Shawn white is a famous American
snowboarder who recently won his third
gold medal at the recent Winter Olympic
Games he began his career in both
skateboarding and snowboarding
eventually turning pro in both sports at
the age of seven now he trained
endlessly and does that training that
made him an expert but before every
competition he hones down and does a
specific set of training that allows him
to prepare for that competition he takes
practice runs and during those practice
runs he assesses the speed of the slope
this the quality of the snow the quality
of the edges of the halfpipe the nuance
of the slope as he goes up for a jump
and comes down in his practice runs he
also assesses his body and his equipment
and how they are working with the
environment is currently and he’s
assessing form and function I’m a
pediatric neurosurgeon I have my
education is culminated in the six years
of residency and the board certification
when my teenage children complained
about high school I remind them that I
after that I had the distinct pleasure
doing here of dedicated work in
pediatric neurosurgery during which I
performed over 100 operations on
pediatric patients with brain tumors
like lichen a professional athlete I
have to complete a specific set of
preparations for every patient in order
to remove their brain tumor safely I
assess form and function and let me give
you some examples je s was a as a great
one girl who came into my clinic with
episodes of difficulty speaking she
would be talking stop talking eventually
dropped whatever she had in her right
hand and fall down and have a seizure
she was brought to the hospital where
they perform a series of investigations
including an EEG which is scalp
electrodes measuring the electro
electrical activity of the brain where
they discovered that seizures were
coming from the left frontal lobe she
had a cat scan and MRI which identified
a tumor in the left frontal lobe now
before we look at this we have to think
about what we’re looking at I’ll teach
you a bit about neuroradiology and then
you’ll know everything about it
so cat scans and MRIs are designed to
take a look at certain large chunks of
anatomy what I tell patients is this
like putting your head through a bread
slicer and then after that they still
let me operate on them what what is that
the top is the front and left and right
are designated what the arrow shows you
is that there’s an area in the brain
that lights up or enhances after the
administration of intravenous dye now
the goal for this patient is for me to
go in and completely remove the tumor
remove any of the brain that’s causing
seizures and to not disturb function I
would then give that tissue to the
pathologist they would give me a
diagnosis and then I would be able to
make a permanent plan for them which may
or may not include chemotherapy or
radiation the problem is it’s that’s
exactly where we think the part of the
brain is that
should talk now look at that so this is
an anatomical drawing of the brain and
what you can see highlighted as Broca’s
area is the area of the brain that we
think is responsible for speech so this
is the left side in right-handed people
we think speak Broca’s areas on the left
and approximately 95% of people but
that’s 95 percent of people that means
that 5% of people it’s somewhere else so
let’s make it more complicated Broca’s
area can be exactly in that part of the
brain or it can be displaced above
behind in front of that area in addition
to differences in left and right-handed
people this possible displacement or
disbursement where the Broca’s area is
larger than you would think
tumors can actually grow as a mass that
pushes brain away or they can grow
within brain so now what do we do we
have to identify function in order to
completely remove this girl’s tumor and
I have to be able to give her back to
her family exactly the way she was so
let’s go to an analogy let’s think of
this auditorium as a skull so the skull
and the bones and the scalp are the
ceiling floor and the walls the front of
the auditorium that’s me represents the
front of the skull Broca’s area is
highlighted in green at the front behind
that we have a red motor strip and that
area is responsible for strength of the
face arm and leg on the opposite side
behind that we have an area highlighted
in green that allows you to understand
speech behind that we have an error in
yellow that’s actually the visual brain
the part that kind of figures out what
exactly you’re looking at of course
vision starts in the eyes proceeds post
that at the back through optic nerves
through wiring called radiations to the
back there’s a motor strip on both sides
and there’s vision on both sides but
speech is usually only on one side now
let’s go back to our patient
so it is extremely important for me to
define function now how do I do that
in order to define function I employed
several tests most simple of which was
functional MRI functional MRI is MRI
technology during which we first
obtained an anatomical scan which are
all familiar with because now you’re no
radiologists so we identify a functional
scan and we ask the patient to sit still
in the MRI scanner we ask them to
perform a number of tasks if I want to
map the area of the brain that’s
responsible for speech I would ask them
to think of as many words as they can to
begin with a certain letter like L if I
wanted to map the motor strip on the
Left I would ask them to either tap
their finger or tap their foot if I
wanted to map vision I would have them
look at a geometric pattern the
functional MRI then detects differences
in blood flow because the area’s the
