- 2 days ago
Trauma Room One S02E02
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00:02in the heart of Liverpool okay let's go is an operating theatre like no other
00:14doctors are the pinnacle of their profession ah big nest of vipers that's all totally abnormal
00:21fight 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 if you
00:41cause an injury to the brain or the spinal cord you can't repair it that's it forever using
00:46groundbreaking technology making life-or-death decisions oh yes I see a blood we don't do
00:55anything should die he needs to wake up I think it's gone well what feels really good I'd love
01:02it when a pun comes together this is trauma room one the Walton Center in Liverpool performs 2,000
01:17emergency operations every year and an ambulances on route with a patient in a critical condition 58
01:29year-old Rachel has been rushed in after collapsing at a nearby A&E department with a bleed on the
01:34brain
01:36it's an emergency the patient is unconscious and needs urgent help she had a cardiac arrest in Arrow Park
01:47luckily it was witnessed and the team were able to to jump on and intervene right then and there the
01:56bleed
01:56was caused by a ruptured aneurysm a weak bulging area in an artery wall Rachel's future is in the
02:06hands of consultant interventional radiologist dr. Faye Babatola three one two three the cause of her
02:14bleeding intracranially looks like it's an aneurysm coming off one of her vertebral arteries this is a
02:20problem because that's the pipe that goes to the back of her head and supplies her brainstem so what we
02:24need to do now is map out all her blood vessels and see what treatment options are feasible for her
02:32there is a risk that if we leave the aneurysm alone she might we bleed but if I block off
02:37the
02:37aneurysm and ruin her brainstem I've not done her any favors whatsoever dr. Babatola's first
02:46task is to find out what can be done that won't make matters worse one of her vertebral arteries is
02:54the problem the question is is the other one big enough to do the job of both of them if
02:59it's big
02:59enough we can just get rid of the vertebral artery on the same side of the aneurysm on it and
03:03that'll
03:04stop her from bleeding in future if the other one's not big enough then there's a risk of giving her
03:09a
03:09big brainstem stroke okay Rachel sharp scratch coming now a bit of stinging and a bit more stinging
03:20deeper down now dr. Babatola inserts a catheter into a blood vessel in Rachel's groin and we're all done
03:32and guides it to the site of the aneurysm we've got an empty syringe for ACT perfect the first part
03:40is
03:40the angiogram so basically what I'm trying to do is get into the feeding vessel that has the aneurysm
03:45on it so I'm just having to do what we call a roadmap we did a scan with some dye
03:52injected into
03:53the veins wait for it to go around to the arteries in her head take another scan and it lights
04:00up the
04:00blood vessels and then you can see this pouch sitting on the vertebral artery and it's pretty
04:05obvious that's where the blood's coming from this bulge here is the aneurysm the 3d model I need to
04:15have a proper look at it but I can't do that while I'm scrubbed but thankfully Dr. Pulacino he's gonna
04:21get my projections for me and I'm gonna carry on with the angiogram stay very very still the scans
04:28will determine whether anything can be done to save Rachel's life
04:39there are 20 consultant neurosurgeons screen can go backwards please five consultant orthopedic
04:46surgeons and 27 specialist nurses working at the Walton Center and today 42 year old Michael is being
04:55prepped for surgery he has a rare condition that needs urgent attention symptoms starting a couple
05:04of years ago experiences of dizziness feeling like I was gonna blackout or pass out Michael has a
05:13blockage of an opening deep within the brain that's causing a build-up of fluid hopefully I can move on
05:20just to get back some sort of normality for the operation to be a success and life returning to
05:28normal really and that task is in the hands of consultant neurosurgeon professor Michael Jenkinson
05:37Michael he's had several months of episodes of headaches with some collapses and it turns out he
05:44had viral meningitis when he was 19 and this has scarred some of his fluid systems within his brain
05:51and it's getting intermittent rises and spikes in brain pressure that's causing these symptoms what
05:59we're gonna do today is have a look on the inside of his fluid cavities and if we can see
