S1: From Kerkow media coming up on the show,
S2: I bet you that one day you're going to look
S2: back at this interview in 30 years and you're going
S2: to walk into somebody's office. They're going to make a
S2: little cut your skin. They're going to pop out a
S2: little micro SD card out of your skull implant. And
S2: it's because you said your memory's a little bad. You're
S2: just going to get a new chip. You're going to
S2: upgrade from eight megabytes to 16 megabytes. Dr..
S3: This episode concludes our series with one of the top
S3: rated medical institutions in the country. Johns Hopkins Medicine. When
S3: patients find themselves needing highly specialized, researched and practiced procedures,
S3: it's just assumed that someone has dedicated their career to
S3: optimizing outcomes in that narrow specialty. And one of the
S3: points to this show is recognizing that sometimes we can't
S3: take critical medical needs to the corner gas station. Hopefully,
S3: if you're listening, you have the wherewithal to travel to
S3: the top specialist in the country. We have one of
S3: those here with us today. We hope you and your
S3: loved ones won't need his services. But if you or
S3: someone you care about has a need for neuroplastic and
S3: reconstructive surgery, you'll now know the doctor who created the field.
S3: This is medicine. We're still practicing. I'm Bill Kurtis, of course. First,
S3: my co-host, the quadruple board certified doctor of internal medicine,
S3: pulmonary disease, critical care and neuro critical care. And my
S3: very best friend, Dr. Stephen Tayback. Stephen, how are you doing?
S1: Hey, Bill, good to see you.
S3: And our special guest, Dr. Chad Gordon, he is the
S3: internationally recognized expert and pioneer behind the emerging field known
S3: as neuroplastic and reconstructive surgery. He is chief of Neuroplastic
S3: and reconstructive surgery and director for Johns Hopkins
S4: Medicine,
S3: professor of plastic and reconstructive surgery and neurological surgery at
S3: Johns Hopkins. And he also chairs the Harvard Hopkins Neuroplastic
S3: Surgery Symposium. And he's the president of the Society of
S3: Neuroplastic Surgery. Thanks for joining us, Dr. Gordon.
S2: Thank you, Bill.
S3: First of all, Doctor, what leads to the need for
S3: and exactly what is neuroplastic and reconstructive surgery
S2: from a high level view? What really drives my passion,
S4: the patients and the
S2: team for which I work with
S4: is that all patients
S2: that require brain surgery
S4: should not look like they had brain surgery.
S2: And that really summarizes it to the point of what
S2: we learned over 50 years ago when it comes to
S2: breast cancer surgery. As you can imagine, if a woman
S2: suffers from breast cancer surgery in the 1950s, it was
S2: really about treating the cancer, not really treating the patient.
S2: And what's ironic is that we're here in twenty
S4: twenty and brain
S2: cancer and skull tumors and skull defects are really treated
S2: by brain surgeons who are concentrating on the brain. They're
S2: not really concentrating on the restoration of someone's appearance
S4: to make it look like
S2: they have no deformity or ever had surgery. And that
S2: really encompasses our goal.
S4: So is this largely
S3: a cosmetic process after you have dealt with the challenges
S3: of brain surgery, or is this something you do actually
S3: during the brain surgery itself?
S2: Yes. So I love that you use the word cosmetic
S2: because I absolutely despise that word because the word cosmetic
S2: in plastic surgery is defined as taking someone who looks,
S2: quote unquote, normal and making them more pretty or handsome.
S2: And that's what drives me crazy.
S4: People that have
S2: brain surgery or need
S4: brain surgery, they're not trying to
S2: look more prettier, more handsome. They're just trying to look
S2: like themselves after surgery. And that's our mission. We're not
S2: trying to make you look better. We're trying to make
S2: it look like you never required somebody to open up
S2: your scalp, remove part of your skull and operate on
S2: your brain and put things back
S4: together so that you have no deformity. Imagine going on
S4: a
S2: first date or your brother comes home and has a
S2: den on the side of his head after having brain
S4: surgery. Do you look at them the same way? Do
S4: you think they have the
S2: same mental capacity they used to have? A lot of
S2: times we get this social stigma passed on to us
S2: by having brain surgery because our head doesn't look the same.