brain that are activated a to get a
little more blood flow and then you
could create a map so we can create a
map that allows us to actually draw out
where the area that was activated during
the attempt to produce to think of
certain numbers of words and that is
where her Broca’s area actually is what
you don’t see here is where the tumor is
the tumor is actually underneath and in
front of that area brain another useful
test is to actually perform an MRI that
looks specifically at the wiring of the
brain the brain is an electrical organ
it has wires wires connect one part to
another so in this drawing the red wires
are traveling from left to right the
green from front to back and the blue
from top to bottom and the arrow
indicates the area where her tumor is so
what you can tell is that there is no
wiring or connections that go to that
area of the brain meaning that the tumor
has displaced functioning brain that is
great news
so between the results of the fMRI and
the diffusion tensor imaging this
special MRI I could confidently tell
family I can take out that tumor and
still preserve her ability to speak of
course that takes about two seconds
during which they say how are you going
and what kind of braids can she have
before surgery how much you’re gonna cut
during surgery and what break can she
have after surgery how soon can I wash
our hair and I always tell people that
the haircut you get during surgery is
the worst and the most expensive haircut
you will ever get I guarantee a hundred
percent dissatisfaction so now that
we’ve mapped the function of the brain
it’s time to turn our attention to the
anatomy of the brain and the tumor
around the brain so I have had the
pleasure of working with a number of
people throughout the years who have
been pioneers and things like stealth
technology which I’ll tell you about and
3d technology including 3d printed
materials and you can see there’s a
preview and artificial reality so
stealth technology is essentially a GPS
for the brain what you do is you load a
cat scan or MRI in the computer that has
eyes just like wall-e you register the
patient’s skull or the position of the
patient’s skull with a reference frame
that’s pictured there and then the I
actually have a handheld pointer that I
can use to point to the skull and the
computer screen tells me exactly where I
am on the MRI so not only can I see the
scalp and the skull with my eyes I can
actually tell what’s underneath that
allows me to plan the incision to plan
the removal of bone and actually find
the tumor itself so what’s also very
useful is to actually make 3d printed
models to identify deep regions at
corridors to deep tumors when you look
at a brain when you remove the covering
of the brain you see rounded mounds of
tissue called gyri between gyri our soft
connective tissue that our salsa and
thus else I have no neurologic function
whatsoever and when you would imagine if
there’s a highway that I don’t have to
go through brain to get deep I’d like to
identify that back to our analogy
if you want to get into the middle of
the auditorium you’d like to find an
aisle rather than climbing over
everybody in their seats so let me
introduce you to JJ JJ was a grade 1
girl who was at at the park with her
parents when she suddenly slumped
forward and developed a seizure she was
brought to the hospital where an MRI
demonstrated that she had a very deep
lesion in an area of the brain called
the insula this is her her printed brain
we were able to print the tissue in a
soft translucent material of the brain
and the tumor and a darker harder
material and was actually able to
perform the surgery essentially with my
fingers with far less blood loss so what
I was able to do was pull apart
different areas of the model to actually
identify a sulcus that would allow me to
get as close as I could to her tumor and
indeed the picture shows that I was able
to find a sulcus that would allow me to
get down to and only remove
approximately four millimeters of brain
before I completely removed her tumor so
that is something that actually would
have been very very difficult to do in
two dimensional imaging so we can
actually use other technologies to
almost operate before we get to the
operating room so this is me setting up
my artificial reality suite and wearing
these fashionable goggles and I have two
handheld controllers in this artificial
reality environment I can actually put
anything I want I can put the two
dimensional images that radiologists
look at I can actually combine all the
different slices of brain to make 3d
models I can combine different 3d models
some of the blood vessels of the brain
somewhere I can visualize the tumor
somewhere I could visualize the wiring
put them all together put them in the
position that I would normally place the
patient before surgery and remove
certain parts like I was operating in
order to really prepare myself for the
anatomy that I’m going to see now in
that way we’re almost able to do the
surgery before we get there that means
I’m really well-prepared and that’s
what’s important
so like an elite athlete I spent years
honing my craft every patient that comes
in the clinic represents a unique set of
different challenges based on their
different tumor anatomy and functional
brain tumors can grow anywhere and they
can affect any kind of function in any
surgery that I plan for them can
potentially disrupt their function and I
don’t want to do any of those things I
want to give them back – a tumor so I am
assessing form and function in that
particular patient at that particular
time and that is the epitome of individualized medicine