06:04the scarring and
06:05the narrowing and it looks reasonable we're gonna put a little balloon in and try and inflate that and
06:10make the fluid pathways flow more readily this is the MRI of Michael's brain these dark spaces here
06:22they're the ventricles the fluid cavities they're very dilated and enlarged they normally drain through
06:29these very small holes into another fluid cavity and this is where the blockages it's a bit like if you
06:35imagine the plug hole in your bath if you've got a load of hair in the plug hole your path
06:41will
06:41gradually fill up so what we're hoping to do is go in with our camera unpick the hair in the
06:48plug hole
06:49so to speak and re-establish the flow of fluid through his brain professor Jenkinson is performing
06:57an endoscopic or keyhole surgery this is an excellent case to treat with endoscopic surgery
07:05this allows us to put a camera into the fluid cavities so we're just marking where we're going
07:11to make our entry through the skull and see exactly what the problem is and address that problem head
07:18on the risk we always warn people about stroke or risk of death but the pathway that we're trying
07:26to open is very close to his memory circuits so the risk is if we open up the pathways we
07:33could impact
07:33his memory so that's what the balance is can we do something without making him worse for Michael it's a
07:41risk worth taking okay starting give me the mono please 58 year old Rachel was rushed to the hospital
08:07after collapsing with a ruptured brain aneurysm we do the timeouts a condition that is fatal in
08:15about 50 percent of cases just relax for me dr. Babatola has taken scans of Rachel's brain to
08:24pinpoint the exact location of the bleed it's crack on don't worry leave it to me he confers with his
08:31colleague consultant interventional radiologist dr. Richard Pulicchino I've done a vertical run and
08:39spin and I think it's a dissecting aneurysm yeah I don't think there are any vessels nearby we know
08:48she's had a bleed and this is adjacent to the bleed so this is what is known as a dissecting
08:53aneurysm if
08:55you don't do anything there's a risk of it re-rupturing and the second bleed tends to be much worse
09:00than
09:01the first bleed and there's a higher chance of mortality and morbidity so it's important that we do we offer
09:08her
09:08something now looking at the scans with dr. Pulicchino I thought okay there is an abnormality here and my options
09:16are I can get rid of this whole vessel or we could go in and just fill it in and
09:22block it off which is what we opted to do
09:26dr. Babatola is going to perform an aneurysm coiling the procedure involves inserting a catheter into an artery in the
09:36groin the tube is guided through the network of blood vessels up into the head and finally into the aneurysm
09:46platinum coils are then passed through the tube into the aneurysm once it is full of coils blood cannot enter
09:53it which prevents it growing or rupturing
09:59rachel so we found the cause of your bleeding you've got an aneurysm in your head and we think we
10:03can get rid of it and I think that's the safest thing for you at the moment because the biggest
10:06risk to you right now is if that bleeds a second time so get you off to sleep and then
10:11we'll do that as soon as possible
10:17risks of not doing this is that she has another bleeding dies
10:21bit of rao please the main complication but happens less frequently is there is a risk of having a stroke
10:29maybe when we are interfering with a blood vessel that goes to the back of her head if any clots
10:33form
10:33they can go into the basilar artery and cause problems
10:36so I just have to be very careful and hope I don't cause any problems
10:41can you follow me up please
10:45exactly the same as my aneurysm
10:47the difference is I've changed to a larger sheath in the groin so I can take this larger guide catheter
10:54I can then take thinner wires and tubes up past the aneurysm and into the aneurysm and then seal it
11:01off with platinum coils
11:03yeah that's good and then have a road map there please
11:11okay
11:12let's see what we're dealing with
11:15it's a risky procedure
11:16but it could save Rachel's life
11:28as the radiology team fight to save Rachel
11:32another patient is undergoing urgent surgery
11:3942 year old Michael has a rare condition blocking an opening deep in his brain
11:44causing a dangerous build-up of fluid
11:46we're just cutting through this scalp