S2: But really it's just an appearance thing. And so I
S2: cringe when I hear the word cosmetic because I feel
S2: that I need to defend all the patients in the
S2: world that either need brain surgery or have had brain
S4: surgery and that don't
S2: look like themselves anymore.
S3: I noticed during one of your online videos that you
S3: talked about having performed about 500 surgeries, what is the
S4: original and critical
S3: need for the brain surgery that usually leads to them
S3: coming to you?
S4: So most often
S2: they're coming because they've either
S4: suffered trauma.
S2: When you have an injury
S4: to your head, the thing that
S2: will kill you is
S4: brain swelling. And the way to
S2: make you survive is to remove part of your
S4: skull that allows your
S2: brain to swell without herniated and causing your
S4: death or impairment forever. Now, when that bone comes off,
S4: a lot of times the
S2: swelling will go away after weeks or months and then
S2: needs to be put back
S4: in. But if it takes too
S2: long, then the bones are no longer viable. The other
S2: scenario is just related to common day brain surgery. It
S2: doesn't really matter why you needed brain surgery.
S4: The access
S2: to the
S4: brain is 75
S2: percent on the side of your head. We don't go
S2: through your forehead and we don't go through the back
S2: of your head because the bone is either thicker or
S2: going right through your forehead would leave a deformity in
S2: and a scar in itself. So seventy five per. Cent
S2: of all brain surgeries through the side, unfortunately, you have
S2: a large chewing muscle there,
S4: you have a temporal fat
S2: pad there, you have a delicate scalp there, and not
S2: all that area is covered by hair. And so the
S2: simple matter of having brain surgery
S4: requires removing
S2: part of the bone like a bottle cap and putting
S2: that bottle
S4: cap back.
S2: That is actually dead bone. Once you've disconnected it, problems
S2: can happen with that bone. It can shrivel up like
S2: a grape goes to a raisin. It can get infected
S2: because it was taken off and
S4: then put back
S2: chemotherapy, radiation, smoking, diabetes. All these comorbidities can lead to problems.
S2: So no one having trauma to your head, no to
S2: ever requiring brain surgery. A lot of times they don't
S2: look like themselves ever again because the person who did
S2: their brain surgery was trained for seven years in a
S2: residency to operate on the brain. They weren't trained to
S2: reconstruct the skull or to do the operation in a
S2: way to preserve an appearance. And then the third thing
S2: is really tumours. You can unfortunately have a brain tumour
S2: that invades part of your skull, which means it wouldn't
S2: make sense taking that part of your brain out and
S2: leaving the skull disease behind.
S4: So they've lost their
S2: skull because of a tumor of the brain invading it
S2: or people actually can develop skull tumors.
S3: I have to ask you, Dr.
S4: Gordon, what's
S3: the difference between what you're going to do in closing
S3: and optimizing the look that someone has after brain surgery
S3: versus the doctor that focused on the brain? What are
S3: you going to bring to the party?
S2: So you just said it yourself. They're focused on the brain.
S4: It all comes down
S2: to attention, to detail. When I'm opening up the scalp.
S2: I'm not worried about the brain. I'm opening up the
S2: scalp and using delicate maneuvers for the muscle and the fat,
S2: getting down to the bone, then turning the operation over
S2: to the brain surgeon. When the brain surgery is involved
S2: and when they're done doing the part that they so
S2: much care about, they can leave the operating room. And
S2: then I put everything back together again, just like a
S2: hood
S4: on a car. You wouldn't want
S2: to scratch your debt on your Bentley or Ferrari. And
S2: that's what these patients, unfortunately, are getting. Try running a
S2: company as a CEO or try being a teacher or
S2: doctor with a debt on
S4: the side of your head or a scar
S2: that healed pretty wide because it was closed under high
S2: tension or missing some of your hair on the side
S2: of your head. Because the best clarity of the scalp
S2: isn't that good like it was.
