Alexandra J. Golby, MD, Director, Image-guided Neurosurgery at Brigham and Women’s Hospital, discusses technological advancements to improve the precision of surgery to remove brain tumors.

It’s estimated that each year nearly 80,000 people are diagnosed with primary brain tumors and 100,000 with metastatic brain tumors. Nearly everybody is at risk for developing a brain tumor. Brain tumors can affect people from childhood to the last years of their lives. Men are slightly more affected than women and the causes of most brain tumors are not known.

There are a number of unique challenges in treating brain tumors. One challenge is that primary tumors can have indistinct margins that are difficult to see. Another challenge is that the tissue around a brain tumor is uniquely important and may impact things like language, visual and motor function.

The AMIGO Suite, opened in 2011 at Brigham and Women’s Hospital, is the Advanced Multimodality Image Guided Operating Suite. It's an NIH-funded national center which was developed with the goal of translating technological advances into improvements in surgical and interventional care for patients. In the AMIGO Suite, there is an intraoperative MRI scanner which can be brought in and out of the operating room during surgery to help surgeons visualize a patient’s tumor better.

Image-guided surgery uses the information obtained from advanced imaging and translates that into the planning and execution of surgery by acquiring high resolution and specialty structural images of the brain and also functional images of the brain. These images can be registered to one another and then to the patient's head during surgery. This allows surgeons to pinpoint the location of the tumor as well as the areas that we would like to preserve, areas that serve critical brain functions are located.

One of the big challenges, even with image-guided surgery, is that as we perform the surgery, the configuration of the brain is changing, and we call that brain shift. And it's due to changes in the brain itself and also as we remove tissue, things are constantly shifting and moving. When we're talking about doing brain tumor surgery, a few millimeters of movement can be a big difference. How to measure and track brain shift is an important area of research and a number of technologies are being studied to understand how to measure brain shift during surgery.

The development of various intraoperative imaging technologies allows surgeons to provide the most accurate surgical treatment for each individual patient.

Learn more about precision brain surgery at Brigham and Women’s Hospital:
https://www.brighamandwomens.o....rg/neurosurgery/brai

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A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: https://kikoxp.com/posts/5084 (dermpath) & https://kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology)

Topics discussed:

Epidermis:
Layers of epidermis: 0:10
Melanocytes vs Keratinocytes: 5:16
Langerhans cells: 10:10 & 33:30 & 57:30

Dermis:
Papillary and reticular dermis: 11:50
Three types of white empty spaces on a slide: vessels, glands/ducts/cysts, or artifact: 15:25
Blood vessels & nerves: 18:24 & 48:50 & 58:59
Arrector pili & other dermal smooth muscle: 20:00

Adnexal:
Sebaceous gland: 21:10
Hair follicle 23:14
Eccrine sweat glands and ducts 24:45 & 50:00
Gland/duct vs blood vessel 27:20 & 48:50
Apocrine glands: this video https://kikoxp.com/posts/7837 (at 12:30)
Acrosyringium: this video https://kikoxp.com/posts/7837 (at 10:00)

Three types of pink bundles: smooth muscle, nerve, dense connective tissue: 27:50

Acral skin (palm sole) with contact dermatitis 29:37
Parakeratosis 30:00
Perivascular lymphocytes 30:40
Eosinophils vs neutrophils 31:20
Spongiosis with desmosome keratinocyte spines 32:10
Spongiotic vesicles with Langerhans cells 33:30
Normal acral skin (palm & sole) with stratum lucidum 34:20
Normal glomus body/apparatus (canal of Sucquet-Hoyer) 35:40
Nerve 36:46 & 51:50
Adipose tissue (white fat cells) in subcutis with Lochkern 37:55
Normal scalp skin with large anagen hair follicles: 39:30
Hair follicle anatomy (bulb/matrix, inner root sheath, outer root sheath, hair shaft, isthmus, infundibulum): 40:55 (labeled images):
https://kikoxp.com/posts/3661 & https://kikoxp.com/posts/7899
Pacinian corpuscle 50:40
Meissner corpuscle 1:02:28

Dense regular connective tissue (Fascia/Tendon/Ligament) vs Smooth Muscle 53:00

Basic Normal Skin Immunohistochemistry:
-cytokeratin in epidermis: 55:33
-S100 in melanocytes and Langerhans cells and adipocytes: 57:30
-Desmin in smooth muscle (arrector pili and blood vessels): 58:59
-CD31 in endothelial cells of blood vessels: 59:33
-SOX-10 in melanocytes: 1:00:40