11:49consultant neurosurgeon professor Jenkinson is being assisted by neurosurgical registrar Mr Ahmad Ali
11:58yeah that looks good
11:59yeah that looks good
12:00well there's his coronal suture
12:02we're all good man
12:08looks good
12:09righty-o
12:10Ahmed is just opening the juror
12:13that's the tough outer lining of the brain
12:17oh that's perfect
12:18okay
12:18yeah
12:19and under this layer we'll see the surface of the right frontal lobe the right side of the brain
12:28we're just making a opening so that we can get this long sheath through the brain tissue and into the
12:36fluid calvertis
12:38this allows us to do it with image guidance
12:41so sat nav for the brain
12:45right entry
12:46absolutely bang on
12:48that's perfect
12:50so in the bottom right image there
12:52we can see the two circles lining up
12:54and you want to keep them on target
12:57this is where my misspent youth comes in handy
13:00having played too many video games
13:02first person shoot em ups
13:03so you've got to get those two circles lined up
13:06that means you're bang on target with your trajectory
13:08so that you can get the camera into the fluid cavities
13:12first time and without damaging the rest of the brain
13:15can we have the top lights off then please
13:22wow look at that
13:25so on the left where there's that big hole
13:27that should be a fully formed membrane
13:31and what Michael's got here
13:33is that that wall has been thinned down and weakened
13:36and there's holes in it
13:38that's amazing
13:40not for Michael
13:42but you can see here the consequences of viral meningitis
13:46which is a an infection and an inflammation in the brain tissue
13:51and you get scar tissue formed
13:54in 15 years as a consultant
13:5710 years in training
14:00I've not seen anything like this before
14:137am in Liverpool
14:16the staff at the Walton Centre are already hard at work
14:21and today is a day that could change 36 year old Scott's life forever
14:29father of three Scott was working out at his local gym
14:32when he felt a pain in his back
14:34his GP sent him for an MRI scan
14:38the results were devastating
14:42I have a tumour that's grown on the inside of my spinal cord
14:46and is pushing on the nerves
14:51I'm numb from the waist down and I have issues walking
14:54because I can't keep me balance or the strength in my legs
14:57it's not there basically
15:00you take for granted certain things like just walking
15:03and I was active with my kids taking them to their rugby training
15:08I can't even do that because I can't drive a car
15:13what I'm hoping for is basically the pain to stop
15:17and some sort of basically just get back to normal life
15:22wife Sophie is hoping for the same thing
15:27I'm really nervous trying to keep it all together
15:30but I think today is a little bit of closure maybe
15:37just to improve his quality of life
15:40have his independence back
15:41it would mean the world
15:43just to get back to some normality
15:47Consultant neurosurgeon Mr Suresh Chandra Sekharan
15:51is preparing for surgery
15:53He is a gentleman who is 36 years old
15:55who presents with gradual decline of his mobility
15:58he's had a scan which revealed a thoracic tumour
16:04to get to this tumour
16:05we need to first localise the level
16:07which is a T5, T6
16:09we will open it up and then take the tumour out
16:13it is a big serious operation
16:16the thoracic cord is unforgiving
16:18any manipulation of the thoracic cord
16:20could lead to paralysis
16:22he can be paralysed from his waist below completely
16:30it is a challenge
16:31no two tumours are alike
16:33each one is different
16:35it is a different route to get to the same thing
16:38so the scenario changes
16:40it is like driving different routes each time you go home
16:45starting
16:47Mr Chandra Sekharan
16:49is going to perform a laminoplasty
16:55the consultant will remove a section of bone that covers the dura
16:59which protects the spinal cord
17:01once they open the dura
17:03they can access and remove the tumour
17:07when the tumour is removed
17:08if the bone is intact
17:10they will screw it back into place
17:15I chose to do a laminoplasty because this gentleman is quite young
17:19and there are possibilities that if you take the bone off
17:23they can always develop instability
17:24and they can develop kyphosis later on in life
17:28so restoring the normal anatomy would be the best in a younger patient
17:33it is not going deep enough
17:36it is always a challenge
17:38operating on thoracic tumours
17:40because there is always a risk of paralysis
