Brain Surgery

THE RED PRACTITIONER'S GUIDE TO STATE-APPROVED BRAIN SURGERY

Over the course of the great war, it was discovered by central command that the performance of advanced surgical methods decreased the rate of recovery from attrition in battle. Thanks to GREAT LEADER, the wise decision was made to outlaw such methods, leading to glorious victory! In his boundless wisdom, GREAT LEADER has lifted the restrictions on a number of surgical interventions. Many less-storied medical practitioners lack experience with these techniques, which are designed to resolve traumatic injuries in the brain and treat the near-dead back to total life.

In order to treat these complex injuries, one must first understand what they are.

CLINICAL CATEGORIES OF VARIOUS TRAUMAS TO THE HUMAN BRAIN

a) BRAIN CONTUSIONS

A contusion of the brain occurs from a direct physical impact against the skull with little elsewise movement of the head. Contusions are like bruises on the flesh which cause hematoma beneath, resulting in swelling. Inside the skull, however, this can result in edema.

Contusions on the brain can be treated by debriding the damaged tissue and packing the tissue that remains.

b) CONCUSSIONS

A concussion refers to the effect on the brain from an angled blunt impact which causes the head to move so rapidly that the brain bounces around inside the skull, bruising against the walls of its own protector - often swelling and causing edema. A concussion can sometimes be deadlier than a contusion, but may also be easier to treat.

Mild to moderate concussions can be cured with the miracle drug Alkysine, but more severe concussions will require debriding and packing.

c) BRAIN LACERATIONS

A brain laceration is an open gash from a sharp, edged object such as a knife being swung into the brain laterally. Lacerations always present with edema from internal bleeding, but minor lacerations may sometimes close on their own.

Brain lacerations can be treated by stitching together the wounded flesh and packing the crevices.

d) BRAIN PUNCTURES

A brain puncture occurs when a sharp object thrusts forward through the skull and sticks into the brain. Brain punctures are extremely dangerous and should be treated as quickly as possible to prevent death from edema due to internal bleeding. Brain punctures caused by bullet wounds are usually fatal and untreatable, but those blessed by GREAT LEADER may survive the experience if given rapid care.

Punctures in the brain tissue are usually treated by stitching and packing.

e) STROKES

A stroke occurs when the supply of blood to part of the brain is interrupted, depriving it of necessary nutrients and oxygen. The old and infirm may suffer from ischemic strokes caused by travelling of a blood clot from elsewhere in the body, but their usefulness already nears its end. Strokes caused by damage to the brain are the result of internal bleeding, which also leads to the formation of a clot, which can further impede bloodflow.

Treating a stroke properly requires the removal of the blood clot, followed by packing the leftover gap.

f) EDEMA

An edema is caused by the brain swelling within the skull and pressing against its container. This can result in a number of unpleasant effects, including dizziness, blurred vision, headaches, and death.

Edemas should be treated by trepanning; however, if the brain is experiencing internal bleeding, the bleeding should generally be resolved first. Edemas will eventually result in death if left untreated.

If the skull is broken, blood will pour through it and leak from the ears, sinuses and mouth instead of pooling and forming an edema.

There are a number of medical complications that can arise from brain damage, which medical practitioners should be aware of for ease of diagnosis. Brain damage may present along with:

• Persistent stuttering • Difficulty understanding speech • Partial paralysis of one side of the body, otherwise known as Bellue's Palsy. • Partial or total blindness • Temporary deafness • Various difficulties with physical coordination • Bouts of fainting

SURGICAL TECHNIQUES

1) TREPANNING

Trepanning is one of the oldest surgical techniques in known history, dating back to the first skull-piercing of a wily blue in ancient times to release his demonic spirit. It has become an important step in treating brain injury in its totality now that the human body is better understood. Trepanning requires the use of a manually-actuated drill with a hollow bit called a trephine. No surgical incisions need to be made beforehand, but it is recommended to put the patient under general anesthesia to prevent them from going into hypovolemic shock or screaming obnoxiously.

First, the trephine should be applied to the side of the head, and the surgeon should turn the handle until the skull has been drilled open. Once the hollow drillbit reaches the brain, pressure from the edema will cause excess fluid to drain through the trephine, relieving any internal swelling.

It is important to note that if the brain is still bleeding internally before trepanning is performed, the brain will immediately form another edema. It is recommended to treat internal bleeding beforehand to keep the brain cooperative, though trepanning can also be done in emergency to prevent imminent death.

Don't forget that sawing open a patient's skull can also relieve edema.

After trepanning has been completed, the leftover wound should be treated with a medical trauma kit to pack the bone and stop any external bleeding.

2) DEBRIDING

Debriding is the process of cutting away tissue that has necrotized or been damaged beyond repair. It is a necessary first step in the treatment of brain contusions and concussions. Debriding is performed by careful application of a scalpel to the surface of the brain.

Debriding brain tissue will cause tremendous bleeding until the tissue has been packed, so it should be done under administration of a blood IV.

3) STITCHING

To treat injuries to the brain caused by sharp objects penetrating the skull, the remaining healthy tissue needs to first be sewn back together. Once this is done, the surgeon can proceed with packing the gaps.

4) PACKING

Packing is a common medical technique for treating external wounds, and the principle for internal injuries is the same. It is accomplished via liberal application of the surgeon's medical trauma kit. This is the final step in treating any type of brain injury, and should put the unruly patient back in line.

Once the trauma has been treated, the skull should be put back together in the ordinary fashion. Patients may request a period of rest, but be sure to urge them otherwise - if they are on their feet, they can be of use to GREAT LEADER!