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00:00in the heart of liverpool okay let's go is an operating theater like no other
00:14doctors are the pinnacle of their profession ah big nest of vipers that's all totally abnormal
00:20fight to save lives are you alright buddy a bit of pain there yes straight down my face in
00:27neurosurgeon being able to change lives for the better there's no other job that I'd rather be
00:32doing it's high-stakes surgery this is amazing I've not seen anything like this before ready
00:39steady go if you cause an injury to the brain or the spinal cord you can't repair it that's
00:45it forever using groundbreaking technology making life or death decisions oh yes I see
00:53your blood if we don't do anything she'll die he needs to wake up I think it's gone well
01:00it feels really good I love it when a pond comes together this is trauma room one
01:0728 year old dance choreographer Daniel is being rushed in from A&E after collapsing at a festival
01:27when we went to resource they just said that that they couldn't do anything for him
01:39found out later he's had a bleed to the brain then he was put in a coma
01:48Daniel must have a portion of his skull removed is the razor about Becca oh yeah lovely yeah senior
01:57neurosurgical registrar mr. Cahill Hannon and neurosurgical registrar mr. Ahmed Ali will
02:03perform the procedure the scan at the time showed that he had a blood clot within the substance of the
02:10brain which particularly in young people is very unusual I can show you on the scans you certainly
02:18don't need to be a neurosurgeon to see that there's a big large clot on the left side of the brain and
02:21it's causing pressure on the remaining parts of the brain Daniel's bleed was in the deep structures of
02:27the brain those deep parts are supplied by blood vessels which come up from the base of the skull and
02:33they're very thin and they're susceptible to bursting with problems like high blood pressure which we think
02:38is what happened in this case so blood is coming into the inside of the head which is a very fixed
02:43compartment because it's all made of bone and so if there's a big clot there it's taken up volume
02:48it's raising pressure inside the head that's why we needed to get the clot out is to decompress so the
02:54plan for this surgery is we're gonna remove a piece of bone close to the top of the skull and about
02:58here on the left hand side and then that'll enable us to hopefully make a small minimally invasive
03:02tract in the brain and remove as much of the plot as we can however if during the operation
03:07the brain appears very swollen then we've planned a very large incision such that we can remove a
03:11very large piece of bone that'll relieve that pressure and but my hope is we don't have to do
03:15that your skull is what's called a fixed box so once the pressure inside the skull increases that
03:22causes pressure on the brain and ultimately death Daniel's intracranial pressure was nearly double the
03:28normal adult range that's life threatening for this man unfortunately so we need to get on with
03:34it off you go and just focus on this bit if the pressure doesn't decrease they'll need to do a bigger
03:42operation we'll get it open as wide as we can and just do a craniotomy about here and then if it's very
03:47very swollen not cooperative then we'll just open the whole thing once we've done the craniotomy which is
03:55the opening into the bone then we can apply an ultrasound probe onto the surface of the brain
03:59and that's really very helpful for helping us to localize exactly where the blood clot is and it's
04:05also helpful at the end to assess that we've got out a reasonable proportion of it local anesthetic okay
04:11can I get the lights on please okay give me the knife please let's do it okay starting
04:19so first stage is opening the skin the scalp is very thick and it has a very rich blood supply
04:26so we stop any of the scalp bleeding that's going to get in the way during the course of the operation
04:30so we're just going through his scalp layers now trying to clear the space to then make the opening
04:37into the bone and after that it's about assessing how well the incision that we've made thus far
04:41allows us to access where we need to get to
04:43at its widest point the blood clot is 1.5 centimeters behind the coronal suture and then
04:50from its widest point to its posterior aspect it's about three centimeters so therefore I'd take it
04:54back about five centimeters I think retract this please you don't want to make unnecessarily large
04:59incisions because that leads to increased problems with wound that increases the risk of infection it
05:04takes longer it takes longer to close it at the end however at the same time what you absolutely don't
05:08want to do is compromise on your access so that's what we're just discussing here is to
05:12optimize the size of the incision such that we can get to the piece of bone that we want to get
05:16to on the basis of what we've seen on the scan around 105,000 people have spinal cord damage in the UK