17:43but you got all the precautions needed
17:44and we will take all the necessary care
17:47and get the surgery done
17:58one in 15,000 people suffer a ruptured brain aneurysm in England each year
18:06of those who survive
18:07about 66% have some permanent disability
18:15consultant radiologist Dr. Babatola
18:18my catheter first please
18:19is carrying out an aneurysm coiling on 58-year-old Rachel
18:24there's a few torturous loops I've got to go around
18:26and then I'll be inside the aneurysm
18:29and then we start coiling
18:31thank you
18:33the issue is here
18:35we think that's where she's bled from
18:37so as long as I don't poke that
18:38but we should be okay
18:42so onwards and upwards
18:51okay, spin
18:57argh
18:58that projection doesn't allow me to get past the aneurysm
19:03so I'm just going to park this one here
19:07after one or two attempts I thought this is too risky
19:10I'm going to end up going straight through the blood vessel with one of my wires
19:15and that's exactly what happened to me
19:16I ended up poking it
19:17thankfully it didn't bleed
19:18but I gave up trying to get past almost immediately once it happened
19:21and just filled the aneurysm in the vessel from that point on
19:26can we have 5,000 units of heparin please
19:30so I've got both micro catheters into the aneurysm
19:33so now I'm going to deploy my first coil
19:36so now I'm going to deploy my first coil
19:40push please
19:46right, we are in
19:50so can I have a 3x6 hydrophil as well
19:53and then we'll go with some smaller hydrosofts and hopefully finish this off
20:01I'm blocking off the whole aneurysm and the blood vessel with it
20:03because that's the only option for this one
20:06because can you see this black line here
20:09that's blood coming in from the other vertebral artery
20:12so if we block this, that will still supply everything
20:16if she only had this artery and not the other ones
20:18then this would not be a viable tactic for her
20:25but just as plan B
20:28seems to be on track
20:30this isn't working, coils stretched
20:33I don't want to rupture this dissecting aneurysm
20:36so I'll choose a soft catheter
20:37but then I have to get something a bit firmer
20:40I have an echelon 45 degree instead of that
20:43this is too soft
20:44in order to be able to push these coils in
20:47and actually seal off the blood vessel
20:48by which time I was far enough away from the rupture point
20:51that it wasn't going to be an issue
20:53so now I just need to figure out how I get this back in
20:59this all takes time
21:01a luxury Rachel doesn't have
21:23consultant neuroradiologist Dr Babatola is performing a life-saving coiling procedure on 58-year-old Rachel
21:32she was rushed to the hospital with a life-threatening bleed on the brain
21:36I need to fill this like aneurysm sac and then come slightly into the vessel
21:41the problem is always when do you stop
21:46that bit's still filling
21:48nearly blocked off this bleeding point
21:50that's the main priority
21:51so though it looks pretty dense when you look at it like that
21:54there are gaps in between
21:56so I need to block off the vessel
22:05so now we've done the risky bit
22:07I'm going to stop there
22:09can I have a road map there please?
22:11all I need is good enough to stop her from having a second bleed
22:14trying to get a perfect result can often land you in trouble
22:18perfection is the enemy of good
22:25yep, it's worked
22:29so if we look at the previous run that I did
22:33so you can see how the blood was coming up
22:35and then going through
22:37so now
22:39you see how this bit's not even filling
22:43and that's it
22:45all finished
22:50so, successful
22:51we've managed to block off the bleeding points
22:54it is filling a little bit from the back end
22:56but it's not reaching the actual aneurysm itself
22:58so that should be okay
23:04it was just difficult to get the coils into the right place
23:08but we've managed to achieve what we set out to do
23:11which is block off the artery and the aneurysm
23:15so we need to keep an eye on her for the next two weeks
23:18so everyone's different
23:19some patients recover fully
23:21other people, you know, not back to work but living their lives
23:24but some people, even though we've done all this
23:26still don't survive because of other complications
23:29so we'll see which one she is
23:38the spinal service at the Walton Centre is one of the busiest in the country
23:42and in theatre three
23:4436-year-old Scott is undergoing major surgery to remove a tumour from his spinal cord
23:52ready for the microscope?