S4: These are small details. And to you,
S2: it might sound funny because you're having brain surgery. What
S2: do you care about a bad scar? What do you
S2: care about a dent? But guess what, it's not nineteen
S2: seventy anymore. It's not nineteen eighty anymore.
S4: Bill, patients
S2: deserve a
S4: bar that is very,
S2: very high. Now neurosurgeons are doing complex operations like they've
S2: never been done before and getting amazing outcomes. And that's
S2: why this field is growing so fast.
S3: Speaking about that, I can't help but ask. The annoying
S3: question is, does insurance pay for you?
S4: Every single one
S2: that six hundred and fifty school reconstructions that I've performed
S2: have been covered every
S4: single time. All I have
S2: to do is simply take a picture and write a
S2: letter and state the exact thing us in the beginning
S2: of this show. This is not cosmetic surgery. That's my
S2: opening line. This is making the patient look like
S4: themselves before they
S2: had brain surgery.
S1: Question for, you know, in my realm with neuro critical care,
S1: which is also had a metamorphosis, we're seeing a lot
S1: more therapeutic craniectomy. In the old days, it was like
S1: a last ditch effort that perhaps you would do a
S1: craniectomy for somebody who is having a brain herniation. Is
S1: this adding a considerable number of cases to your institution
S1: or are there highly technical neurosurgical procedures that are really
S4: adding more to to your numbers out there in Johns Hopkins?
S2: Stephen, you're exactly right. The literature is showing now that
S2: when you have a major injury to your
S4: brain, the best thing
S2: to do is to get the bone off. And big
S2: is better. The more bone you take off in that
S2: critical window of injury, the more chance that the brain
S2: has room to
S4: survive and swell safely.
S2: 10, 20, 30 years ago, that
S4: was a, let's say, a
S2: controversial topic. But the answer is now clear. And by
S2: taking that bone off,
S4: like you said, requires
S2: the bone to be either stored in a
S4: freezer or stored sometimes
S2: under the skin of your abdominal wall. And that leads
S2: risk for infection. Just like if you leave something in
S2: your refrigerator for too long, it's not good anymore. And
S2: that bone shrivels up or gets infected. And that's where
S2: I come into play. So I've been placing skull implants
S2: for the last 10 or 11 years.
S4: I place a lot more than the average surgeon.
S2: I've invented different design algorithms. Unlike the original design algorithm
S2: for skull implants, when skull implants were started around the
S2: year 2000,
S4: they were built and only
S2: manufactured to replace the missing bone. But when that bone
S2: comes
S4: off, you also have muscle
S2: and fat that shrinks away. And so if you don't
S2: design the implant the right way, you'll still end up
S2: having a dent because it's not filling in the muscle
S2: and the fat that you're missing. The other thing that
S2: we've invented recently, our smart cranial implants, just like your
S2: phone has changed your life, there is no reason why
S2: we shouldn't be putting in smart cranial implants. Many of
S2: these patients that you just described in your nerves critical
S2: care unit have brain injuries that either lead to hydrostatic.
S2: Fliss or a high pressure inside their head or seizures
S2: with epilepsy, so why are we taking giant 3D printed
S2: skull implants that are solid and plastic with underutilized space
S2: and so it hopkins'. We've written many patents and performed
S2: many first in human operations, using that space inside to
S2: add technologies to us. It's the ultimate wearable technology and
S2: we can reconstruct you with that same
S4: skull implant and nobody knows there's
S2: things inside
S3: by smart. Do you mean, Doctor, that it actually allows
S3: for expansion at certain times?