05:31the Walton Center delivers thousands of spinal procedures each year 81 year old Jeff is on his
05:40way down to surgery to have an urgent operation on his spinal cord didn't think this day had come
05:46I've been unable to stand well not been able move my legs so not been out of the outfit over 12 months
05:55consultant neurosurgeon mr. Nick Carlton bland is in charge of Jeff's treatment Jeffrey has become weaker in
06:06his legs and he's developed numbness we did a scan and what we can see is that the spinal cord itself is
06:13inflamed and filled with abnormal fluids normally the spinal cord receives blood via the arteries and
06:20it's drained by the veins Jeffrey essentially has a abnormal connection between the arteries and the veins and
06:27so effectively what's happened is that his spinal cord has become waterlogged his legs aren't moving very well
06:33because the nerves going to the legs are impaired the team are first going to remove a section of
06:40spinal bones which protect the spinal cord they will cauterize and then sever the abnormal connection
06:47between an artery and a vein which should ease the swelling on Jeff's spine if we don't intervene the
06:53worst-case scenario is his spinal cord gets more and more full and the deterioration in his movement and
06:59his bladder and bowel function get worse occasionally we also see the spinal cord continue to fill up with
07:05fluid until it gets to the neck and so arm function can go and even worse and we do see this a very
07:10occasionally it can go up into the brain stem and actually affect the patient's ability to breathe or
07:15swallow operating on this 81 year old patient comes with high risk it's quite slow with the heart rate
07:23that's one of our concerns is the bradycardia
07:27Jeff he has an abnormality of the conduction system in his heart and his heart was irregular so we had the
07:32cardiologists look at this and ultimately they felt that it was safe to do the anaesthetic without any sort of
07:38pacemaker a heart problem could be really really serious if he were to have an arrhythmia or even a cardiac arrest
07:45then that could be you know a life-threatening complication one two three also putting a patient
07:52face down prone is quite a cardiovascular stress especially if there's blood loss involved as well
07:58and it definitely ups the risk assisting mr. Carlton bland today is neurosurgical registrar mr. Asad
08:07nabby a problem shared is a problem hard happy with Jeff's condition so far ready it's time for knife
08:16to skin as we go into Jeffrey's back we're going to be moving the skin and muscles to one side to
08:24expose the bony architecture of the spine so the spine is absolutely protected by inches of muscle and
08:32so surgically we have to be quite vigorous to get in there it takes some force to get through thick
08:37muscle but once they're in it's a whole different game one wrong move and it could cause permanent
08:44paralysis
09:02the Walton Center is the UK's only standalone specialist hospital trust for neurology and neurosurgery
09:09earlier today 28 year old Daniel was rushed in with a life-threatening blood clot in the brain
09:16mr. Hannon and mr. Ali are urgently operating on him to try and remove as much of the blood clot as they
09:24can think we might have take an extra centimeter on that side as well and yeah assisting with today's
09:32surgery is neurosurgical resident miss Lana al-moussaya so line up you do the bar holds I made you do the
09:38craniotomy yeah I'm I have a pen please per hole here for a hole there and then take it to about there
09:48and then I was thinking about coming into it at that sort of angle there yeah okay let's go
09:54lovely yeah just scrape that away for me
10:02just one last blow for freedom should get you through that there we go we're done bone flap coming
10:15to you Isaac okay so the juror is the lining of the brain that's the last layer before we get down
10:20onto the surface of the brain itself it has its own blood supply and you can also get some venous
10:24bleeding from around the edge of the Jura so we're taking care of that archer clip after we do that
10:30then we're gonna put the ultrasound probe on and we'll see what the clock looks like and then we're
10:34gonna open the Jura go into the brain and remove as much of the blood clot as we can safely and cool
10:39so guys we're gonna get the ultrasound in can we have all the theater lights off please apart from
10:48the top lights so let's have a look and see okay there you go no mistaking that is there this is
10:55normal brain at the close to the top of the screen where it says the Walton Center that gray stuff that
11:00bright white stuff is the clot and we're just having a look to assess exactly how best to get into it now
11:05so I think we go two centimeters down in that direction and then we strike gold and we're not
11:13worried about motor cortex here well yeah we can see what landmarks we have you know ideally you
11:19want to go in through a horizontally orientated gyrus right rather than a vertically orientated one