23:57this is T5 and 6 lamina
23:59so we're going to take these two off
24:01and then we'll get the dura underneath
24:05can I have an up cut please, one millimetre?
24:07they're working millimetres from critical structures in the spine
24:15so that's the midline
24:16so we're going to drill two trenches and see if you can take the bone in total
24:19and under the bone is the dura
24:22and that's where the tumour lies
24:25drilling near the spinal cord
24:26you've got to be very careful and very meticulous
24:28because even the slightest inattention
24:31can cause the drill to go into this cord
24:33and cause permanent damage to the spinal cord
24:36there's also the blood supply of the cord
24:38called the artery of Adamkiewicz
24:40which if damaged can cause a thoracic cord stroke
24:45and that can lead to debilitating injuries like paralysis
24:51up cut please, two millimetre
24:53of course we take all precautions not to do that and avoid as much as we can
24:57any sort of unnecessary damage
25:01just trying to take the bone out to get to the dura
25:05lexotomy please
25:06I'm planning to do a laminoplasty for this gentleman
25:09which is laminectomy is removing the bone completely
25:13versus laminoplasty where we put the bone back in
25:17putting the bone back in retains a normal anatomy for the patient
25:20and it also prevents the chances of instability
25:26you've got bone there
25:28you've got bone there, bone there
25:32you've got bone there, bone there
25:36it's moving
25:46you've got bone there
25:50you've got bone there you've got bone there
26:00you've got bone there
26:02we've taken the bone out now
26:05Bipolar down to ten, please.
26:08Removing the bone has revealed an extra complication.
26:11We can see a large blood vessel on top of the dura.
26:14A vein on the dura.
26:17And our tumour is underneath this bit here,
26:19but we've got to sort this vessel out before we do anything.
26:22An already complex operation just got even harder.
26:37One of the rarest cases Professor Jenkinson has ever seen.
26:4242-year-old Michael is undergoing complex elective brain surgery.
26:49This is amazing.
26:51I've not seen anything like this before.
26:54Assisted by Mr Ali, Professor Jenkinson is performing
26:58an endoscopic procedure to open up a blocked fluid pathway.
27:02You can see here that little hole right in the middle of the screen.
27:07And that is absolutely tiny.
27:10So, normally, fluid from this cavity here,
27:14that should flow through that hole into another cavity.
27:18And that's why I think it's causing the issues.
27:22We've got a monopolar.
27:23If we make this the septum bigger,
27:25we can just have a quick peek over the other side.
27:30OK, that's half a second.
27:35We're making a bigger hole in this bit of tissue.
27:39This is called the septum pellucidum.
27:41It's the normal membrane that divides the two cavities.
27:47When we do this operation,
27:49this is what you could describe as advanced plumbing,
27:54re-establishing fluid pathways, diverting fluid.
28:01Let's give you that back.
28:02Oh, and actually, look at that.
28:03That hole seems to be getting bigger.
28:05Just, I mean, we're not doing anything yet,
28:07but it seems to be a bit bigger.
28:09Right, you've got that balloon, then.
28:11I think this might work, you know.
28:12I'm quietly optimistic.
28:15The balloon is there to slowly and gently inflate the fluid pathway.
28:20We can do that in quite a controlled way,
28:23and it prevents us from damaging the surrounding structures too much.
28:29Right, we're not going to inflate.
28:30I'm just going to see if this balloon will bit and pass through.
28:37Look at the size of that.
28:38I mean, that's ridiculous, right?
28:39This is a two-millimeter balloon.
28:42The opening, called the foramen of Monroe,
28:45should be five millimeters in a healthy adult.
28:50Can I have the EM stilette instead?
28:52Let's try that, which is a bit more rigid.
28:56The stilette makes it easier to manoeuvre
28:58through the delicate brain tissue.
29:00I feel like you've widened it now.
29:02The balloon could fit now, right?
29:03I think the balloon will fit.
