Plunging: Do you trust your neurosurgeon?

[Ivan Seeking]

The inadvertent 'plunging' of an instrument into the cranial cavity is a feared complication of drilling a burr hole and while anecdotes abound, little is known about the extent or the consequences of this problem. A survey by anonymous postal questionnaire of 304 neurosurgeons in Britain and Ireland was conducted to analyse the extent of this complication. Of respondents, 65.6% had experienced 'plunging', 22.3% having 'plunged' at least twice, indicating a high prevalence of this complication. The Cushing perforator was implicated by most. 'Plunging' carried a 12% risk of death or permanent neurological morbidity. The authors analyse the prevalence and significance of this preventable complication, and discuss various options available to minimize its occurrence.
http://taylorandfrancis.metapress.com/app/home/contribution.asp?wasp=n2v6e330wp6qtjc81kdw&referrer=parent&backto=issue,1,22;journal,7,59;linkingpublicationr esults,1:100434,1

This gives the expression "take the plunge" a whole new twist for me. :surprised

[franznietzsche]

Frankly if you need brain surgery, the risk of death and brain damage is probably greater if you don't do it. But still...

[BobG]

Whenever we'd launch a new satellite, there was always something that could go wrong, many of them pretty stupid. Which tempts a few to shrug their shoulders and say, "Well, launching a satellite isn't exactly rocket science, you know .... er .... ah .... bad analogy. I mean it's not exactly brain surgery, you know."

I guess nothing's quite as precise a science as people would like to believe.

[Moonbear]

No, I would never trust a neurosurgeon...never never never! Then again, when you need neurosurgery, you haven't got much choice, do you? The good news is that most of the procedure is automated, and the residents who still care a bit about patients do more of the work than the surgeons do, but I still don't trust them.

Now, I've occassionally run into this problem drilling through a rat skull, but that's only because I have to use a dremmel tool for the job. When you get to larger skulls, there are hand-crank drills that are designed specifically to avoid this problem. As soon as they penetrate through the skull, they catch and lock. I've stared at these things for a long time and have yet to figure out what magic charm makes them stop at precisely the right time, but they work. Of course the lazy neurosurgeons are probably using some sort of electric or pneumatic drill. Even with that method, they shouldn't be "plunging" an instrument into the brain unless they are being completely careless. The dura surrounding the brain is pretty tough, and you might nick that if you punch through the skull faster than you expected, but should have enough control over your instrument not to go much deeper than that.