WEBVTT - 29 - Smart Cranial Implants - The Brain 2.0 0:00:00.090 --> 0:00:02.970 From Kerkow media coming up on the show, 0:00:03.420 --> 0:00:05.520 I bet you that one day you're going to look 0:00:05.519 --> 0:00:07.950 back at this interview in 30 years and you're going 0:00:07.950 --> 0:00:10.170 to walk into somebody's office. They're going to make a 0:00:10.170 --> 0:00:12.450 little cut your skin. They're going to pop out a 0:00:12.450 --> 0:00:15.510 little micro SD card out of your skull implant. And 0:00:15.510 --> 0:00:18.090 it's because you said your memory's a little bad. You're 0:00:18.090 --> 0:00:19.739 just going to get a new chip. You're going to 0:00:19.739 --> 0:00:24.750 upgrade from eight megabytes to 16 megabytes. Dr.. 0:00:26.760 --> 0:00:29.850 This episode concludes our series with one of the top 0:00:29.850 --> 0:00:34.560 rated medical institutions in the country. Johns Hopkins Medicine. When 0:00:34.560 --> 0:00:39.870 patients find themselves needing highly specialized, researched and practiced procedures, 0:00:40.110 --> 0:00:43.320 it's just assumed that someone has dedicated their career to 0:00:43.320 --> 0:00:47.010 optimizing outcomes in that narrow specialty. And one of the 0:00:47.010 --> 0:00:50.190 points to this show is recognizing that sometimes we can't 0:00:50.190 --> 0:00:54.150 take critical medical needs to the corner gas station. Hopefully, 0:00:54.360 --> 0:00:57.450 if you're listening, you have the wherewithal to travel to 0:00:57.450 --> 0:01:00.330 the top specialist in the country. We have one of 0:01:00.360 --> 0:01:02.790 those here with us today. We hope you and your 0:01:02.790 --> 0:01:05.640 loved ones won't need his services. But if you or 0:01:05.640 --> 0:01:08.910 someone you care about has a need for neuroplastic and 0:01:08.910 --> 0:01:12.930 reconstructive surgery, you'll now know the doctor who created the field. 0:01:13.260 --> 0:01:18.080 This is medicine. We're still practicing. I'm Bill Kurtis, of course. First, 0:01:18.090 --> 0:01:21.900 my co-host, the quadruple board certified doctor of internal medicine, 0:01:22.110 --> 0:01:26.699 pulmonary disease, critical care and neuro critical care. And my 0:01:26.700 --> 0:01:30.030 very best friend, Dr. Stephen Tayback. Stephen, how are you doing? 0:01:30.360 --> 0:01:31.490 Hey, Bill, good to see you. 0:01:32.310 --> 0:01:35.430 And our special guest, Dr. Chad Gordon, he is the 0:01:35.430 --> 0:01:39.539 internationally recognized expert and pioneer behind the emerging field known 0:01:39.540 --> 0:01:44.580 as neuroplastic and reconstructive surgery. He is chief of Neuroplastic 0:01:44.580 --> 0:01:47.460 and reconstructive surgery and director for Johns Hopkins 0:01:47.460 --> 0:01:47.910 Medicine, 0:01:48.240 --> 0:01:52.440 professor of plastic and reconstructive surgery and neurological surgery at 0:01:52.440 --> 0:01:57.150 Johns Hopkins. And he also chairs the Harvard Hopkins Neuroplastic 0:01:57.150 --> 0:02:00.840 Surgery Symposium. And he's the president of the Society of 0:02:00.840 --> 0:02:03.940 Neuroplastic Surgery. Thanks for joining us, Dr. Gordon. 0:02:04.530 --> 0:02:05.260 Thank you, Bill. 0:02:05.790 --> 0:02:09.389 First of all, Doctor, what leads to the need for 0:02:09.389 --> 0:02:12.899 and exactly what is neuroplastic and reconstructive surgery 0:02:13.380 --> 0:02:17.609 from a high level view? What really drives my passion, 0:02:18.030 --> 0:02:19.650 the patients and the 0:02:19.650 --> 0:02:21.210 team for which I work with 0:02:21.630 --> 0:02:22.769 is that all patients 0:02:22.770 --> 0:02:24.239 that require brain surgery 0:02:24.389 --> 0:02:26.669 should not look like they had brain surgery. 0:02:27.120 --> 0:02:29.700 And that really summarizes it to the point of what 0:02:29.700 --> 0:02:31.830 we learned over 50 years ago when it comes to 0:02:31.830 --> 0:02:35.700 breast cancer surgery. As you can imagine, if a woman 0:02:35.700 --> 0:02:38.970 suffers from breast cancer surgery in the 1950s, it was 0:02:38.970 --> 0:02:42.220 really about treating the cancer, not really treating the patient. 0:02:42.570 --> 0:02:45.060 And what's ironic is that we're here in twenty 0:02:45.060 --> 0:02:47.100 twenty and brain 0:02:47.100 --> 0:02:50.490 cancer and skull tumors and skull defects are really treated 0:02:50.490 --> 0:02:53.850 by brain surgeons who are concentrating on the brain. They're 0:02:53.850 --> 0:02:57.510 not really concentrating on the restoration of someone's appearance 0:02:57.840 --> 0:02:58.830 to make it look like 0:02:58.860 --> 0:03:01.650 they have no deformity or ever had surgery. And that 0:03:01.650 --> 0:03:03.040 really encompasses our goal. 0:03:03.480 --> 0:03:05.190 So is this largely 0:03:05.190 --> 0:03:09.720 a cosmetic process after you have dealt with the challenges 0:03:09.720 --> 0:03:12.600 of brain surgery, or is this something you do actually 0:03:12.600 --> 0:03:14.609 during the brain surgery itself? 0:03:14.639 --> 0:03:17.340 Yes. So I love that you use the word cosmetic 0:03:17.340 --> 0:03:21.630 because I absolutely despise that word because the word cosmetic 0:03:21.810 --> 0:03:25.530 in plastic surgery is defined as taking someone who looks, 0:03:25.530 --> 0:03:29.070 quote unquote, normal and making them more pretty or handsome. 0:03:29.639 --> 0:03:31.530 And that's what drives me crazy. 0:03:31.650 --> 0:03:32.370 People that have 0:03:32.370 --> 0:03:33.300 brain surgery or need 0:03:33.300 --> 0:03:34.770 brain surgery, they're not trying to 0:03:34.770 --> 0:03:37.680 look more prettier, more handsome. They're just trying to look 0:03:37.680 --> 0:03:41.610 like themselves after surgery. And that's our mission. We're not 0:03:41.610 --> 0:03:43.980 trying to make you look better. We're trying to make 0:03:43.980 --> 0:03:46.740 it look like you never required somebody to open up 0:03:46.740 --> 0:03:49.110 your scalp, remove part of your skull and operate on 0:03:49.110 --> 0:03:50.280 your brain and put things back 0:03:50.280 --> 0:03:53.160 together so that you have no deformity. Imagine going on 0:03:53.160 --> 0:03:53.220 a 0:03:53.220 --> 0:03:56.520 first date or your brother comes home and has a 0:03:56.520 --> 0:03:58.410 den on the side of his head after having brain 0:03:58.410 --> 0:04:00.780 surgery. Do you look at them the same way? Do 0:04:00.780 --> 0:04:01.500 you think they have the 0:04:01.500 --> 0:04:04.440 same mental capacity they used to have? A lot of 0:04:04.440 --> 0:04:06.960 times we get this social stigma passed on to us 0:04:06.960 --> 0:04:09.540 by having brain surgery because our head doesn't look the same. 0:04:09.720 --> 0:04:12.660 But really it's just an appearance thing. And so I 0:04:12.660 --> 0:04:15.180 cringe when I hear the word cosmetic because I feel 0:04:15.180 --> 0:04:17.130 that I need to defend all the patients in the 0:04:17.130 --> 0:04:20.190 world that either need brain surgery or have had brain 0:04:20.190 --> 0:04:21.359 surgery and that don't 0:04:21.360 --> 0:04:22.760 look like themselves anymore. 