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Brainiac! Brain Aneurysms, Pituitary Tumors, Arteriovenous Malformation, and More

By: Camey VanSant

By Alessandra

Welcome to another update on my gap year! I am really excited to share with you how my internship at a neurosurgery clinic at Stanford has been going!

Did you know that surgeons remove pituitary tumors through your nose? When I learned this, I was shocked. I only heard about using tools to take out parts of the brain in ancient Egyptian culture during the mummification process. Okay, okay, before I go into more detail about the endoscopic endonasal approach (the technique of removing brain lesions and tumors from the nostrils), let me fill you in on what my internship entails.

Every Monday for the past two months, I’ve been shadowing Dr. Dodd, a neurosurgeon, and his nurses, Ko, Jennifer, and Jennifer C at Stanford Neurosurgery Clinic. I follow the nurses to the patients’ rooms and watch as they do a quick exam and ask a multitude of questions about the patients’ medications, medical history, and symptoms. Then, we return to the little room Dr. Dodd and his nurses share to discuss the patients’ answers with Dr. Dodd. He spends some time scanning through the MRIs and CT scans of their brains. This has got to be one of my favorite parts of the internship. These images allow you to see the brain in multidimensional images. Dr. Dodd has a team that formulates 3D images of select parts of the patients’ brains (like a brain aneurysm or tumor) to get more distinct and focused images. Sometimes I can spot the problem areas on the images but there are so many white, black, and grey spots that it is hard to decipher what is normal versus abnormal. Dr. Dodd always points them out to me with ease and explains the patient’s condition. Then, Dr. Dodd, one of the nurses, and I return to the patients’ room and discuss their diagnosis and the next treatment steps with tests and procedures. Many patients are also post-op patients that he meets with for a check-up.

I’ve learned so much about the brain, surgery, and being a doctor from this internship. For instance, did you know that to treat a brain aneurysm, Dr. Dodd goes through an artery in the patient’s upper thigh to get to the brain and places either a coil or a stent in the aneurysm to treat it? A brain aneurysm is like a blister on an artery in the brain. If that blister pops, blood will leak into the brain and the fluid around it which can cause a stroke and may be fatal if not treated immediately. That is called a rupture. By placing a coil in that blister, the blood will clot in the blister so blood will no longer flow into the blister, preventing further pressure on the walls of the “blistered” area, averting a rupture. A stent is also used to cut off blood flow to the “blistered” area. The choice to use a stent or a coil depends on the diameter of the entrance into the aneurysm and its shape.

Now the part you have all been waiting for! The pituitary tumors! I’ll let you know that pituitary tumors affect many other aspects of your body. The pituitary gland is responsible for the majority of your body’s hormones and sits at the base of the brain in between both hemispheres. When patients come in with a pituitary tumor, it is often benign but they may experience changes in appetite, voice pitch, menstruation or testosterone levels, sodium levels, energy, weight loss or gain, and so much more. This is because the production and function of one’s thyroid-stimulating, growth, stress, and reproductive hormones can be affected by the tumor. Our hormones are responsible for so many things and are a means of communication to our organs which can affect organ function. In addition to the hormonal changes, one may experience double vision, vision loss, and changes to one’s visual field. This is due to the tumor placing pressure on the optic nerves that sit right below the pituitary gland. Typically, a patient’s vision will return back to normal post-surgery but they may require life-long hormone replacements if they have permanent damage to their hormone production. Due to the non-invasive nature of the surgeries on both pituitary tumors and brain aneurysms, the success rates are very high. Pituitary tumors and brain aneurysms are the most common issues I’ve seen while shadowing at the clinic, however, I’ve also seen other brain lesions, arteriovenous malformation (bundles of arteries and veins that are tangled and have irregular connections), shunts to manage spinal fluid pressure, facial tics, and more. However, I think that one of the most interesting things I’ve learned is about how to build a relationship with patients.

One cool thing about living in the Bay Area is how diverse it is. I’ve seen patients from all different backgrounds which sometimes requires Dr. Dodd to bring in an interpreter. We’ve had interpreters for Tagalog, Mandarin, Spanish, and Urdu come into the clinic. Communication is one of Dr. Dodd’s most important jobs. Patients often arrive scared, confused, and concerned. I’ve learned about the importance of making sure that the patient is able to communicate all their symptoms as well as Dr. Dodd communicating the patient’s diagnosis and the treatment plan. Without this detailed and clear communication, patients have less trust in Dr. Dodd and are still scared, making them less likely to follow his recommendations for treatment. Dr. Dodd has amazing bedside manners with patients and tries his best to ease any and all of their concerns while being truthful about the risks of surgery. I’ve learned so much about what it means to be a doctor and how to treat patients through this process and it’s opened up my eyes to the importance of patient communication and advocation as a doctor.

Overall, I’ve had a blast shadowing Dr. Dodd, Nurse Ko, and Nurse Jennifer. As a planned neuroscience major, I’m excited to explore more opportunities at Duke and continue to learn more about the brain. The picture I’ve attached is of me with the Ko, Jennifer, and Dr. Dodd. They have been such a fun team to shadow!

(P.S. I shadowed with a Duke alum for the first few days which was super cool! She recently graduated and is currently working in a cardiology lab as well and planning to apply to medical school! She shared a bit about her amazing Duke experience! I also met an incoming Duke sophomore who shared about her experience/research she was doing and her past experience also shadowing Dr. Dodd. What a coincidence!)

Me with Dr. Dodd, nurse Jennifer C, nurse Jennifer, and nurse Jolie in the clinic office
Categories: Alessandra