S2: No, that's a good question, Bill. By meaning smart, I mean,
S2: it has an inherent function inside rather than being a
S2: solid piece of plastic that was made with a 3-D
S4: printer to reconstruct
S2: your missing bone. Why wouldn't I put a device in
S2: there that helps the brain that's injured three or four
S2: millimeters away? So either a computer
S4: in there, a
S2: biosensor in there that tells you the pressure's high, a
S2: shutoff valve in there, maybe have too much fluid on
S2: your brain like a hydrocephalus. The most exciting thing that
S2: we're developing
S4: right now, and we're actually
S2: in the middle of animal trials similar to Elon Musk
S2: with his animal trials is we're creating the world's first
S2: full implant with a medicine reservoir that will deliver medicine
S2: through multiple catheters to your brain. To Stephen's point, he
S2: has dozens of patients that come through the NICU with
S2: brain problems related to their brain tumors.
S4: It's hard to
S2: fix brain tumors because of the blood brain barrier. We
S2: just can't get medicine to the brain.
S4: The brain is designed
S2: to keep out toxins just like chemotherapy agents. And so
S2: we're going to try to bypass the blood brain barrier
S2: like never before. And we're going to put these skull
S2: implants in and it's going to have a gas tank
S2: and it's going to have catheters and it's going to
S2: revolutionize the world.
S4: So question for you, because
S1: obviously, I mean, I'll have to just deduce that if
S1: somebody is having any kind of neurosurgery, it would be
S1: ideal to have a
S4: plastic's approach initially
S1: rather than just to have an plastic's approach after
S4: the fact and with the few
S1: thousand institutions that perform neurosurgery. My understanding is that there's
S1: only one.
S4: Dr. Gordon, what do we do
S1: at our local community hospital that needs neurosurgery? What can
S1: we tell our neurosurgeons? How can we alter their
S4: approach so that
S1: your work is much less invasive or
S4: intensive three months
S1: down the road, six months down the road, when they
S1: actually have to come to you?
S2: There's not enough we can do. And the way we
S2: do this is we approach it from multiple angles. Number one,
S2: we started a fellowship at Johns Hopkins. So we train
S2: one or two surgeons a year that come in from
S2: around the world, around the country, and they spend one
S2: or two years with us and they do one hundred
S2: and thirty skull reconstructions in one year. And I teach
S2: them all the fine details. So that allows them to
S2: leave Baltimore and go start their
S4: own program with another
S2: amazing brain surgery program. And so that's one angle. But
S2: as you could see, that's puny.
S4: That's going to
S2: take a millennium to really reach the world. The other
S2: thing we do is we do a symposium every year,
S2: as you touched on in the beginning of the show,
S2: we've gone back and forth between Johns Hopkins and Harvard
S2: Medical School for the last six years.
S4: And we bring
S2: together neurosurgeons and plastic surgeons and experts from
S4: around the world. And we try to
S2: open up the other side of the brain and say,
S2: put the ego aside as a neurosurgeon and say maybe
S2: I should work more with my plastic surgeon. And then
S2: for the plastic surgeon that attends the conference, we show
S2: him these new techniques that I employ in Baltimore
S4: and to show them, yes, as a
S2: plastic surgeon doing hand surgery or breast cancer, maybe open
S2: your eyes to the idea or conception that you can
S2: work more closely with your neurosurgeon.
S1: Most of the plastic reconstructive surgeons I know have gone
S1: into the big money fields, the cosmetic fields, to use
S1: the word that you despise, how to make people look
S1: prettier and also to make lots of money in so doing.
S1: So what made you decide to do something that is
S1: really in a much more
S4: academic and much more
S1: altruistic endeavor? What was it that motivated you?
S2: The real answer
S4: is that when I went to
S2: college, I started off as a
S4: chemistry major and they
S2: made me take either a language or an art class.
S2: So I took art and it was drawing one to
S2: one and I fell in love with it. And by
S2: sophomore year, I went back to my premed advisor and
S2: I said, you know, I really love this drawing and sculpture.