0:04:23.400 --> 0:04:26.010 I noticed during one of your online videos that you 0:04:26.010 --> 0:04:30.419 talked about having performed about 500 surgeries, what is the 0:04:30.420 --> 0:04:32.549 original and critical 0:04:32.550 --> 0:04:36.450 need for the brain surgery that usually leads to them 0:04:36.450 --> 0:04:37.290 coming to you? 0:04:37.620 --> 0:04:38.910 So most often 0:04:38.910 --> 0:04:40.470 they're coming because they've either 0:04:40.470 --> 0:04:41.790 suffered trauma. 0:04:42.120 --> 0:04:43.230 When you have an injury 0:04:43.230 --> 0:04:44.670 to your head, the thing that 0:04:44.670 --> 0:04:45.659 will kill you is 0:04:45.660 --> 0:04:47.760 brain swelling. And the way to 0:04:47.760 --> 0:04:49.679 make you survive is to remove part of your 0:04:49.680 --> 0:04:51.119 skull that allows your 0:04:51.120 --> 0:04:53.669 brain to swell without herniated and causing your 0:04:53.670 --> 0:04:57.450 death or impairment forever. Now, when that bone comes off, 0:04:57.450 --> 0:04:58.170 a lot of times the 0:04:58.170 --> 0:05:00.810 swelling will go away after weeks or months and then 0:05:00.810 --> 0:05:01.710 needs to be put back 0:05:01.710 --> 0:05:03.180 in. But if it takes too 0:05:03.180 --> 0:05:05.760 long, then the bones are no longer viable. The other 0:05:05.760 --> 0:05:09.090 scenario is just related to common day brain surgery. It 0:05:09.089 --> 0:05:11.400 doesn't really matter why you needed brain surgery. 0:05:11.760 --> 0:05:12.659 The access 0:05:12.660 --> 0:05:12.930 to the 0:05:12.930 --> 0:05:14.310 brain is 75 0:05:14.310 --> 0:05:16.440 percent on the side of your head. We don't go 0:05:16.440 --> 0:05:18.240 through your forehead and we don't go through the back 0:05:18.240 --> 0:05:20.280 of your head because the bone is either thicker or 0:05:20.279 --> 0:05:22.650 going right through your forehead would leave a deformity in 0:05:22.650 --> 0:05:24.790 and a scar in itself. So seventy five per. Cent 0:05:24.790 --> 0:05:27.489 of all brain surgeries through the side, unfortunately, you have 0:05:27.490 --> 0:05:28.780 a large chewing muscle there, 0:05:28.779 --> 0:05:29.860 you have a temporal fat 0:05:29.860 --> 0:05:32.469 pad there, you have a delicate scalp there, and not 0:05:32.470 --> 0:05:35.080 all that area is covered by hair. And so the 0:05:35.080 --> 0:05:36.820 simple matter of having brain surgery 0:05:36.820 --> 0:05:38.110 requires removing 0:05:38.110 --> 0:05:41.050 part of the bone like a bottle cap and putting 0:05:41.050 --> 0:05:41.529 that bottle 0:05:41.529 --> 0:05:42.490 cap back. 0:05:42.610 --> 0:05:46.090 That is actually dead bone. Once you've disconnected it, problems 0:05:46.089 --> 0:05:48.729 can happen with that bone. It can shrivel up like 0:05:48.730 --> 0:05:51.880 a grape goes to a raisin. It can get infected 0:05:51.880 --> 0:05:52.960 because it was taken off and 0:05:52.960 --> 0:05:53.770 then put back 0:05:54.100 --> 0:05:59.410 chemotherapy, radiation, smoking, diabetes. All these comorbidities can lead to problems. 0:05:59.740 --> 0:06:02.650 So no one having trauma to your head, no to 0:06:02.650 --> 0:06:05.470 ever requiring brain surgery. A lot of times they don't 0:06:05.470 --> 0:06:08.170 look like themselves ever again because the person who did 0:06:08.170 --> 0:06:10.240 their brain surgery was trained for seven years in a 0:06:10.240 --> 0:06:13.119 residency to operate on the brain. They weren't trained to 0:06:13.120 --> 0:06:15.490 reconstruct the skull or to do the operation in a 0:06:15.490 --> 0:06:18.460 way to preserve an appearance. And then the third thing 0:06:18.460 --> 0:06:22.870 is really tumours. You can unfortunately have a brain tumour 0:06:22.870 --> 0:06:25.359 that invades part of your skull, which means it wouldn't 0:06:25.360 --> 0:06:27.580 make sense taking that part of your brain out and 0:06:27.580 --> 0:06:29.279 leaving the skull disease behind. 0:06:29.589 --> 0:06:30.580 So they've lost their 0:06:30.580 --> 0:06:32.920 skull because of a tumor of the brain invading it 0:06:33.460 --> 0:06:35.800 or people actually can develop skull tumors. 0:06:36.250 --> 0:06:37.330 I have to ask you, Dr. 0:06:37.330 --> 0:06:38.290 Gordon, what's 0:06:38.290 --> 0:06:42.520 the difference between what you're going to do in closing 0:06:42.520 --> 0:06:46.360 and optimizing the look that someone has after brain surgery 0:06:46.690 --> 0:06:49.750 versus the doctor that focused on the brain? What are 0:06:49.750 --> 0:06:50.920 you going to bring to the party? 0:06:51.250 --> 0:06:54.180 So you just said it yourself. They're focused on the brain. 0:06:54.520 --> 0:06:55.390 It all comes down 0:06:55.390 --> 0:06:58.480 to attention, to detail. When I'm opening up the scalp. 0:06:58.690 --> 0:07:01.360 I'm not worried about the brain. I'm opening up the 0:07:01.360 --> 0:07:05.230 scalp and using delicate maneuvers for the muscle and the fat, 0:07:05.589 --> 0:07:08.290 getting down to the bone, then turning the operation over 0:07:08.290 --> 0:07:10.810 to the brain surgeon. When the brain surgery is involved 0:07:11.140 --> 0:07:13.240 and when they're done doing the part that they so 0:07:13.240 --> 0:07:15.700 much care about, they can leave the operating room. And 0:07:15.700 --> 0:07:18.220 then I put everything back together again, just like a 0:07:18.220 --> 0:07:18.460 hood 0:07:18.460 --> 0:07:19.929 on a car. You wouldn't want 0:07:19.930 --> 0:07:22.930 to scratch your debt on your Bentley or Ferrari. And 0:07:22.930 --> 0:07:26.230 that's what these patients, unfortunately, are getting. Try running a 0:07:26.230 --> 0:07:28.750 company as a CEO or try being a teacher or 0:07:28.750 --> 0:07:29.860 doctor with a debt on 0:07:29.860 --> 0:07:31.480 the side of your head or a scar 0:07:31.480 --> 0:07:34.090 that healed pretty wide because it was closed under high 0:07:34.090 --> 0:07:36.940 tension or missing some of your hair on the side 0:07:36.940 --> 0:07:39.310 of your head. Because the best clarity of the scalp 0:07:39.310 --> 0:07:40.690 isn't that good like it was. 0:07:41.080 --> 0:07:43.720 These are small details. And to you, 0:07:43.720 --> 0:07:46.210 it might sound funny because you're having brain surgery. What 0:07:46.210 --> 0:07:47.739 do you care about a bad scar? What do you 0:07:47.740 --> 0:07:50.350 care about a dent? But guess what, it's not nineteen 0:07:50.350 --> 0:07:52.600 seventy anymore. It's not nineteen eighty anymore. 0:07:52.600 --> 0:07:53.740 Bill, patients 0:07:53.740 --> 0:07:54.250 deserve a 0:07:54.250 --> 0:07:55.420 bar that is very, 0:07:55.420 --> 0:07:59.350 very high. Now neurosurgeons are doing complex operations like they've 0:07:59.350 --> 0:08:02.950 never been done before and getting amazing outcomes. And that's 0:08:02.950 --> 0:08:05.110 why this field is growing so fast. 0:08:05.470 --> 0:08:08.170 Speaking about that, I can't help but ask. The annoying 0:08:08.170 --> 0:08:10.450 question is, does insurance pay for you? 0:08:10.600 --> 0:08:11.620 Every single one 0:08:11.620 --> 0:08:14.380 that six hundred and fifty school reconstructions that I've performed 0:08:14.560 --> 0:08:15.640 have been covered every 0:08:15.640 --> 0:08:17.050 single time. All I have 0:08:17.050 --> 0:08:19.060 to do is simply take a picture and write a 0:08:19.060 --> 0:08:21.670 letter and state the exact thing us in the beginning 0:08:21.670 --> 0:08:24.880 of this show. This is not cosmetic surgery. That's my 0:08:24.880 --> 0:08:27.790 opening line. This is making the patient look like 0:08:27.790 --> 0:08:29.080 themselves before they 0:08:29.080 --> 0:08:29.860 had brain surgery. 