29:09Just gently inflate that.
29:14Perfect. Just hold it there.
29:18During the operation, I had to decide
29:20how wide we had to make the opening
29:23to be wide enough that it allowed good flow of fluid,
29:26but not so wide that we risk damaging his memory circuits.
29:30What I can't tell is whether there's any membrane underneath.
29:37And there's no real way of telling that during the operation.
29:41It's just a sort of sixth sense, a judgment that you have to make
29:45at the time and think, hmm, that looks about right.
29:49Michael's future is depending on it.
30:02Over 50,000 spinal surgeries are performed in the UK every year.
30:07And earlier today, dad of three, Scott, was admitted to the hospital
30:12for an emergency surgery to remove a tumour from his spinal cord.
30:19Stop this bleeding.
30:21Have the bayonet and surgery cell, please.
30:24But consultant neurosurgeon Mr. Chandrasekharan and his team
30:28have hit a problem.
30:30There's an enlarged vein just where the tumour lies.
30:34There's always a risk of bleeding,
30:36so we have to either see if you can preserve it
30:38or sacrifice that blood vessel.
30:41It's a setback they don't need.
30:44It's called an epidural vein.
30:46It was restricting the access into the tumour
30:49where we have to open the dura up.
30:51It was coming in the way of the operative site.
30:54It was just mainly on top of the dura.
30:56So we decided to sacrifice it to enable better access.
31:00We have to sacrifice a vessel.
31:15With all obstructions out of the way,
31:17Mr. Chandrasekharan can now open up the dura
31:20to access the tumour.
31:23Inside knife, please.
31:32Spinal fluid coming out.
31:36Can we have some hitch stitches, please?
31:42That's the tumour there,
31:43that you see the white thing there.
31:48Clip and cut, please.
32:01Okay.
32:03That's tumour.
32:09If you look there,
32:10what you've got is a tumour
32:11that is pearly white substance.
32:15Some more tumour.
32:16This was a free-floating tumour.
32:18It wasn't attached to any structure.
32:21It was just pressing on the spinal cord.
32:24It's a very, very rare tumour.
32:25It's less than 1% of the spinal tumours.
32:28Some more tumour.
32:31But removing the tumour
32:32is just the start of Scott's treatment.
32:35Wash, please.
32:37Once it's excised,
32:38we send it for histology
32:40where the neuropathologist
32:41will have a look at it under the microscope
32:43and give us a diagnosis
32:45and it helps us with further treatment.
32:49We've taken all the tumour out.
32:52We're just closing the dura up
32:54and then we'll put the bone back
32:55and then close up.
33:02Hopefully, he should be as he was preoperatively.
33:05And as time goes by, he will improve
33:07because we've taken the whole compression off.
33:10We're going to close up now.
33:11So, we'll see what he does when he wakes up.
33:18It went fine.
33:19We've taken all of the tumour out.
33:21We need to wait for a formal result.
33:23If it is what I think it is, an epidermoid,
33:25then he would not need any further treatment,
33:27which is good.
33:29And it's essentially rehab for him from now on
33:32to see how much of improvement he will have.
33:35Any thoracic tumours usually take some time
33:38to improve postoperatively.
33:39He was weak on his left leg to start with
33:42and the right hips as well.
33:43So, I'm hoping it will be gradually improving
33:45in weeks to come.
34:00Twelve days ago, 58-year-old Rachel
34:03was rushed to the hospital after collapsing
34:05with a life-threatening bleed on the brain.
34:09OK, two minutes of noise for the scan now.
34:11An aneurysm coiling saved her life,
34:15and today, she's having an MRI scan
34:18to check on her progress.
34:24The results were positive,
34:26and four days on, she's going home.
34:30It's all happened like a complete whirlwind.
34:34It doesn't feel like 16 days.
34:36It's like a big blur of headache and pain relief.
34:44Originally, they said, I might go home next week.
34:47Then somebody said, pack your bags, you're going.
34:51Hell, I'm trying not to burst into tears.
34:53I was so happy.