snowboarder who recently won his third
gold medal at the recent Winter Olympic
Games he began his career in both
skateboarding and snowboarding
eventually turning pro in both sports at
the age of seven now he trained
endlessly and does that training that
made him an expert but before every
competition he hones down and does a
specific set of training that allows him
to prepare for that competition he takes
practice runs and during those practice
runs he assesses the speed of the slope
this the quality of the snow the quality
of the edges of the halfpipe the nuance
of the slope as he goes up for a jump
and comes down in his practice runs he
also assesses his body and his equipment
and how they are working with the
environment is currently and he’s
assessing form and function I’m a
pediatric neurosurgeon I have my
education is culminated in the six years
of residency and the board certification
when my teenage children complained
about high school I remind them that I
after that I had the distinct pleasure
doing here of dedicated work in
pediatric neurosurgery during which I
performed over 100 operations on
pediatric patients with brain tumors
like lichen a professional athlete I
have to complete a specific set of
preparations for every patient in order
to remove their brain tumor safely I
assess form and function and let me give
you some examples je s was a as a great
one girl who came into my clinic with
episodes of difficulty speaking she
would be talking stop talking eventually
dropped whatever she had in her right
hand and fall down and have a seizure
she was brought to the hospital where
they perform a series of investigations
including an EEG which is scalp
electrodes measuring the electro
electrical activity of the brain where
they discovered that seizures were
coming from the left frontal lobe she
had a cat scan and MRI which identified
a tumor in the left frontal lobe now
before we look at this we have to think
about what we’re looking at I’ll teach
you a bit about neuroradiology and then
you’ll know everything about it
so cat scans and MRIs are designed to
take a look at certain large chunks of
anatomy what I tell patients is this
like putting your head through a bread
slicer and then after that they still
let me operate on them what what is that
the top is the front and left and right
are designated what the arrow shows you
is that there’s an area in the brain
that lights up or enhances after the
administration of intravenous dye now
the goal for this patient is for me to
go in and completely remove the tumor
remove any of the brain that’s causing
seizures and to not disturb function I
would then give that tissue to the
pathologist they would give me a
diagnosis and then I would be able to
make a permanent plan for them which may
or may not include chemotherapy or
radiation the problem is it’s that’s
exactly where we think the part of the
brain is that
should talk now look at that so this is
an anatomical drawing of the brain and
what you can see highlighted as Broca’s
area is the area of the brain that we
think is responsible for speech so this
is the left side in right-handed people
we think speak Broca’s areas on the left
and approximately 95% of people but
that’s 95 percent of people that means
that 5% of people it’s somewhere else so
let’s make it more complicated Broca’s
area can be exactly in that part of the
brain or it can be displaced above
behind in front of that area in addition
to differences in left and right-handed
people this possible displacement or
disbursement where the Broca’s area is
larger than you would think
tumors can actually grow as a mass that
pushes brain away or they can grow
within brain so now what do we do we
have to identify function in order to
completely remove this girl’s tumor and
I have to be able to give her back to
her family exactly the way she was so
let’s go to an analogy let’s think of
this auditorium as a skull so the skull
and the bones and the scalp are the
ceiling floor and the walls the front of
the auditorium that’s me represents the
front of the skull Broca’s area is
highlighted in green at the front behind
that we have a red motor strip and that
area is responsible for strength of the
face arm and leg on the opposite side
behind that we have an area highlighted
in green that allows you to understand
speech behind that we have an error in
yellow that’s actually the visual brain
the part that kind of figures out what
exactly you’re looking at of course
vision starts in the eyes proceeds post
that at the back through optic nerves
through wiring called radiations to the
back there’s a motor strip on both sides
and there’s vision on both sides but
speech is usually only on one side now
let’s go back to our patient
so it is extremely important for me to
define function now how do I do that
in order to define function I employed
several tests most simple of which was
functional MRI functional MRI is MRI
technology during which we first
obtained an anatomical scan which are
all familiar with because now you’re no
radiologists so we identify a functional
scan and we ask the patient to sit still
in the MRI scanner we ask them to
perform a number of tasks if I want to
map the area of the brain that’s
responsible for speech I would ask them
to think of as many words as they can to
begin with a certain letter like L if I
wanted to map the motor strip on the
Left I would ask them to either tap
their finger or tap their foot if I
wanted to map vision I would have them
look at a geometric pattern the
functional MRI then detects differences
in blood flow because the area’s the
brain that are activated a to get a