0:08:30.250 --> 0:08:33.429 Question for, you know, in my realm with neuro critical care, 0:08:33.429 --> 0:08:36.280 which is also had a metamorphosis, we're seeing a lot 0:08:36.280 --> 0:08:39.610 more therapeutic craniectomy. In the old days, it was like 0:08:39.610 --> 0:08:41.949 a last ditch effort that perhaps you would do a 0:08:41.950 --> 0:08:45.790 craniectomy for somebody who is having a brain herniation. Is 0:08:45.790 --> 0:08:48.939 this adding a considerable number of cases to your institution 0:08:48.940 --> 0:08:52.179 or are there highly technical neurosurgical procedures that are really 0:08:52.179 --> 0:08:55.630 adding more to to your numbers out there in Johns Hopkins? 0:08:56.020 --> 0:08:59.410 Stephen, you're exactly right. The literature is showing now that 0:08:59.410 --> 0:09:01.150 when you have a major injury to your 0:09:01.150 --> 0:09:02.590 brain, the best thing 0:09:02.590 --> 0:09:04.570 to do is to get the bone off. And big 0:09:04.570 --> 0:09:07.480 is better. The more bone you take off in that 0:09:07.480 --> 0:09:11.260 critical window of injury, the more chance that the brain 0:09:11.290 --> 0:09:11.950 has room to 0:09:11.950 --> 0:09:14.050 survive and swell safely. 0:09:14.410 --> 0:09:15.939 10, 20, 30 years ago, that 0:09:15.940 --> 0:09:17.050 was a, let's say, a 0:09:17.050 --> 0:09:21.370 controversial topic. But the answer is now clear. And by 0:09:21.370 --> 0:09:22.390 taking that bone off, 0:09:22.390 --> 0:09:23.920 like you said, requires 0:09:23.920 --> 0:09:25.359 the bone to be either stored in a 0:09:25.360 --> 0:09:27.130 freezer or stored sometimes 0:09:27.130 --> 0:09:29.920 under the skin of your abdominal wall. And that leads 0:09:29.920 --> 0:09:31.990 risk for infection. Just like if you leave something in 0:09:31.990 --> 0:09:35.200 your refrigerator for too long, it's not good anymore. And 0:09:35.200 --> 0:09:37.660 that bone shrivels up or gets infected. And that's where 0:09:37.660 --> 0:09:40.569 I come into play. So I've been placing skull implants 0:09:40.570 --> 0:09:42.189 for the last 10 or 11 years. 0:09:42.280 --> 0:09:45.130 I place a lot more than the average surgeon. 0:09:45.340 --> 0:09:49.990 I've invented different design algorithms. Unlike the original design algorithm 0:09:49.990 --> 0:09:52.240 for skull implants, when skull implants were started around the 0:09:52.240 --> 0:09:52.990 year 2000, 0:09:53.320 --> 0:09:54.760 they were built and only 0:09:54.760 --> 0:09:57.939 manufactured to replace the missing bone. But when that bone 0:09:57.940 --> 0:09:58.270 comes 0:09:58.270 --> 0:09:59.710 off, you also have muscle 0:09:59.710 --> 0:10:01.900 and fat that shrinks away. And so if you don't 0:10:01.900 --> 0:10:04.000 design the implant the right way, you'll still end up 0:10:04.000 --> 0:10:06.250 having a dent because it's not filling in the muscle 0:10:06.250 --> 0:10:08.530 and the fat that you're missing. The other thing that 0:10:08.530 --> 0:10:12.250 we've invented recently, our smart cranial implants, just like your 0:10:12.250 --> 0:10:15.070 phone has changed your life, there is no reason why 0:10:15.070 --> 0:10:18.220 we shouldn't be putting in smart cranial implants. Many of 0:10:18.220 --> 0:10:21.040 these patients that you just described in your nerves critical 0:10:21.040 --> 0:10:24.010 care unit have brain injuries that either lead to hydrostatic. 0:10:24.080 --> 0:10:27.140 Fliss or a high pressure inside their head or seizures 0:10:27.140 --> 0:10:30.500 with epilepsy, so why are we taking giant 3D printed 0:10:30.500 --> 0:10:34.059 skull implants that are solid and plastic with underutilized space 0:10:34.400 --> 0:10:37.010 and so it hopkins'. We've written many patents and performed 0:10:37.010 --> 0:10:39.980 many first in human operations, using that space inside to 0:10:39.980 --> 0:10:43.579 add technologies to us. It's the ultimate wearable technology and 0:10:43.580 --> 0:10:45.260 we can reconstruct you with that same 0:10:45.260 --> 0:10:47.000 skull implant and nobody knows there's 0:10:47.000 --> 0:10:47.690 things inside 0:10:48.050 --> 0:10:51.050 by smart. Do you mean, Doctor, that it actually allows 0:10:51.050 --> 0:10:52.640 for expansion at certain times? 0:10:52.670 --> 0:10:55.340 No, that's a good question, Bill. By meaning smart, I mean, 0:10:55.340 --> 0:10:58.670 it has an inherent function inside rather than being a 0:10:58.670 --> 0:11:01.430 solid piece of plastic that was made with a 3-D 0:11:01.429 --> 0:11:02.719 printer to reconstruct 0:11:02.720 --> 0:11:05.450 your missing bone. Why wouldn't I put a device in 0:11:05.450 --> 0:11:08.030 there that helps the brain that's injured three or four 0:11:08.030 --> 0:11:10.370 millimeters away? So either a computer 0:11:10.370 --> 0:11:11.020 in there, a 0:11:11.030 --> 0:11:13.819 biosensor in there that tells you the pressure's high, a 0:11:13.820 --> 0:11:15.920 shutoff valve in there, maybe have too much fluid on 0:11:15.920 --> 0:11:19.130 your brain like a hydrocephalus. The most exciting thing that 0:11:19.130 --> 0:11:19.819 we're developing 0:11:19.820 --> 0:11:21.559 right now, and we're actually 0:11:21.559 --> 0:11:24.350 in the middle of animal trials similar to Elon Musk 0:11:24.350 --> 0:11:27.380 with his animal trials is we're creating the world's first 0:11:27.410 --> 0:11:30.800 full implant with a medicine reservoir that will deliver medicine 0:11:30.800 --> 0:11:34.250 through multiple catheters to your brain. To Stephen's point, he 0:11:34.250 --> 0:11:37.370 has dozens of patients that come through the NICU with 0:11:37.370 --> 0:11:39.820 brain problems related to their brain tumors. 0:11:40.130 --> 0:11:40.970 It's hard to 0:11:40.970 --> 0:11:43.670 fix brain tumors because of the blood brain barrier. We 0:11:43.670 --> 0:11:45.319 just can't get medicine to the brain. 0:11:45.830 --> 0:11:46.670 The brain is designed 0:11:46.670 --> 0:11:50.120 to keep out toxins just like chemotherapy agents. And so 0:11:50.120 --> 0:11:52.070 we're going to try to bypass the blood brain barrier 0:11:52.070 --> 0:11:54.559 like never before. And we're going to put these skull 0:11:54.559 --> 0:11:56.750 implants in and it's going to have a gas tank 0:11:56.870 --> 0:11:59.060 and it's going to have catheters and it's going to 0:11:59.059 --> 0:12:00.220 revolutionize the world. 