34:55A woman over the way from me said she saw my face going
34:59and she burst into tears for me.
35:05Very lucky.
35:07Originally, I was very blasé to that thought,
35:11but as I recovered more and more,
35:13I can't believe that I drove to the hospital
35:16and probably within ten minutes, I'd flat-lined on the floor.
35:21I'm so relieved that it all went in the right order
35:28at the right time.
35:29Very lucky.
35:30Very lucky.
35:45The Walton Centre, Liverpool.
35:49Where yesterday, 36-year-old Scott had complex spinal surgery
35:54to remove a tumour that was having a severe impact on his mobility.
36:01Consultant neurosurgeon, Mr Chandra Sekharan,
36:04is doing his morning rounds.
36:07I'm going to see Scott now, post-operatively,
36:09see how he's doing, assess his lower limb power.
36:13I'm hoping he'll be much better than what he was yesterday.
36:17How are you doing?
36:18I'm okay.
36:19Yeah, in pain?
36:20Yeah, it's expected.
36:21Your pain usually gets worse before it gets better.
36:24Okay, let's see what you can do with your legs.
36:27Okay, bend your knees up.
36:28Straighten them out.
36:29Good.
36:30And this one.
36:31Straight, straight, straighten them out.
36:34Great, okay.
36:35Pull your feet up towards you.
36:37Okay, big toe up.
36:40Great.
36:40How's the sensation?
36:41I feel better.
36:43Any questions?
36:45No.
36:45No? Good.
36:48Very, very pleased with how it's come up.
36:50He was really weak on the left leg before we started,
36:53and now he's got full power, so I'm really pleased.
36:56Much better than what I expected.
36:57I'm really happy.
37:00Four days later,
37:01and Scott is having physio to get him moving again.
37:05Or I lead him at the right.
37:07Mm-hmm.
37:08Just like, like, see doing that.
37:10So, again, just step together.
37:13Nice and slow.
37:17Good.
37:19He's done really well.
37:21It's really nice to see.
37:22Before his operation, he had quite a lot of weakness in his leg.
37:25You feeling okay?
37:26Yeah.
37:26But he's had a lot of improvement in it.
37:28That's it.
37:29So we'll be sending him home with the crutches,
37:32and then we'll put in community therapy.
37:34He'll hopefully progress off them.
37:35And we've practised the stairs,
37:37and we know he's going to manage them when he goes home.
37:38Yeah, I think if I just take me time.
37:41Yeah, you're safe and you're steady.
37:44It was good to walk like that,
37:45to have a little bit of freedom.
37:47Being stuck next to the bed and asking for help,
37:49it's not a nice thing to go through.
37:53And I didn't think I'd be in this position where I am now
37:56from when I first come in.
37:57I honestly believed I was going to be still in bed
38:00and not at this stage where I am now.
38:15The Walton Centre perform almost 4,000 elective surgical cases a year.
38:23In theatre, Professor Jenkinson is using a balloon catheter...
38:28Just gently inflate that.
38:29..to open up a blocked fluid pathway in 42-year-old Michael's brain.
38:35And deflate.
38:37There's fluid now.
38:39You see this flow?
38:39Yeah, yeah, yeah, there is.
38:41There's more, definitely more.
38:41I mean, if the scar process has burnt out,
38:45there's not going to be an active scarring inflammatory process,
38:48so he may not need a huge amount of help here.
38:54Inflate.
38:56Perfect.
38:59This is like an isometric contraction.
39:02We're doing horse stumps.
39:05Let me just have a wash again.
39:11I mean, that definitely looks bigger.
39:12It's definitely bigger.
39:14I mean, it's a lot bigger than it was.
39:16I guess the question is how much you push it.
39:19If we keep inflating this balloon over and over again,
39:22that's putting more pressure on the brain,
39:24more pressure on those memory circuits,
39:26and the more you do it,
39:27the more you increase the risk for Michael that his memory is worse.
39:30And that's why you have to stop.
39:32When you wake up from brain surgery,
39:34you're not going to be the same as before you went to sleep,
39:36because we've been in your head.
