and the patient
restored (one hopes) to normal function, or at least something close.
The most amazing aspect of craniotomy is that folks have
been performing it long before modern medicine came on the scene. It turns
out we’ve been cutting into each other’s skulls for thousands of years.
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The ancients may have been trepanning for some of the same
reasons we perform craniotomies, since some of the skulls show evidence of
traumatic injury. Was trepanation done solely for medical reasons? Probably
not. There may have been a ceremonial component to it, perhaps to release bad
spirits or correct psychotic behavior. Perhaps it was to obtain bone amulets, since
it was performed on the dead as well as the living and nothing says
"fashion" like sporting a bit of cranial bling.
Whatever the reason, we know that people around the world
for thousands of years were dabbling in neurosurgery long before there were neurosurgeons.
Just as early explorers wondered what lay beyond the horizon, the human body
also afforded a landscape worth exploring. And what better place to start than
a hole in the head?
Have a great week and I'll catch you next Friday.