0:12:00.650 --> 0:12:02.090 So question for you, because 0:12:02.090 --> 0:12:05.180 obviously, I mean, I'll have to just deduce that if 0:12:05.179 --> 0:12:08.300 somebody is having any kind of neurosurgery, it would be 0:12:08.300 --> 0:12:09.260 ideal to have a 0:12:09.260 --> 0:12:12.050 plastic's approach initially 0:12:12.050 --> 0:12:14.570 rather than just to have an plastic's approach after 0:12:14.570 --> 0:12:16.850 the fact and with the few 0:12:16.850 --> 0:12:21.890 thousand institutions that perform neurosurgery. My understanding is that there's 0:12:21.890 --> 0:12:22.400 only one. 0:12:22.400 --> 0:12:24.500 Dr. Gordon, what do we do 0:12:24.500 --> 0:12:28.010 at our local community hospital that needs neurosurgery? What can 0:12:28.010 --> 0:12:30.650 we tell our neurosurgeons? How can we alter their 0:12:30.650 --> 0:12:32.030 approach so that 0:12:32.030 --> 0:12:34.429 your work is much less invasive or 0:12:34.429 --> 0:12:36.020 intensive three months 0:12:36.020 --> 0:12:38.090 down the road, six months down the road, when they 0:12:38.090 --> 0:12:39.290 actually have to come to you? 0:12:40.070 --> 0:12:42.890 There's not enough we can do. And the way we 0:12:42.890 --> 0:12:46.430 do this is we approach it from multiple angles. Number one, 0:12:46.429 --> 0:12:48.740 we started a fellowship at Johns Hopkins. So we train 0:12:48.740 --> 0:12:50.360 one or two surgeons a year that come in from 0:12:50.360 --> 0:12:53.000 around the world, around the country, and they spend one 0:12:53.000 --> 0:12:55.020 or two years with us and they do one hundred 0:12:55.020 --> 0:12:58.189 and thirty skull reconstructions in one year. And I teach 0:12:58.190 --> 0:13:00.710 them all the fine details. So that allows them to 0:13:00.710 --> 0:13:02.090 leave Baltimore and go start their 0:13:02.090 --> 0:13:03.530 own program with another 0:13:03.530 --> 0:13:06.620 amazing brain surgery program. And so that's one angle. But 0:13:06.620 --> 0:13:08.179 as you could see, that's puny. 0:13:08.270 --> 0:13:08.750 That's going to 0:13:08.750 --> 0:13:11.540 take a millennium to really reach the world. The other 0:13:11.540 --> 0:13:13.760 thing we do is we do a symposium every year, 0:13:13.820 --> 0:13:15.559 as you touched on in the beginning of the show, 0:13:15.860 --> 0:13:18.410 we've gone back and forth between Johns Hopkins and Harvard 0:13:18.410 --> 0:13:20.090 Medical School for the last six years. 0:13:20.330 --> 0:13:21.020 And we bring 0:13:21.020 --> 0:13:23.990 together neurosurgeons and plastic surgeons and experts from 0:13:23.990 --> 0:13:25.490 around the world. And we try to 0:13:25.490 --> 0:13:27.650 open up the other side of the brain and say, 0:13:27.770 --> 0:13:30.560 put the ego aside as a neurosurgeon and say maybe 0:13:30.559 --> 0:13:33.079 I should work more with my plastic surgeon. And then 0:13:33.080 --> 0:13:35.460 for the plastic surgeon that attends the conference, we show 0:13:35.460 --> 0:13:37.550 him these new techniques that I employ in Baltimore 0:13:37.910 --> 0:13:39.410 and to show them, yes, as a 0:13:39.410 --> 0:13:43.190 plastic surgeon doing hand surgery or breast cancer, maybe open 0:13:43.190 --> 0:13:46.099 your eyes to the idea or conception that you can 0:13:46.100 --> 0:13:47.840 work more closely with your neurosurgeon. 0:13:48.290 --> 0:13:51.410 Most of the plastic reconstructive surgeons I know have gone 0:13:51.410 --> 0:13:54.710 into the big money fields, the cosmetic fields, to use 0:13:54.710 --> 0:13:57.170 the word that you despise, how to make people look 0:13:57.170 --> 0:14:00.260 prettier and also to make lots of money in so doing. 0:14:00.590 --> 0:14:03.410 So what made you decide to do something that is 0:14:03.410 --> 0:14:04.910 really in a much more 0:14:04.910 --> 0:14:06.439 academic and much more 0:14:06.440 --> 0:14:09.290 altruistic endeavor? What was it that motivated you? 0:14:09.710 --> 0:14:10.580 The real answer 0:14:10.580 --> 0:14:12.080 is that when I went to 0:14:12.080 --> 0:14:13.729 college, I started off as a 0:14:13.730 --> 0:14:15.140 chemistry major and they 0:14:15.140 --> 0:14:18.080 made me take either a language or an art class. 0:14:18.650 --> 0:14:20.930 So I took art and it was drawing one to 0:14:20.930 --> 0:14:22.780 one and I fell in love with it. And by 0:14:22.790 --> 0:14:24.920 sophomore year, I went back to my premed advisor and 0:14:24.920 --> 0:14:27.530 I said, you know, I really love this drawing and sculpture. 0:14:27.890 --> 0:14:30.080 I said, I'm thinking of going as a fine arts 0:14:30.080 --> 0:14:32.570 major with a minor in chemistry. And they said, you're 0:14:32.570 --> 0:14:36.140 absolutely crazy. You'll never go to medical school. This is 0:14:36.140 --> 0:14:38.720 the stupidest thing I've heard in a long time. And 0:14:38.720 --> 0:14:41.470 I just decided to push through it. And I finished 0:14:41.480 --> 0:14:44.630 as a premed major with a major fine arts drawing sculpture, 0:14:44.960 --> 0:14:47.840 and I pushed through to get into medical school. And 0:14:47.840 --> 0:14:49.280 when I was there, I realized 0:14:49.670 --> 0:14:50.720 the beautiful thing about 0:14:50.720 --> 0:14:52.850 being a fine arts majors. They teach you something called 0:14:52.850 --> 0:14:54.740 a mind's eye, which is the ability to see it 0:14:54.740 --> 0:14:57.500 before you create it. And I think what that helped 0:14:57.500 --> 0:15:00.230 me do was to give me a new perspective for 0:15:00.230 --> 0:15:04.550 school reconstruction that the neurosurgeons had and developed. A neurosurgeon 0:15:04.850 --> 0:15:05.720 most often is 0:15:05.720 --> 0:15:06.560 coming to a 0:15:06.560 --> 0:15:10.430 skull reconstruction as an afterthought. They've already done the part 0:15:10.430 --> 0:15:12.980 that they care most about. This is just something that 0:15:12.980 --> 0:15:14.600 needs to be done so the patient can wake up 0:15:14.600 --> 0:15:17.470 and move on. That's not what it is for me. 0:15:17.630 --> 0:15:19.070 For me, it's fixing the 0:15:19.070 --> 0:15:20.330 patient and let's 0:15:20.330 --> 0:15:23.120 say an artistic way point blank so it doesn't look 0:15:23.120 --> 0:15:24.600 like you ever had. Skull reconstruction, 0:15:24.900 --> 0:15:26.700 and I think in the right way, 0:15:26.700 --> 0:15:27.000 done 0:15:27.000 --> 0:15:28.800 safely, we can get you there. 0:15:29.520 --> 0:15:33.060 So, Dr. Gordon, I understand you've also received some awards 0:15:33.060 --> 0:15:33.960 for computer 0:15:33.960 --> 0:15:35.460 assisted and robot 0:15:35.460 --> 0:15:37.570 assisted technologies. What are you doing there? 0:15:38.040 --> 0:15:41.520 When I came to Hopkins, it was actually part of 0:15:41.520 --> 0:15:45.420 a team they were building for reconstruction of face patients 0:15:45.420 --> 0:15:47.100 who needed face transplantation. 0:15:47.190 --> 0:15:48.210 You were actually involved 0:15:48.210 --> 0:15:49.920 in one of the first ones that Cleveland was? 0:15:49.950 --> 0:15:52.530 Yes. So the first face transplant, the United States was 0:15:52.530 --> 0:15:54.900 done in December 2008. I was on the team. It 0:15:54.900 --> 0:15:56.910 was an extremely amazing time in my life. 0:15:57.270 --> 0:15:58.080 And after I 0:15:58.080 --> 0:16:00.150 had gone to Boston and finished training, I was recruited 0:16:00.150 --> 0:16:02.010 to Hopkins to help with face transplant program. 0:16:02.490 --> 0:16:03.120 And when I got 0:16:03.120 --> 0:16:05.100 here, I realized that the first one we did in 0:16:05.100 --> 0:16:07.410 the United States took us twenty two hours. But when 0:16:07.410 --> 0:16:10.110 we spent maybe eight hours dissecting a face off of 0:16:10.110 --> 0:16:11.760 the donor who was brain dead 0:16:11.760 --> 0:16:13.920 but still with a beating heart, and we had a 0:16:13.920 --> 0:16:15.000 wonderful recipient, 0:16:15.000 --> 0:16:16.320 kind of cold, who needed a 0:16:16.320 --> 0:16:18.660 face after being shot in the face by her husband. 