little more blood flow and then you
could create a map so we can create a
map that allows us to actually draw out
where the area that was activated during
the attempt to produce to think of
certain numbers of words and that is
where her Broca’s area actually is what
you don’t see here is where the tumor is
the tumor is actually underneath and in
front of that area brain another useful
test is to actually perform an MRI that
looks specifically at the wiring of the
brain the brain is an electrical organ
it has wires wires connect one part to
another so in this drawing the red wires
are traveling from left to right the
green from front to back and the blue
from top to bottom and the arrow
indicates the area where her tumor is so
what you can tell is that there is no
wiring or connections that go to that
area of the brain meaning that the tumor
has displaced functioning brain that is
great news
so between the results of the fMRI and
the diffusion tensor imaging this
special MRI I could confidently tell
family I can take out that tumor and
still preserve her ability to speak of
course that takes about two seconds
during which they say how are you going
and what kind of braids can she have
before surgery how much you’re gonna cut
during surgery and what break can she
have after surgery how soon can I wash
our hair and I always tell people that
the haircut you get during surgery is
the worst and the most expensive haircut
you will ever get I guarantee a hundred
percent dissatisfaction so now that
we’ve mapped the function of the brain
it’s time to turn our attention to the
anatomy of the brain and the tumor
around the brain so I have had the
pleasure of working with a number of
people throughout the years who have
been pioneers and things like stealth
technology which I’ll tell you about and
3d technology including 3d printed
materials and you can see there’s a
preview and artificial reality so
stealth technology is essentially a GPS
for the brain what you do is you load a
cat scan or MRI in the computer that has
eyes just like wall-e you register the
patient’s skull or the position of the
patient’s skull with a reference frame
that’s pictured there and then the I
actually have a handheld pointer that I
can use to point to the skull and the
computer screen tells me exactly where I
am on the MRI so not only can I see the
scalp and the skull with my eyes I can
actually tell what’s underneath that
allows me to plan the incision to plan
the removal of bone and actually find
the tumor itself so what’s also very
useful is to actually make 3d printed
models to identify deep regions at
corridors to deep tumors when you look
at a brain when you remove the covering
of the brain you see rounded mounds of
tissue called gyri between gyri our soft
connective tissue that our salsa and
thus else I have no neurologic function
whatsoever and when you would imagine if
there’s a highway that I don’t have to
go through brain to get deep I’d like to
identify that back to our analogy
if you want to get into the middle of
the auditorium you’d like to find an
aisle rather than climbing over
everybody in their seats so let me
introduce you to JJ JJ was a grade 1
girl who was at at the park with her
parents when she suddenly slumped
forward and developed a seizure she was
brought to the hospital where an MRI
demonstrated that she had a very deep
lesion in an area of the brain called
the insula this is her her printed brain
we were able to print the tissue in a
soft translucent material of the brain
and the tumor and a darker harder
material and was actually able to
perform the surgery essentially with my
fingers with far less blood loss so what
I was able to do was pull apart
different areas of the model to actually
identify a sulcus that would allow me to
get as close as I could to her tumor and
indeed the picture shows that I was able
to find a sulcus that would allow me to
get down to and only remove
approximately four millimeters of brain
before I completely removed her tumor so
that is something that actually would
have been very very difficult to do in
two dimensional imaging so we can
actually use other technologies to
almost operate before we get to the
operating room so this is me setting up
my artificial reality suite and wearing
these fashionable goggles and I have two
handheld controllers in this artificial
reality environment I can actually put
anything I want I can put the two
dimensional images that radiologists
look at I can actually combine all the
different slices of brain to make 3d
models I can combine different 3d models
some of the blood vessels of the brain
somewhere I can visualize the tumor
somewhere I could visualize the wiring
put them all together put them in the
position that I would normally place the
patient before surgery and remove
certain parts like I was operating in
order to really prepare myself for the
anatomy that I’m going to see now in
that way we’re almost able to do the
surgery before we get there that means
I’m really well-prepared and that’s
what’s important
so like an elite athlete I spent years
honing my craft every patient that comes
in the clinic represents a unique set of
different challenges based on their
different tumor anatomy and functional
brain tumors can grow anywhere and they
can affect any kind of function in any
surgery that I plan for them can
potentially disrupt their function and I
don’t want to do any of those things I
want to give them back – a tumor so I am
assessing form and function in that
particular patient at that particular
time and that is the epitome of individualized medicine
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