S2: I said, I'm thinking of going as a fine arts
S2: major with a minor in chemistry. And they said, you're
S2: absolutely crazy. You'll never go to medical school. This is
S2: the stupidest thing I've heard in a long time. And
S2: I just decided to push through it. And I finished
S2: as a premed major with a major fine arts drawing sculpture,
S2: and I pushed through to get into medical school. And
S2: when I was there, I realized
S4: the beautiful thing about
S2: being a fine arts majors. They teach you something called
S2: a mind's eye, which is the ability to see it
S2: before you create it. And I think what that helped
S2: me do was to give me a new perspective for
S2: school reconstruction that the neurosurgeons had and developed. A neurosurgeon
S2: most often is
S4: coming to a
S2: skull reconstruction as an afterthought. They've already done the part
S2: that they care most about. This is just something that
S2: needs to be done so the patient can wake up
S2: and move on. That's not what it is for me.
S2: For me, it's fixing the
S4: patient and let's
S2: say an artistic way point blank so it doesn't look
S2: like you ever had. Skull reconstruction,
S4: and I think in the right way,
S2: done
S4: safely, we can get you there.
S3: So, Dr. Gordon, I understand you've also received some awards
S3: for computer
S4: assisted and robot
S3: assisted technologies. What are you doing there?
S2: When I came to Hopkins, it was actually part of
S2: a team they were building for reconstruction of face patients
S2: who needed face transplantation.
S4: You were actually involved
S3: in one of the first ones that Cleveland was?
S2: Yes. So the first face transplant, the United States was
S2: done in December 2008. I was on the team. It
S2: was an extremely amazing time in my life.
S4: And after I
S2: had gone to Boston and finished training, I was recruited
S2: to Hopkins to help with face transplant program.
S4: And when I got
S2: here, I realized that the first one we did in
S2: the United States took us twenty two hours. But when
S2: we spent maybe eight hours dissecting a face off of
S4: the donor who was brain dead
S2: but still with a beating heart, and we had a
S2: wonderful recipient,
S4: kind of cold, who needed a
S2: face after being shot in the face by her husband.
S4: We literally brought the
S2: face out of room number four and went into room
S2: number five. And we went like this. How do they
S2: go together?
S4: You know, it was literally a guesstimate.
S2: And when I got to Baltimore, I realized there were
S2: so many smart people around me. If I could take
S2: out my cell phone and get to the market much better,
S2: I'm sure we could design computers and robots programs to
S2: either help with face transplant or to even help with
S2: skull reconstruction. And that's what we've done and we've gotten
S2: many patents on that.
S3: Is that like a 3-D mapping of the face and
S3: skull structure?
S2: That's exactly right. So imagine something in space and something
S2: that needs that floating object and having a computer guided
S2: program that changes from green to blue when it lands
S2: in the right spot. You know, it's something as simple
S2: as that. And what's ironic is when we developed that
S2: for face, we realized, well, this object could be a
S2: skull implant and the recipient could just be a skull
S2: missing part of his skull.
S4: And so a face go into
S2: a face
S4: recipient is almost like a skull
S2: implant going to skull recipient. So there was a lot
S2: of overlap. Again, the most exciting ones I like to
S2: talk about are the skull implants of the future. We
S2: literally are designing skull implants that will be around in 20, 30, 20, 40.
S2: And you're going to remember tonight's radio show and you're
S2: going to say, man, I thought that guy was crazy
S2: when he was talking about putting things aside, solid pieces
S2: of plastic. And it's going to be normal. For instance,
S2: I have an animal right now walking around with four
S2: catheters in his brain and nobody can tell because the
S2: animal looks normal. Here's a crazy statistic, Bill.
S4: As soon as we
S2: turn sixty five, one in five of us will have
S2: a brain problem that will require surgery. And one, when
S2: you require
S4: surgery, you're going to want
S2: to look like yourself and you're going to want to
S2: go back to your amazing
S4: job and you're going to want to
S2: go out for dinner without the waiter looking at the
S2: side of your head and saying, why is he a
S2: dent on the side of your head or why does
S2: he have a bump on the side of his head?