0:16:18.840 --> 0:16:20.310 We literally brought the 0:16:20.310 --> 0:16:22.800 face out of room number four and went into room 0:16:22.800 --> 0:16:25.860 number five. And we went like this. How do they 0:16:25.860 --> 0:16:26.430 go together? 0:16:26.680 --> 0:16:29.060 You know, it was literally a guesstimate. 0:16:29.220 --> 0:16:31.080 And when I got to Baltimore, I realized there were 0:16:31.080 --> 0:16:33.780 so many smart people around me. If I could take 0:16:33.780 --> 0:16:36.290 out my cell phone and get to the market much better, 0:16:36.330 --> 0:16:39.270 I'm sure we could design computers and robots programs to 0:16:39.270 --> 0:16:41.940 either help with face transplant or to even help with 0:16:41.940 --> 0:16:44.130 skull reconstruction. And that's what we've done and we've gotten 0:16:44.130 --> 0:16:45.270 many patents on that. 0:16:45.390 --> 0:16:48.060 Is that like a 3-D mapping of the face and 0:16:48.060 --> 0:16:48.880 skull structure? 0:16:48.930 --> 0:16:53.250 That's exactly right. So imagine something in space and something 0:16:53.250 --> 0:16:56.820 that needs that floating object and having a computer guided 0:16:56.820 --> 0:16:59.550 program that changes from green to blue when it lands 0:16:59.550 --> 0:17:01.890 in the right spot. You know, it's something as simple 0:17:01.890 --> 0:17:05.490 as that. And what's ironic is when we developed that 0:17:05.490 --> 0:17:07.830 for face, we realized, well, this object could be a 0:17:07.830 --> 0:17:10.470 skull implant and the recipient could just be a skull 0:17:10.470 --> 0:17:11.640 missing part of his skull. 0:17:11.910 --> 0:17:13.590 And so a face go into 0:17:13.590 --> 0:17:13.949 a face 0:17:13.950 --> 0:17:15.629 recipient is almost like a skull 0:17:15.630 --> 0:17:18.270 implant going to skull recipient. So there was a lot 0:17:18.270 --> 0:17:21.449 of overlap. Again, the most exciting ones I like to 0:17:21.450 --> 0:17:24.720 talk about are the skull implants of the future. We 0:17:24.720 --> 0:17:28.980 literally are designing skull implants that will be around in 20, 30, 20, 40. 0:17:29.190 --> 0:17:31.949 And you're going to remember tonight's radio show and you're 0:17:31.950 --> 0:17:34.380 going to say, man, I thought that guy was crazy 0:17:34.380 --> 0:17:36.689 when he was talking about putting things aside, solid pieces 0:17:36.690 --> 0:17:39.629 of plastic. And it's going to be normal. For instance, 0:17:39.630 --> 0:17:41.910 I have an animal right now walking around with four 0:17:41.910 --> 0:17:45.810 catheters in his brain and nobody can tell because the 0:17:45.810 --> 0:17:49.050 animal looks normal. Here's a crazy statistic, Bill. 0:17:49.380 --> 0:17:50.040 As soon as we 0:17:50.040 --> 0:17:52.170 turn sixty five, one in five of us will have 0:17:52.170 --> 0:17:55.530 a brain problem that will require surgery. And one, when 0:17:55.530 --> 0:17:56.220 you require 0:17:56.220 --> 0:17:57.540 surgery, you're going to want 0:17:57.540 --> 0:17:59.490 to look like yourself and you're going to want to 0:17:59.490 --> 0:18:00.390 go back to your amazing 0:18:00.390 --> 0:18:01.770 job and you're going to want to 0:18:01.770 --> 0:18:03.540 go out for dinner without the waiter looking at the 0:18:03.540 --> 0:18:04.950 side of your head and saying, why is he a 0:18:04.950 --> 0:18:06.840 dent on the side of your head or why does 0:18:06.840 --> 0:18:08.190 he have a bump on the side of his head? 0:18:08.190 --> 0:18:11.159 Because they put some technology above his skull. We're going 0:18:11.160 --> 0:18:13.199 to create these things that fit in right into the 0:18:13.200 --> 0:18:16.530 bone space, connect to your brain, close the scalp up 0:18:16.740 --> 0:18:18.389 and nobody will know you're either getting 0:18:18.390 --> 0:18:19.710 battery powered 0:18:19.710 --> 0:18:23.190 electric waves to your brain. It's pretty much what Apple 0:18:23.190 --> 0:18:24.660 and Google and 0:18:24.930 --> 0:18:27.630 all these cell phone companies did over the last thirty years. 0:18:27.960 --> 0:18:29.430 We're going to do with skull implants. 0:18:33.190 --> 0:18:36.090 We're going to take 30 seconds and we'll be right back. 0:18:43.280 --> 0:18:47.120 A moment of your time, a new podcast from Kerkow Media, 0:18:47.810 --> 0:18:51.860 currently 21 years old and today, like magic, extended from 0:18:51.859 --> 0:18:53.900 her fingertips down to the blood to take 0:18:53.900 --> 0:18:55.880 care of yourself because the world needs 0:18:55.880 --> 0:18:56.920 you and you meet 0:18:56.930 --> 0:18:58.760 every do gooder that asked about me was ready to 0:18:58.760 --> 0:19:01.580 spit on my dream. Fingers were facing. You can feel 0:19:01.580 --> 0:19:03.619 like your purpose in your worth is 0:19:03.740 --> 0:19:06.460 really being done to stop me from playing the piano. 0:19:06.470 --> 0:19:09.290 She buys walkie talkies, wonders to whom she should give 0:19:09.290 --> 0:19:10.310 the second. I don't 0:19:10.310 --> 0:19:10.669 love 0:19:10.670 --> 0:19:13.490 humans. We never did. We never. Well, we just find 0:19:13.490 --> 0:19:14.040 what you do. 0:19:14.100 --> 0:19:16.879 Rock climbing is that you can only focus on what's 0:19:16.880 --> 0:19:21.620 right in life. And so our American life begins. We 0:19:21.619 --> 0:19:25.609 may need to stay apart, but let's create together available 0:19:25.609 --> 0:19:29.690 on all podcast platforms. Submit your piece at Kerkow dot com, 0:19:29.690 --> 0:19:30.980 slash a moment of your time. 0:19:37.440 --> 0:19:40.020 Dr. Steve, I wonder if you could tell me you 0:19:40.020 --> 0:19:43.560 were certified in your neuro critical care sometime in the 0:19:43.560 --> 0:19:46.619 last number of years, what are the types of patients 0:19:46.619 --> 0:19:49.620 that come to your hospital? Why are they there? What 0:19:49.619 --> 0:19:51.929 brought them to you? What type of critical care do 0:19:51.930 --> 0:19:54.000 they need and how could this apply? 0:19:54.720 --> 0:19:57.570 Well, that's actually why I asked Dr. Gordon. The question 0:19:57.570 --> 0:20:01.050 relative to craniectomy is because I was the medical director 0:20:01.050 --> 0:20:03.810 of a trauma center for 20 years. But my current 0:20:03.810 --> 0:20:05.669 hospital is not a trauma center. 