11:22yeah what goes through our minds when calculating the route is how easy is it going to be and how
11:29quick is it going to be but also we want to avoid causing any severe disabilities the incentives for
11:34controlling of its movement is probably there so our trajectory was avoiding an area such as the
11:39primary motor cortex which is the central part of the brain that controls the movement and we know
11:43that if we go through there we will definitely cause paralysis okay go ahead just go through that
11:51definitively the team must operate to reduce further swelling of the brain but they have to avoid the
11:59healthy tissue there isn't a completely safe route whatever direction you picked you would have to
12:05have gone through some degree of normal brain because it was bang in the middle the route through the top
12:09is the shortest and easiest and quickest route so we need to do this quickly now because the brain is
12:15going to come out and hernia today 81 year old jeff is undergoing major spinal surgery okie dokie we'll get
12:32the microscope in he has swelling on the spine caused by excess fluid coming from an abnormal blood vessel
12:39connection we just parted the waves of those big powerful muscles in jeffrey's back the first part of the
12:44operation has gone to plan bone scalpel next mr. nabby uses an ultrasonic bone scalpel to cut the spinal bone
12:55which acts as protection for the spinal cord ultrasonic bone scalpel is kind of the next step forward from
13:02using a drill gives very very surgical cuts so we can very precisely remove the bits of bone we need to
13:09take and leave the bits of bone that we don't it seals the bone quite nicely so it reduces blood loss
13:15important for someone with a heart problem and so it's one of the the tools that we that we use quite
13:21regularly when we're doing this sort of surgery thinking of the spine is like a load of rooftops
13:27these are the chimneys the spinous processes which we've just cut and we can remove
13:34um and these are the little bits of roof so we're looking down on rooftops once the team take the
13:41bone away they leave the spinal cord exposed and vulnerable to permanent damage
13:47so you can see i've just picked up the chimney the spinous process asad is detaching it from the
13:56ligaments we're seeing much better the yellow ligaments the ligamentum flavum
14:01it's kind of a springy ligament that stops the the neural elements getting caught up between the
14:06laminae so what you're looking for is a blue white sheet which is going to be the dura the
14:15watertight layer around the spinal cord as you can see you can just catch a little glimpse of it right
14:21there and there it is and all it's growing the dura is a layer of tissue that protects the spinal cord
14:32so we've gone through the roof we've gone through the locked insulation you can see the electrics in
14:37the waterworks the spinal cord in that dura and you can see compared to getting into the spine where
14:43we're blurry of fists and large instruments now we're very much tiny little cutters you know millimetres
14:51uh in uh in size and we're being very very very respectful of this very sensitive bit of nerve
15:01moving with extreme caution to avoid nerve damage the team spots a clear sign they're getting to the root of the problem
15:09already the drawer looks slightly muffled looks slightly abnormal normally it's a bright white sheet
15:14and you can just kind of see it's a bit stippled this is where we want to be you just see asad there
15:20is right on the uh the money i think it's very tempting when you see your target just to rush in there
15:27the team are ready to cut through the protective layer of the spinal cord
15:35but this is the most dangerous part of the operation precision is key
15:48essential tremor is estimated to affect over a million people in the uk for retired builder 66
16:02year old andrew his tremors have been seriously debilitating over the last 12 years
16:08it's impacted everyday life eating drinking socializing and it got to the stage where i
16:14couldn't tolerate it anymore if i go out anywhere else i'll get a beaker or something like that
16:19um as you can see it's really i mean even two hands it's it's very very embarrassing at times
16:27especially when you do spill um liquids anywhere because in this cruel world a lot of people give you
16:34a look of disgust today consultant neurosurgeon mr gibral farrah will be performing a pioneering procedure
16:42what we are going to use now is is a frame which is a head holder and this frame is going to be
16:47linked with that machine which is the ultrasound first andrew must have his head completely shaved
17:01he will be placed in an mri scanner which has a helmet called a transducer the helmet sits on
17:07top of a membrane filled with liquid to keep his head cool the transducer has a thousand ultrasound beams
17:14which collide to create a very small precise burn in the brain tissue this will disrupt the communication
17:21pathway and should reduce andrew's tremors all gone yeah that's nice you look lovely okay so if you
