There’s No Room for Error in brain surgery

There’s No Room for Error in brain surgery



There’s No Room for Error in brain surgery

Apply a No Room for Error mentality to your life


As a doctor that specifically deals with brain and spine surgeries, I have adopted a No Room for Error mentality in the operating room. I believe this same mentality can be helpful in making the best possible life decisions. 


What do I mean by No Room for Error?


It is natural to visualize the successful achievement of a goal. 


On the contrary, it is distinctly unnatural and unpleasant to visualize the worst things that can happen 


No Room for Error demands that I keep, in the foremost part of my consciousness, all the worst things, the disasters great and small, that I must avoid.  Of course, I cannot let that prevent me from assiduously working towards my goals. 


As I describe in the accompanying video:

One type of neurosurgical procedure I perform is with endoscopic, minimally invasive approach to brain surgery. This type of surgery may be useful for patients with hydrocephalus, water on the brain and certain types of brain tumors.


Although I describe the risks of surgery in clear language, very few patients really understand that while they are under anesthesia mere millimeters separate them from disaster.  


There are multiple errors to avoid prior to the actual surgery.  Prior to surgery, CT or MRI data is merged with a computer guidance system. If this is not done properly it would be like driving in a dangerous neighborhood of an unknown city with a faulty GPS.


A No Room for Error mentality helps me avoid complications during surgery. I introduce a camera, the diameter of a pencil, through a dime sized hole I create in the skull. If I drive the camera through the wrong part of the brain, called eloquent cortex, the patient may be paralyzed or unable to speak. 


Once I get to the target, the fluid space in the center of the brain, called the ventricles,  I guide the camera between the lateral and third ventricle, and it’s a tight spot, a little tunnel, called the foramen of monroe. 


On one side of the tunnel is a big vein, thalamostriate, if I damage that, the patient could have a devastating stroke and become a vegetable. 


On the other side of the tunnel is the fornix. If I damage that, the patient would lose the ability to form new memories,  like in the movie Memento or like Dory from Finding Nemo. 


Sometimes,  I need to open up the floor of the third ventricle.  Right below the floor is one of the major arteries of the brain,  the bipolar artery. damage to that artery can cause a terrible stroke or brain death. 


It is impossible to be successful in neurosurgery without a no room for error mentality. But, how does a No Room for Error mentality help in life decisions?


Your cognitive bias prevents you, like Pollyanna, from confronting the worst possible outcome. If your judgement is clouded, you are not willing to visualize disaster and you are less likely to avoid critical errors. 


For example: Before your judgment is clouded by alcohol, decide whether to drive yourself or Uber to that business dinner or cocktail party. Consider the unlikely event that, while under the influence, you will cause a motor vehicle accident while driving home. Consider the injuries you might sustain or cause. Consider the humiliation it would cause you and your family.


A No Room for Error mentality demands that you actively imagine the worst outcome of a high stakes decision. Despite the discomfort of visualizing catastrophe, doing so is the best way to avoid it.