0:20:05.970 --> 0:20:06.419 So on the 0:20:06.420 --> 0:20:10.139 trauma side, there were a lot of patients with gunshot wounds, 0:20:10.350 --> 0:20:15.390 crush injuries from motor vehicle accidents, periodic explosions where there 0:20:15.390 --> 0:20:18.350 would be just penetrating trauma to the skull that that 0:20:18.359 --> 0:20:22.770 created its own defects in my current institution. Now, in 0:20:22.770 --> 0:20:23.250 the neuro 0:20:23.250 --> 0:20:24.930 ICU, we're still clipping 0:20:24.930 --> 0:20:27.690 some aneurysms. Most of them are being coiled, but those 0:20:27.690 --> 0:20:29.939 do require removal of a skull 0:20:29.940 --> 0:20:31.109 flap so that 0:20:31.109 --> 0:20:34.530 the blood vessel that has a defect can be corrected, 0:20:34.680 --> 0:20:37.290 but then that it does leave a defect that needs 0:20:37.290 --> 0:20:40.170 to be replaced. Often in our institution 0:20:40.170 --> 0:20:41.520 with the native bone, 0:20:41.790 --> 0:20:45.899 we do a fair number of emergency craniectomy where the 0:20:45.900 --> 0:20:47.669 brain is so swollen that in order to 0:20:47.670 --> 0:20:49.260 save the patient, you must 0:20:49.260 --> 0:20:50.280 remove a large 0:20:50.280 --> 0:20:51.659 bone flap to allow the 0:20:51.660 --> 0:20:54.090 brain to swell. The brain cannot 0:20:54.090 --> 0:20:55.590 swell very much 0:20:55.590 --> 0:20:59.370 without permanent damage because it's an enclosed space. The beauty 0:20:59.369 --> 0:21:02.670 of the skull is that it keeps the brain very 0:21:02.670 --> 0:21:06.660 well protected. It's sort of buoyant in cerebrospinal fluid. So 0:21:06.660 --> 0:21:09.540 it has internal fluid where the brain can sort of 0:21:09.540 --> 0:21:13.260 bounce around. But there's only room for some fluids, some 0:21:13.260 --> 0:21:16.200 blood and brain tissue. And as soon as you exceed 0:21:16.200 --> 0:21:17.670 your limit, the brain has nowhere 0:21:17.670 --> 0:21:20.400 to go. If you have swelling in your abdomen, you 0:21:20.400 --> 0:21:25.350 can get massively distended without causing major problems. Once your 0:21:25.350 --> 0:21:28.260 brain starts to swell, you have only a little bit 0:21:28.260 --> 0:21:28.410 of 0:21:28.410 --> 0:21:31.050 leeway before that swelling starts 0:21:31.050 --> 0:21:35.310 compressing blood vessels and occludes the blood supply and does 0:21:35.310 --> 0:21:37.920 even more damage to the brain. So you can have 0:21:37.920 --> 0:21:39.659 your initial injury. But then it's the 0:21:39.660 --> 0:21:41.400 swelling that puts so 0:21:41.400 --> 0:21:44.310 much pressure within the brain itself that it starts clamping 0:21:44.310 --> 0:21:47.670 off its own vasculature and then the more brain dies 0:21:47.670 --> 0:21:49.500 because of the brain swelling 0:21:49.859 --> 0:21:52.320 and then the brain has nowhere to go. So it 0:21:52.320 --> 0:21:55.200 tends to go down the center hole where the spinal 0:21:55.200 --> 0:21:57.960 cord is. And so that's what's called a herniation. And 0:21:57.960 --> 0:22:00.150 you cannot come back from that once you get to 0:22:00.150 --> 0:22:03.600 a certain point. So to prevent the swelling from being 0:22:03.600 --> 0:22:06.780 catastrophic and causing brain injury, one of the 0:22:06.780 --> 0:22:10.200 heroic emergency procedures that we see in my institution would 0:22:10.200 --> 0:22:10.890 be an emergency 0:22:10.890 --> 0:22:13.770 craniectomy where the brain is swelling. Now, you give 0:22:13.770 --> 0:22:15.150 it a point of egress 0:22:15.300 --> 0:22:17.399 that will not be harmful. So you open up 0:22:17.400 --> 0:22:20.609 a big skull flap, you let the brain swell, relieve 0:22:20.609 --> 0:22:23.280 the pressure so that the circulation in the brain is 0:22:23.280 --> 0:22:24.060 maintained 0:22:24.330 --> 0:22:28.290 until which time? The underlying problem that caused the swelling 0:22:28.290 --> 0:22:31.409 is able to heal and resolve, and then the brain 0:22:31.410 --> 0:22:33.690 shrinks back down into its normal 0:22:33.690 --> 0:22:35.100 cavity. How does something 0:22:35.100 --> 0:22:38.669 like that happen without terrible risk of infection in the brain? 0:22:38.670 --> 0:22:41.510 If you actually remove someone's top of someone's head, 0:22:41.550 --> 0:22:43.790 well, the scalp will be put back together. 0:22:43.800 --> 0:22:45.000 So the way to look 0:22:45.000 --> 0:22:47.820 at is almost like a three layer peanut butter and 0:22:47.820 --> 0:22:50.340 jelly sandwich. Right? You have your scalp, your bone in 0:22:50.340 --> 0:22:53.280 your brain. And so just because you remove the bone, 0:22:53.640 --> 0:22:56.070 the brain has a lot of room to swell, maybe 0:22:56.070 --> 0:22:58.469 a half an inch, let's say, but the scalp will 0:22:58.470 --> 0:22:59.159 be closed. 0:22:59.310 --> 0:23:00.869 And so the infection 0:23:00.869 --> 0:23:03.659 risk is really coming from the bacteria that's above your skin. 0:23:03.990 --> 0:23:07.050 But to Stephen's point, I'll give him an example of 0:23:07.050 --> 0:23:09.840 why I think skull implants are the future here to stay. 0:23:10.140 --> 0:23:14.159 Stephen's talking about what we describe as intracranial hypertension. Your 0:23:14.160 --> 0:23:18.040 brain is gelo floating in water filled within a structure, 0:23:18.060 --> 0:23:19.190 the box, the skull. 0:23:19.260 --> 0:23:20.910 OK, now, if you add 0:23:20.910 --> 0:23:23.490 blood to that, as Stephen said, or you make swelling 0:23:23.490 --> 0:23:25.770 occur in the brain, you're adding too much pressure in 0:23:25.770 --> 0:23:26.429 the box 0:23:26.430 --> 0:23:28.030 and that's risking life, period. 0:23:28.200 --> 0:23:30.360 So what we need is a pressure monitor. We need 0:23:30.359 --> 0:23:31.379 a pressure sensor. 0:23:31.380 --> 0:23:32.219 And so that's what we 0:23:32.220 --> 0:23:34.140 did three years ago. We did the world's first skull 0:23:34.140 --> 0:23:37.530 implant with a pressure sensor inside. Just let's say, like 0:23:37.530 --> 0:23:38.580 you cook a turkey 0:23:38.580 --> 0:23:40.230 in the oven and that little thing pops out of 0:23:40.230 --> 0:23:42.870 the turkey when it's done. That's the size of this 0:23:42.869 --> 0:23:45.450 little sensor that we put in a second plant. Now, 0:23:45.450 --> 0:23:47.340 to Stephen's point, he's going to say, why did you 0:23:47.340 --> 0:23:48.960 do this first world's case? 0:23:49.200 --> 0:23:51.210 And my answer is going to be that we had 0:23:51.210 --> 0:23:51.740 a 16 0:23:51.750 --> 0:23:52.050 year old 0:23:52.050 --> 0:23:53.250 woman who was shot 0:23:53.250 --> 0:23:56.730 in the head, unfortunately, wrong place, wrong time. And after 0:23:56.730 --> 0:23:59.669 the bullet transverse the side of her brain, the non 0:23:59.670 --> 0:24:02.639 important side, she had a long four or five month 0:24:02.640 --> 0:24:03.989 recovery where she was able to 0:24:03.990 --> 0:24:05.250 walk and speak again. 0:24:05.550 --> 0:24:09.179 However, her skull was never put back. And the reason 0:24:09.180 --> 0:24:10.889 why I had never been put back is because her 0:24:10.890 --> 0:24:13.649 brain never really got rid of the swelling. So the 0:24:13.650 --> 0:24:16.740 mother came to Baltimore with her daughter and said, Dr. Gordon, 0:24:17.130 --> 0:24:19.679 I'm here to get a skull reconstruction from my daughter 0:24:19.680 --> 0:24:21.450 because she wants to go back to a normal life 0:24:21.450 --> 0:24:22.830 not worrying about falling down. 0:24:22.980 --> 0:24:23.760 Her balance is a 0:24:23.760 --> 0:24:26.250 little off because her brain doesn't really have that box. 0:24:26.640 --> 0:24:28.739 But on the other hand, I'm thinking of running out 0:24:28.740 --> 0:24:30.720 of your office because I'm scared that when you go 0:24:30.720 --> 0:24:31.109 to put the 0:24:31.109 --> 0:24:32.640 skull implant on top of my 0:24:32.640 --> 0:24:34.949 daughter's brain that's swollen, you're going to cause her to 0:24:34.950 --> 0:24:37.669 herniate like Stephen described. You're going to. Pushing on her 0:24:37.670 --> 0:24:40.310 swollen brain, so I sat the mom down and said, 0:24:40.760 --> 0:24:43.010 how would you like it if we created the world's 0:24:43.010 --> 0:24:43.250 first 0:24:43.250 --> 0:24:45.170 skull implant with a pressure monitor 0:24:45.350 --> 0:24:48.010 inside that skull implant? It's just a piece of plastic. 