39:37So I'd expect that his memory might feel temporarily worse,
39:41but it's the long-term that you want to minimise harm to.
39:47I think we should call that a day.
39:49I agree.
39:50We can give him a chance to see how that works.
39:53We can review him back in the clinic and see how he goes.
39:56Lights back on, please.
39:59That's pretty good. Woo-hoo!
40:01That went way better than I thought it was going to go.
40:04One, two, three, four.
40:05I'm going to de-scrub.
40:06One, two, three, four, five, six.
40:09Michael's operation has gone really well.
40:10I'm really pleased with how that went.
40:13I was a bit worried before the operation.
40:16I didn't know what we were going to find in there.
40:18Every surgeon wants the operation to go well for their patient
40:21with no major bleeding, no major complications or issues.
40:26That's what surgeons like.
40:28Routine and straightforward and goes to plan.
40:33Michael will go round to recovery.
40:35He'll go up to the ward later on today.
40:38He may notice a temporary worsening in his memory,
40:43but I'm hopeful that that will not be a long-term issue for him.
40:47Professor Jenkinson will find out soon
40:50when he does his afternoon ward rounds.
41:01Five days ago, father of three, Scott, had major surgery
41:05to remove a tumour from his spine.
41:07OK.
41:08OK.
41:10That's tumour.
41:12Today, he's preparing to go home.
41:15Are you excited to come home?
41:16Yeah.
41:16Wife Sophie and son Kai are by his bedside.
41:21Yeah.
41:22I love him being in hospital.
41:24Three meals a day, waking on hand and foot.
41:29She had relief the day he came out of surgery.
41:33It wasn't great.
41:34But since then, he looks absolutely amazing.
41:37He's shocked me a little bit, how quick the recovery has been.
41:41So, yeah, I'm really relieved, happy.
41:45I am looking forward to getting home, home comfort.
41:49Try and get back into some normality as well.
41:53We'll wait on him hand and foot for so long,
41:55and then you've got to promote some independence back, haven't you?
42:10Just four and a half hours ago, Michael had major brain surgery.
42:19Wife Sam is by his bedside.
42:22I can't quite comprehend what's happened this morning.
42:24It doesn't feel like I've been through surgery at all, never mind severe surgery.
42:30I really feel really well, really good.
42:32Balance is great.
42:34I can get up and move out.
42:36I'm genuinely quite shocked by that, yeah.
42:40Professor Jenkinson and Mr Ali check in on him.
42:44Hi.
42:45Here he is, the Lionel Messi of Neurosurgery and Science.
42:49I'll go with that, yeah.
42:49How are you?
42:50You all right?
42:50Yeah, sure.
42:51You all right?
42:54Good.
42:56How are you feeling?
42:57Absolutely spot on.
42:59Any headaches?
43:00Tiny bit of discomfort when I first came on from the general,
43:02but other than that, it's been...
43:04Been all right?
43:04Yeah.
43:05Good.
43:06So the operation went well.
43:07We got in there.
43:08We could tell there'd been something going on there 20 years ago.
43:12Yeah.
43:12And there was a tiny little hole,
43:14and all your fluid is draining down.
43:16It was probably blocked, and we've nicely opened that up,
43:18and we saw some good flow.
43:20So all being well, we can get you home.
43:22You know, you'll be able to judge how your brain feels,
43:25how your memory feels.
43:27Impressed and astounded how just simply walking from the bed
43:30to the toilet in terms of balance and everything,
43:33it's like nothing's happened there.
43:34Right.
43:35It's always nice when you come across a condition
43:38where you can do an operation
43:40and actually change someone's quality of life.
43:43Good.
43:43Thank you so much.
43:44OK?
43:45Thanks, Michael.
43:46No problem at all.
43:47Yeah.
43:47No problem.
43:48And actually give them a good long-term prognosis
43:51and future life.
43:52It's a really nice feeling.
43:53Take care.
43:54Thanks.
43:54See you.
43:55Bye-bye.
43:55See ya.
44:55Death.
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