17:29can hold your head still i'm just going to put this frame around your hair whilst the procedure itself
17:38is painless andrew will spend up to an hour in the scanner and his movement must be restricted
17:45if the procedure is successful the results will be life-changing for andrew i have the membrane
17:52this membrane is applied to the head of a patient and will contain the fluid and the water through
18:01which the ultrasound will pass to create a lesion in the brain of the patient consultant neuroradiologist
18:08dr mark radon will be assisting mr farrah the focused ultrasound gives us a method of operating within
18:17the brain which is less invasive you can remove certain bits of tissue without the need to open
18:25the skull essentially because it doesn't break the skin there is less risk of infection there's less
18:34risk of blood loss and similar complications andrew is now set for the procedure this is a treatment
18:43with a lot of complicated factors to it there are a lot of controls there are a lot of people involved
18:47there's a lot of equipment involved and it's often helpful to have two people there one actually
18:54controlling things and one actually monitoring and making sure that everything is being done in the
18:59correct order are you okay sir perfect i like to think of it as kind of in that way you have two pilots
19:06flying a plane you have a pilot flying and you have a pilot monitoring i kind of feel that my role here is
19:11very much the doctor monitoring essentially now we need to through the spinal okay before starting
19:18the treatment the neurologists first need to take measurements of andrew's tremors we will get a
19:24baseline assessment of the tremor and this will be a comparison benchmark for the actual treatment
19:31that we're doing okay thank you andrew has been asked to follow the spirals and straight lines with his pen
19:40now it's now time to start andrew's ultrasound treatment we are good to go can we readjust the
19:48transductor by p 1.8 and inferior 2.5
19:53it didn't deliver the energy but the team has already hit a problem there must be an air bubble somewhere
20:11yeah we've got to check for air bubbles can you circulate the water
20:15when the ultrasound passes through the fluid if there is gas present this can cause little shock
20:24waves this is something that needs to be detected because it can cause excessive damage to tissues
20:31and neighboring structures and again andrew's right hand movement needs to be retested
20:39any signs of worsening tremor means they'll have to immediately stop the procedure
20:56so if i would you guys just go just go here just go there right there
21:01back in trauma theater 28 year old daniel is in the middle of having a blood clot removed from his brain
21:07we've made what's called a corticotomy which is an opening into the surface of the brain
21:12and we checked the location of that with the ultrasound already we know that it's going to be
21:15about two centimeters down along this trajectory and ahmed's doing that just now you'll get the
21:20scope in now or just go definitely not just go in you do feel the pressure of the situation you know
21:27that if you get the trajectory wrong you're going to miss some of the clot and you want to make sure you
21:32decompress as much as possible to make the operation as worthwhile as possible just go straight down
21:36because we already know the orientation right he's a young guy and he has a lot of rehabilitation
21:42potential and so you feel like you want to get every single part of it correctly
21:48and it should be very obvious when you hit the clock
21:52this is his frontal lobe this is an area called the middle frontal gyrus we've made as small as
21:57hole as possible as we can right through it obviously that means we're going through normal-ish brain but
22:03it's probably quite damaged by the bleed under it keep going be bold
22:14i can help you
22:18and you want to aim towards the tips of those retractors
22:20there you go okay now nice and gentle nice and gentle yeah and just let it come
22:36as we expected about at two centimeters depth immediately a lot of very high pressure
22:41clot and blood came rushing out at us which was the bleed he had
22:45when you're happy you think that you've got what's going to come and advance very slightly
22:51what's the pressure now rosie out of interest 12 there we go
22:57his pressure was around in the high 20s but now that we've taken the clot out it's down into 12 which
23:02is effectively a normal intracranial pressure um which shows that we've done what we aim to achieve
23:06with this operation come out just a second and just put some wash down there wash please
23:10so i think we've decompressed most of it now but obviously we'll try and wash a bit more out
23:16explore a bit more carefully professor andrew broadbelt is overseeing daniel's surgery when
23:23you're removing a blood clot you've got to be careful that you don't cause further damage
23:28obviously the surrounding brain is friable it's been damaged already but there may still be areas that