0:24:48.290 --> 0:24:51.230 We have wireless technology that's already FDA approved. It's just 0:24:51.230 --> 0:24:53.870 nobody ever did it before. And how about I carve 0:24:53.869 --> 0:24:56.180 out a little space in that piece of plastic? I'll 0:24:56.180 --> 0:24:58.669 put a little pressure sensor right above your daughter's brain 0:24:59.000 --> 0:25:02.330 and we could test it wirelessly. Three days after surgery, 0:25:02.330 --> 0:25:05.510 three months after surgery, three years after surgery. So if 0:25:05.510 --> 0:25:08.960 your daughter was to have problems from her head, let's say, 0:25:08.960 --> 0:25:11.510 a headache or change in vision, you could look at 0:25:11.510 --> 0:25:14.180 me and say, is it because you put that skull 0:25:14.180 --> 0:25:16.490 implant that my daughter's having that problems? Or is it 0:25:16.490 --> 0:25:18.800 because she has math homework to do and she has 0:25:18.800 --> 0:25:21.500 a headache? And I could just wave a little wand 0:25:21.500 --> 0:25:22.220 over that smart 0:25:22.220 --> 0:25:23.600 implant, and that's what we did. 0:25:23.990 --> 0:25:26.780 And it was miraculous. It was just published in one 0:25:26.780 --> 0:25:29.330 of the main neurosurgery journals around the world last year. 0:25:29.720 --> 0:25:30.710 And it was the world's 0:25:30.710 --> 0:25:33.500 first smart cranial implant. And I think it's a tip 0:25:33.500 --> 0:25:34.110 of the iceberg. 0:25:34.460 --> 0:25:36.649 A look at your phone. Look how your phone 0:25:36.650 --> 0:25:40.850 changed your life. The single most important organ in your body, Bill, 0:25:41.030 --> 0:25:41.800 is your brain. 0:25:42.050 --> 0:25:44.460 The next one hundred years is about your brain. 0:25:44.840 --> 0:25:46.639 Guess what? You have a bad heart. You have a 0:25:46.640 --> 0:25:47.510 bad lung. You have 0:25:47.510 --> 0:25:49.190 bad liver. You have bad kidneys. 0:25:49.400 --> 0:25:52.310 We got stuff for that. Transplants, machines, whatever you need. 0:25:52.310 --> 0:25:55.310 We got it. You have a bad brain. We have nothing. 0:25:55.490 --> 0:25:58.400 And we will never transplant you a new brain. We 0:25:58.400 --> 0:26:01.490 can only modify the brain that you were born with. Now, 0:26:01.490 --> 0:26:03.350 how are we going to modify your brain over the 0:26:03.350 --> 0:26:06.679 next one hundred years? Guess what? Surgeons from around the 0:26:06.680 --> 0:26:10.550 world have spent billions of dollars developing techniques and 0:26:10.550 --> 0:26:13.730 technologies to put above your skin. OK, nobody wants to 0:26:13.730 --> 0:26:16.490 walk around like Frankenstein with something on their head. They've 0:26:16.490 --> 0:26:18.739 also developed technology that sits above your 0:26:18.740 --> 0:26:20.090 skull, under your skin, 0:26:20.359 --> 0:26:22.430 but you have a bump still on your head and 0:26:22.430 --> 0:26:24.619 it can actually poke up through the skin. With respect 0:26:24.619 --> 0:26:28.100 to time, no one's ever stopped and said, why don't 0:26:28.100 --> 0:26:29.420 we use the space inside 0:26:29.420 --> 0:26:30.949 the skull to modify the brain? 0:26:31.250 --> 0:26:33.470 And that's what we started five years ago. And that's 0:26:33.470 --> 0:26:34.909 why we're super excited, because 0:26:34.910 --> 0:26:37.460 we believe we've solved the Holy Grail. 0:26:37.790 --> 0:26:40.130 The Holy Grail is for the next one hundred years 0:26:40.280 --> 0:26:40.940 to develop 0:26:40.940 --> 0:26:42.199 technologies that will 0:26:42.200 --> 0:26:42.920 modulate 0:26:42.920 --> 0:26:44.510 your brain, whatever disease 0:26:44.510 --> 0:26:48.170 you, God forbid, develop as you get into the 60s, 70s, 80s, 90s. 0:26:48.470 --> 0:26:50.660 We will have an answer for that and we will 0:26:50.660 --> 0:26:53.240 miniaturize it to the point of where on the side 0:26:53.240 --> 0:26:54.890 of your cell phone, you know, you have that little 0:26:54.890 --> 0:26:57.080 micro SD card that popped out of the side of 0:26:57.080 --> 0:26:59.720 your cell phone. I bet you that one day you're 0:26:59.720 --> 0:27:01.760 going to look back at this interview in thirty years 0:27:02.030 --> 0:27:04.429 and you're going to walk into somebody's office. They're going 0:27:04.430 --> 0:27:06.530 to make a little cut your skin. They're going to 0:27:06.530 --> 0:27:08.780 pop out a little micro SD card out of your 0:27:08.780 --> 0:27:11.540 skull implant. And it's because you said your memory's a 0:27:11.540 --> 0:27:13.760 little bad. You're just going to get a new chip. 0:27:13.910 --> 0:27:16.850 You're going to upgrade from eight megabytes to 16 megabytes. 0:27:17.119 --> 0:27:19.670 So I have to ask you about some side effects here. 0:27:19.670 --> 0:27:23.780 When you're replacing the skull with a plastic, do you 0:27:23.810 --> 0:27:27.919 find that you've had to manage debilitating headaches? What are 0:27:27.920 --> 0:27:31.010 the side effects and ramifications of some of these surgeries? 0:27:31.220 --> 0:27:34.790 In nineteen sixty eight, there was a orthopedic surgeon that 0:27:34.790 --> 0:27:36.830 stood up in front of all his colleagues and said, 0:27:37.070 --> 0:27:40.430 we're doing it completely wrong. And everybody said, what? What's 0:27:40.430 --> 0:27:42.710 he talking about? This orthopedic surgeon 0:27:42.710 --> 0:27:43.910 said that the way we 0:27:43.910 --> 0:27:47.810 treat osteoarthritis or joint disease of the knee is we 0:27:47.810 --> 0:27:50.270 used to put a metal rod or metal plate across 0:27:50.270 --> 0:27:52.220 the knee and fused the knee so you don't bend 0:27:52.220 --> 0:27:54.890 your knee is that we're doing it wrong? We need 0:27:54.890 --> 0:27:55.730 to cut the knee 0:27:55.730 --> 0:27:57.109 out, literally cut the 0:27:57.109 --> 0:27:59.300 knee out that you were born with and take a 0:27:59.300 --> 0:28:01.340 box and open up a piece of plastic or a 0:28:01.340 --> 0:28:04.730 plastic joint and replace that joint in nineteen sixty eight. 0:28:04.910 --> 0:28:07.250 He got booed off the stage and was told he's crazy. 0:28:07.609 --> 0:28:09.500 Well guess what, in twenty twenty one if you have 0:28:09.500 --> 0:28:12.050 a bad knee, nobody's going to question the fact that 0:28:12.050 --> 0:28:14.119 we're going to replace your joint that you were born 0:28:14.119 --> 0:28:16.430 with for a piece of plastic out of a box. 0:28:16.910 --> 0:28:19.520 When they started doing joint replacements, they had 0:28:19.520 --> 0:28:23.210 high problems with complications, infections and bleeding. 0:28:23.720 --> 0:28:27.170 But what happens was there was a subset of surgeons 0:28:27.170 --> 0:28:28.280 in orthopedic surgeons 0:28:28.280 --> 0:28:30.199 that said, you know what, I'm going to 0:28:30.200 --> 0:28:30.800 dedicate 0:28:30.800 --> 0:28:32.360 my life to doing knee 0:28:32.359 --> 0:28:35.600 replacement or I'm going to dedicate my life to shoulder replacement. 