Digit/Finger/Toe histology (amputation for subungual acral melanoma) 1:04:10 & 1:08:30
-bone 1:05:40
-glomus body 1:05:15
-tendon/ligament 1:06:10
-artery 1:06:58
-fingernail/toenail 1:08:54
-acrosyringium 1:10:45

Solar elastosis (what wrinkles look like microscopically!) 1:11:50

Other videos you might like:
Tendon vs Nerve Histology Made Simple with the Ramen Noodle Sign (of Fulton) video: https://kikoxp.com/posts/4466
Melanocytes vs Keratinocytes made easy video: https://kikoxp.com/posts/3802
Blood Vessel vs Gland vs Artifact Made Easy video: https://kikoxp.com/posts/4808

The basic normal structures of the skin discussed and described by a dermatopathologist. This material is intended for use by medical students, junior pathology or dermatology residents, or for anyone else studying normal human histology. Special thanks to two of my medical students at UAMS for helping make this video possible. Miki Lindsey convinced me that I really needed to sit down and record this video. Akash Patel took time to edit the video and make it ready for YouTube. My sincere thanks to both of them for helping me overcome procrastination.

Huge thanks to Abigail Cline, a medical student at Medical College of Georgia, for volunteering to type a transcript of this ENTIRE video (over 14,000 words!) so that I could provide closed caption subtitles for those with hearing impairments and for those who may need assistance in understanding spoken English (particularly given how quickly I speak!). You can access a text version of her transcript of my video here: https://kikoxp.com/posts/5390

Correction - I made a mistake in the video. I said that sebaceous gland secretions are turned into smelly substances by bacteria and that this makes body odor. That is incorrect. That is actually true of APOCRINE gland secretions not sebaceous secretions.

Also, in the past I used "keratinocyte" and "squamous cell" interchangeably (this is because in dermatopathology, we see and talk about squamous cell carcinomas all the time, and those tumors are composed of keratinocytes). But technically, in normal skin histology, "squamous cell" refers only to the flattened keratinocytes in the superficial epidermis. Thankfully, a histology PhD colleague pointed this out to me and corrected my lazy nomenclature!

Please check out my Soft Tissue Pathology & Dermatopathology survival guide textbooks: http://bit.ly/2Te2haB ‬

This video is geared towards medical students, pathology or dermatology residents, or practicing pathologists or dermatologists. Of course, this video is for educational purposes only and is not formal medical advice or consultation.

Presented by Jerad M. Gardner, MD. Please subscribe to my channel to be notified of new pathology teaching videos.

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Chest pain is a frequent complaint of patients seeking urgent medical assistance, and accounts for an estimated 2-4 per cent of all A&E visits in the UK (Becker, 2000). Generally, acute chest pain should be considered cardiovascular in origin until proven otherwise and it is common in clinical practice to err on the conservative or ‘safe’ side when evaluating people with chest pain. Individuals with suspected ischaemic chest pain must be evaluated rapidly for several reasons: - Myocardial ischaemia, if prolonged and severe, can cause myocardial infarction (necrosis); - Treatment strategies that achieve myocardial salvage (thrombolytic therapy or primary coronary angioplasty) are available for patients with acute coronary syndromes and these treatments reduce morbidity and mortality;

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The spleen, a spongy, soft organ about as big as a person’s fist, is located in the upper left part of the abdomen, just under the rib cage. The splenic artery brings blood to the spleen from the heart. Blood leaves the spleen through the splenic vein, which drains into a larger vein (the portal vein) that carries the blood to the liver. The spleen has a covering of fibrous tissue (the splenic capsule) that supports its blood vessels and lymphatic vessels. The spleen is made up of two basic types of tissue, each with different functions: White pulp Red pulp The white pulp is part of the infection-fighting (immune) system. It produces white blood cells called lymphocytes, which in turn produce antibodies (specialized proteins that protect against invasion by foreign substances). The red pulp filters the blood, removing unwanted material. The red pulp contains other white blood cells called phagocytes that ingest microorganisms, such as bacteria, fungi, and viruses. It also monitors red blood cells, destroying those that are abnormal or too old or damaged to function properly. In addition, the red pulp serves as a reservoir for different elements of the blood, especially white blood cells and platelets (cell-like particles involved in clotting). However, releasing these elements is a minor function of the red pulp.

Microsurgical resection of Vocal fold polyp

This block is used for procedures of the hand, forearm, and elbow. An injection is given in the patient's axilla (armpit) into a space that surrounds a bundle of nerves that supply feeling to the lower arm. This is usually done with the patient awake with sedation, but can be done with the patient under General Anesthesia.

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To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine.

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