23:34are working and useful so the aim is to take the blood clot out and just the blood clot and try and
23:42preserve surrounding brain the team needs to go deeper into the brain tissue to get the remaining
23:48blood clot out but doing so is a risky procedure
24:09each year about 10 000 people in the uk have a spontaneous brain bleed
24:14mr hannon and mr ali are part way through taking out a dangerous blood clot from 28 year old daniel's
24:22brain any more thick slot coming or not no that's it not really okay why don't we just relax and then
24:28we'll have another look with the ultrasound the blood vessels where this is probably bled from are all
24:32actually at the base of the brain we've come in from the top so the vessels that we're worried about
24:36are all at the bottom look at the cavity there if you look at that dark spot right in the middle that's
24:41where we've been into the clot but then there's still some residual so have a look and see what
24:46you can find there more bipolar phase the team is working to remove as much of the blood clot as
24:52possible but it's proving difficult to extract okay so why don't you be slightly bolder go slightly
24:58further into the corticotomy at the base there yeah there you go have a look
25:04that's clot there at the base of that i'm sure even further around i would say
25:14a bit of wash lana why don't you loosen it up just wash washy washy and it also will
25:20help to loosen up any clot that's a bit recalcitrant at the base you know
25:23yeah let's have one last look shall we i don't think there's much to be gained by going rooting
25:34after that i think we're at the limit of what we can do really it's just risky if you keep pulling
25:39on it those blood vessels at the bottom could really bleed so it's probably worth just leaving
25:43it as is i think we just close really yeah cool all right let's have the bone flap please thank you
25:50the final piece of the jigsaw putting daniel's skull back together this is anterior which is
25:58this one yeah what's this pressure now 11. if we put it back on and screw it and the pressure
26:04comes up then we take it off yeah what's the pressure doing now give it a few seconds just to see
26:15so we're just putting the bone back on and holding it for a few seconds just to see if the pressure rises
26:19it'll tell us an idea whether we need to take the bone off i mean pressure's now yeah let's put the
26:25back on yeah let's put it back on the team have done everything they can for now daniel's condition
26:31remains life-threatening we'll keep him deeply sedated on the intensive care unit and allow the
26:35residual swelling to resolve over the next few days he might swell again and if he does he's going to need
26:42a much more aggressive operation next called a decompressive craniectomy but we take off half of his
26:47skull to relieve pressure the next 48 hours are critical for daniel at present we think that
26:54we've done everything we need to do and unfortunately we just need to wait and see now we can't we don't
26:58have a crystal ball
27:01andrew is currently undergoing an mri-guided focused ultrasound to reduce involuntary tremors in his right hand
27:17a focused ultrasound generates significant heat in order to burn the target area to prevent unintended
27:27heating of the scalp cold water is circulated around the head but an air bubble in the cooling fluid is
27:34causing a problem one of the safety features in the system is an acoustic monitoring if it detects air bubbles
27:41it will stop the treatment there was a little bit of air in the fluid that's cooling the patient's scalp
27:51so that it interfered with some of the energy being delivered so we just have to release it
27:56there is definitely a failure rate of the procedure and there is also a recurrence of the tremor
28:02maybe we try it with the lower power longer duration maybe reduce it 700 take it up to 15 seconds
28:10we refill the membrane with fluid so there is no air bubble any longer and we are able to deliver the
28:15temperature that we wanted and now we are going to do one single lesion and this should be the end
28:22of the treatment with the air bubble eliminated they can now continue with the procedure
28:28yes
28:38yes that's perfect so we reach the temperature and i'm quite happy with the spot
28:44the ultrasound waves reached a high enough temperature to penetrate andrew's brain tissue
28:53but he'll have to wait to find out if it's completely stopped his tremors
28:57i feel no pain whatsoever slightly numbness on the back of my head but there's no pain no blood
29:04you know it's fantastic it really is
29:06it's not all right sandy yeah good thank you
29:11back in theater mr carlton bland is in the middle of trying to remove
29:24an abnormal cluster of blood vessels from 81 year old jeff's spinal cord
29:32the team has paused the surgery to check they're in the right area before going any further
29:37so you can see here that's the top of our wounds that's the bottom of our wounds and that
29:45is the abnormal blood vessels which is going to be coming in here so we're right on track