0:28:35.780 --> 0:28:38.690 And instead of doing one knee replacement a year, I'm 0:28:38.690 --> 0:28:41.090 going to do one hundred knee replacements a year. If 0:28:41.090 --> 0:28:43.760 you do something much more than the average person, your 0:28:43.760 --> 0:28:46.730 outcomes will be much better. Your complication rates will be 0:28:46.730 --> 0:28:49.970 much less. And that's why I developed neuroplastic surgery. The 0:28:49.970 --> 0:28:50.660 surgeons that we're 0:28:50.660 --> 0:28:51.920 training are saying, 0:28:51.920 --> 0:28:54.200 you know what, I'm going to dedicate my life to 0:28:54.200 --> 0:28:55.970 doing skull implants and doing skull 0:28:55.970 --> 0:28:57.590 reconstruction and getting less 0:28:57.590 --> 0:28:59.000 complications and better outcomes. 0:28:59.540 --> 0:29:02.330 Do you see in the future that ever there be 0:29:02.330 --> 0:29:05.690 a reason to have an implant in a healthy brain 0:29:05.690 --> 0:29:06.110 in order 0:29:06.110 --> 0:29:07.520 to predict potentially 0:29:07.520 --> 0:29:07.880 future 0:29:07.880 --> 0:29:09.530 problems? Yes. So let me take it 0:29:09.530 --> 0:29:10.310 one step further. 0:29:10.700 --> 0:29:14.060 I believe that we are going to start removing normal skulls. 0:29:14.510 --> 0:29:17.090 I believe there's patients, just like you said, whether it's 0:29:17.090 --> 0:29:20.180 normal skull, healthy skull or healthy brain. So if you 0:29:20.180 --> 0:29:20.720 come to me and 0:29:20.720 --> 0:29:22.160 you say, my mom and dad 0:29:22.160 --> 0:29:24.620 both had Alzheimer's and they both developed it in their 0:29:24.620 --> 0:29:28.040 fifties and I'm 30 years old and we have medicine 0:29:28.040 --> 0:29:29.600 nowadays that is affected 0:29:29.600 --> 0:29:31.670 to Alzheimer's. But when I give it to you in 0:29:31.670 --> 0:29:33.590 a pill form or inject it into your arm, it 0:29:33.590 --> 0:29:35.900 really doesn't get to your brain. So if I said 0:29:35.900 --> 0:29:36.650 to you at age 30. 0:29:36.710 --> 0:29:37.910 Five, that I 0:29:37.910 --> 0:29:40.760 have something that I can remove your totally normal skull 0:29:41.030 --> 0:29:42.800 and put in a little thing the size of a 0:29:42.800 --> 0:29:45.800 half dollar with a catheter into your brain and remove 0:29:45.800 --> 0:29:48.260 your normal skull. And for the next 15 years, I'm 0:29:48.260 --> 0:29:50.150 going to pump in medicine into your brain 0:29:50.300 --> 0:29:52.550 that can prevent Alzheimer's. And it's the size 0:29:52.550 --> 0:29:54.950 of a half dollar. Are you going to take that, Stephen? 0:29:55.490 --> 0:29:56.220 Yeah, you bet. 0:29:56.480 --> 0:29:58.100 There you go. So that's where we're going to be 0:29:58.370 --> 0:30:02.810 thinking about the military. Think about our military, our wounded warriors, 0:30:03.020 --> 0:30:05.180 see how much powerful things we could do to them. 0:30:05.180 --> 0:30:07.550 We could remove part of their normal skull. We could 0:30:07.550 --> 0:30:09.709 put medicine in there. So God forbid they're injured on 0:30:09.710 --> 0:30:12.980 the battlefield. You could take out your Bluetooth wireless cell 0:30:12.980 --> 0:30:16.940 phone and activate some pain medicine, some seizure medicine, whatever 0:30:16.940 --> 0:30:19.490 you need for your wounded warriors can be delivered in 0:30:19.490 --> 0:30:23.210 real time wirelessly from around the world. How about if 0:30:23.210 --> 0:30:24.200 I take out your normal 0:30:24.200 --> 0:30:27.920 skull and I put a little camera or ultrasound device 0:30:27.920 --> 0:30:29.150 into your skull space 0:30:29.360 --> 0:30:31.880 and let's say you had an aneurysm clipping, but the 0:30:31.880 --> 0:30:34.850 doctor who did the atavism clip thing tells you there's 0:30:34.850 --> 0:30:37.790 really a significant risk that the other side might have 0:30:37.790 --> 0:30:40.730 a problem one day and explode and cause bleeding. How 0:30:40.730 --> 0:30:42.590 cool would it be if I put a little camera 0:30:42.590 --> 0:30:45.200 inside your skull and you could check your cell phone 0:30:45.200 --> 0:30:46.790 once a day to see if you have blood inside 0:30:46.790 --> 0:30:48.990 your head or your doctor could check inside your skull? 0:30:49.190 --> 0:30:50.300 This is where we're going. 0:30:50.540 --> 0:30:52.010 I have no doubt we're going there. 0:30:52.130 --> 0:30:54.770 The question I have is how fast can we work 0:30:54.890 --> 0:30:57.830 and how big of a team can we create? Because 0:30:57.830 --> 0:30:59.600 these patients need it. They need it. 0:30:59.600 --> 0:31:03.110 Now, all I can say is, thank God we have 0:31:03.110 --> 0:31:06.170 people like you who are willing to dedicate yourself to 0:31:06.380 --> 0:31:09.620 something that initially feels like it's off the beaten path 0:31:09.620 --> 0:31:13.070 until you need it. We appreciate what all you guys do, 0:31:13.070 --> 0:31:16.700 but it sounds like you're really breaking tremendous new ground. 0:31:17.030 --> 0:31:19.490 How can they reach you? How can our neurosurgeons get 0:31:19.490 --> 0:31:22.610 in touch with you to possibly get some information that 0:31:22.610 --> 0:31:25.820 can help them with their initial surgical approaches? And then 0:31:25.820 --> 0:31:28.730 how do they reach you after the fact when perhaps 0:31:28.730 --> 0:31:30.430 they need your help with reconstruction? 0:31:30.440 --> 0:31:32.510 So the most simplest way, Stephen, is to go on 0:31:32.510 --> 0:31:35.750 Google and type in neuro plastic surgery. Chad Gordon, and 0:31:35.750 --> 0:31:37.940 you'll see everything we've done over the last 10 years. 0:31:37.940 --> 0:31:40.580 That would literally be the simplest way. If you want 0:31:40.580 --> 0:31:42.500 to take it one step further, you could type in 0:31:42.500 --> 0:31:46.880 Hopkins Medicine, Dogpatch Signora Plastic Surgery, and you'll get to 0:31:46.880 --> 0:31:50.480 answer a plastic surgery website with my office coordinator, our 0:31:50.480 --> 0:31:53.780 physician's assistant, and you'll get all our phone numbers and emails. 0:31:54.490 --> 0:31:57.380 Dr. Gordon, thank you very much for joining us today. Very, 0:31:57.380 --> 0:32:01.130 very enlightening. And of course, Dr. Tayback, my good friend, 0:32:01.580 --> 0:32:04.310 thank you as always, for joining after a long day 0:32:04.310 --> 0:32:07.670 of work, a special thanks to Johns Hopkins for providing 0:32:07.670 --> 0:32:09.890 us a tour of some of the most accomplished and 0:32:09.890 --> 0:32:13.520 dedicated specialists in medicine. I have no doubt we'll be 0:32:13.520 --> 0:32:17.060 back again next year diving into specialists we don't know 0:32:17.060 --> 0:32:21.020 we need until we need them. And Johns Hopkins is 0:32:21.020 --> 0:32:25.280 an incredible institution. Medicine We're Still Practicing is produced and 0:32:25.280 --> 0:32:29.240 edited by A.J. Mosley, mastering by Steve Rexburg Music for 0:32:29.240 --> 0:32:32.920 We're Still Practicing, as composed and performed by Celeste Anorectic. 0:32:33.260 --> 0:32:35.360 Don't forget to hit that follow button so you don't 0:32:35.360 --> 0:32:38.000 have to hunt around for our next episode. We'll catch 0:32:38.000 --> 0:32:40.190 you next week. Everybody stay healthy. 0:32:50.840 --> 0:32:52.070 From Kerkow media 0:32:52.700 --> 0:32:54.440 media for your mind.