29:49to get to this abnormal connection roughly here
29:52so we can see here that there is a quite a large vessel just where the fistula is so i think what
30:00we're going to do is open up and have a look inside at the spinal cord if that appears to be going to
30:06a blood vessel inside here then we'll know this is the offending culprit the spinal cord transmits
30:13motor signals to the rest of the body any damage here could lead to permanent paralysis
30:20so just open the drawer so you expect to see a big rush of the spinal fluid we may see some vessels there as well
30:29opening up the drawer see that csf fluid
30:35leaking out ah i think we can see quite nicely there's some very abnormal large vessels
30:42there big nest of vipers you see that that's all totally abnormal ah you can even see the fistulas
30:49connection there can't we so if you see directly beneath my instrument instruction please yeah
30:55there's a huge vessel coming out of the nerve root this is literally exactly what our radiologist told
31:00us we would find and there it is so that vein has got an abnormal arterial connection and these veins
31:07have hugely backed up the pressure in the veins are far too much and the spinal cord has then swollen up
31:12so now it's going to be our surgical target i love it when a pond comes together
31:22before disconnecting the tangle of vessels mr carlton bland checks in with the clinical science team
31:28who've been monitoring jeff's motor and sensory systems throughout
31:31so we've stimulated that we know that taking that vessel is okay uh neurologically things are stable
31:44so we can start to disconnect that abnormal blood vessel now mr carlton bland uses heat to seal off the
31:52abnormal connection
32:01fantastic
32:03so we've identified the abnormal artery venous connection and we've now cauterized it and that's
32:09going down yes so we can see already which is unusual we can see that the blood vessels are emptying very
32:16very slowly out they're less full of blood so they're lighter color and um they're starting to
32:22actually shrink already it's very tempting as a surgeon to see abnormal vessels in there and remove
32:27them we don't need to those vessels are doing a useful job to drain the spinal cord if we take those
32:33then we could potentially you know cause further damage so i think we've done the job today
32:38fantastic right and we'll just start closing please
32:42the risky procedure has gone well i'm really really pleased we've achieved the surgical objective
32:48nicely done oh beautiful but jeff's recovery is only just beginning neurological recovery is quite
32:55slow and so i would expect him to be very weak in his legs for a number of weeks or even months but
33:01hopefully long term as the spinal cord drains and becomes a normal size and and less waterlogged and
33:07hopefully we'll see um the the nerves improve and his movement to the sensation improve
33:23it's about uh three times higher than the normal rate
33:26the pressure inside his brain has risen again to dangerous new levels it went up to 42 which is very
33:36high it's about uh three times higher than the normal range we tried various other measures by giving him drugs and
33:43other therapies which could bring his intracranial pressure down so the next option is to operate on him
33:49he now needs a second emergency operation to save his life
34:06this is the last resort for him
34:11neurosurgical fellow mr muhammad el mola will be leading the operation
34:17the pressure into his brain started to increase so we had another scan it did show that the bleeding
34:23reaccumulated again the pressure is high if it goes too high it affects the blood supply to the brain
34:30which can eventually lead to a brain death
34:36daniel's mom claire can only wait we've got a call at six o'clock in the morning
34:42just to say that the pressure was high overnight and they'd have to operate again
34:49obviously he is poorly but
34:53he's in the best place isn't he
34:57and they're doing everything they can to save him
34:59we are going to be making a very big caution mark incision to cover almost half of the head
35:05and the aim of the surgery is to take that piece of the bone
35:08off so when the brain swells it will swell to the outside so it doesn't press against the hard bone
35:23sorry i need i need the rake i'll just count hands
35:26miss al nusaya is once again assisting in surgery
35:30so we're just opening the skin and the uh subcutaneous tissue making a flap
35:46so we have to expose the bone that we're gonna be taking off
35:53hopefully once they open the skull you will see a sudden drastic drop in pressure
35:58so
36:02here you go
36:07what's the pressure now 19 19. all right
36:12we took the small piece of bone that was there before
36:17mr l moller has taken off the piece of skull that was removed and replaced in the first operation
36:22but there is a serious problem so they opened the skull but the brain looks quite swollen up
36:30and the pressure is still high the brain is so swollen it's dangerously pushing through the original hole in the skull
36:38the team must urgently remove a larger piece of bone to relieve the life-threatening pressure
36:47so this is emergent surgery right so the speed is also important ready on
36:52every second counts we need to be a bit quicker the brain is gonna both out here
37:11so
37:18so
37:2028 year old daniel is having an operation to save his life can you see the brain almost coming out of the
37:26small hole mr l moller is trying to relieve the dangerously high levels of pressure in daniel's brain
37:33literally you can lose parts of the brain coming out through that if you don't release the pressure
37:37quick enough
37:41very good okay
37:44okay big wash
37:47i'm bipolar
37:47now
37:48good drop
37:5211 yeah okay so we are got some control now so the pressure is lowered now
37:58well mr l moller and his team's work has paid off
38:04now the brain is not strangled against the the dura
38:09so he's extended the bony incision and he's taken more of the skull out
38:13and that's certainly helped him uh certainly helps in bringing the pressure down
38:19i got a bit stressed when the brain started bulging through the smaller hole the bony work is
38:24finished so and the pressure is seven now so not bad with the pressure coming down in daniel's brain
38:33and bleeding stopped yep the team can close the incision the brain will have no bone cover on top
38:39of it it will be the muscles and skin we do that until the patience is improved and then we can put
38:46artificial bone graft after that that looks exactly similar to the piece of the bone that we took
38:51and they take not most of the skull on one side without the protection of his skull daniel's brain
39:01is exposed vulnerable to hemorrhaging infection and fluid build-up it's a critical time it's too
39:09early to tell what the outcome will be we are still in the critical situation we need to see him in
39:16itu with the normal pressures and then we'll start waking up and assess him
39:34for the past four or five years i've had really apparent tremors which have impacted on me everyday
39:39life a great deal and it got to the stage where i couldn't tolerate it anymore just hours ago andrew
39:46had a pioneering treatment yes that's perfect hello sir how are you and now can you straight your arm
39:56can you bend your elbow for me and hold so it's a very good control of the tremor
40:01can i ask you to hold the cap for me that's very good that's very good control yeah so you're quite
40:10happy yeah yeah okay excellent it's been a pleasure again yeah most welcome my pleasure my pleasure take
40:17care see you how do you do it i'm elated to be honest with you i've had the opportunity to have
40:24procedure which is relatively new in britain and i'm lucky enough to have had it here at walton
40:32it's very satisfying and we are able to actually to treat this patient as a day case
40:36if you are able to correct the tremor then you improve their quality of life in every single aspect
40:44my grandkids can no longer call me granddad shaky you know i'm just granddad handy now
40:54my grandkids can no longer call me granddad hiya professor andrew broadbelt is visiting horsley
41:08intensive care unit and is checking in on daniel after he underwent life-saving surgery 24 hours ago
41:15his pressures are under control so um we now just have to let him heal really and see yeah okay
41:24okay see you later
41:27he's stable is what i'd say so you know with his clot he's had quite a big insult to his brain
41:35and we need to see if that settles down and over what period of time we've done everything we can to
41:41control the intracranial pressure to stop him from getting worse and causing more damage
41:48and we get a better idea over the next few days okay so if swelling settles down in the next few
41:52days that's great the longer it takes i'm more worried i become but we'll see we're just praying and
42:00praying that he fights it he's he's strong he's just he does his street dance he's got that strength
42:08behind him and he's going to do it for us aren't you dan he just needs to come back for his brother
42:13and his sister and me and his dad and he's got so many friends and family that
42:20he can't go anywhere he needs he needs to wake up
42:22i'll have to take a selfie do you want me to take it take me go to the sides i want to
42:37then go on and go on and go on there you go go two weeks ago jeff had surgery on a cluster of
42:44abnormal blood vessels on his spinal cord oh look at my hair down today he's leaving the walton center
42:53and heading to warrington hospital for further rehabilitation model patient mate yeah of course
43:00you've been great here you've all looked after me i couldn't do that a few months ago couldn't lift my
43:07foot off bed so brilliant couldn't bend my knee couldn't do it oh it's a big change yeah take a few
43:16months to get walking again take a bit of time but we'll get there hopefully i'll have my football boots on
43:25thanks a lot bye bye bye see ya
43:55so
44:04so
44:08so
44:14so
44:18Transcription by CastingWords
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