S2: Because they put some technology above his skull. We're going
S2: to create these things that fit in right into the
S2: bone space, connect to your brain, close the scalp up
S2: and nobody will know you're either getting
S4: battery powered
S2: electric waves to your brain. It's pretty much what Apple
S4: and Google and
S2: all these cell phone companies did over the last thirty years.
S2: We're going to do with skull implants.
S3: We're going to take 30 seconds and we'll be right back.
S5: A moment of your time, a new podcast from Kerkow Media,
S5: currently 21 years old and today, like magic, extended from
S5: her fingertips down to the blood to take
S2: care of yourself because the world needs
S1: you and you meet
S5: every do gooder that asked about me was ready to
S5: spit on my dream. Fingers were facing. You can feel
S5: like your purpose in your worth is
S3: really being done to stop me from playing the piano.
S5: She buys walkie talkies, wonders to whom she should give
S5: the second. I don't
S1: love
S3: humans. We never did. We never. Well, we just find
S2: what you do.
S5: Rock climbing is that you can only focus on what's
S5: right in life. And so our American life begins. We
S5: may need to stay apart, but let's create together available
S5: on all podcast platforms. Submit your piece at Kerkow dot com,
S5: slash a moment of your time.
S3: Dr. Steve, I wonder if you could tell me you
S3: were certified in your neuro critical care sometime in the
S3: last number of years, what are the types of patients
S3: that come to your hospital? Why are they there? What
S3: brought them to you? What type of critical care do
S3: they need and how could this apply?
S1: Well, that's actually why I asked Dr. Gordon. The question
S1: relative to craniectomy is because I was the medical director
S1: of a trauma center for 20 years. But my current
S1: hospital is not a trauma center.
S4: So on the
S1: trauma side, there were a lot of patients with gunshot wounds,
S1: crush injuries from motor vehicle accidents, periodic explosions where there
S1: would be just penetrating trauma to the skull that that
S1: created its own defects in my current institution. Now, in
S1: the neuro
S4: ICU, we're still clipping
S1: some aneurysms. Most of them are being coiled, but those
S1: do require removal of a skull
S4: flap so that
S1: the blood vessel that has a defect can be corrected,
S1: but then that it does leave a defect that needs
S1: to be replaced. Often in our institution
S4: with the native bone,
S1: we do a fair number of emergency craniectomy where the
S1: brain is so swollen that in order to
S4: save the patient, you must
S1: remove a large
S4: bone flap to allow the
S1: brain to swell. The brain cannot
S4: swell very much
S1: without permanent damage because it's an enclosed space. The beauty
S1: of the skull is that it keeps the brain very
S1: well protected. It's sort of buoyant in cerebrospinal fluid. So
S1: it has internal fluid where the brain can sort of
S1: bounce around. But there's only room for some fluids, some
S1: blood and brain tissue. And as soon as you exceed
S4: your limit, the brain has nowhere
S1: to go. If you have swelling in your abdomen, you
S1: can get massively distended without causing major problems. Once your
S1: brain starts to swell, you have only a little bit
S1: of
S4: leeway before that swelling starts
S1: compressing blood vessels and occludes the blood supply and does
S1: even more damage to the brain. So you can have
S1: your initial injury. But then it's the
S4: swelling that puts so
S1: much pressure within the brain itself that it starts clamping
S1: off its own vasculature and then the more brain dies
S4: because of the brain swelling
S1: and then the brain has nowhere to go. So it
S1: tends to go down the center hole where the spinal
S1: cord is. And so that's what's called a herniation. And
S1: you cannot come back from that once you get to
S1: a certain point. So to prevent the swelling from being
S4: catastrophic and causing brain injury, one of the
S1: heroic emergency procedures that we see in my institution would
S1: be an emergency
S4: craniectomy where the brain is swelling. Now, you give
S1: it a point of egress
S4: that will not be harmful. So you open up
S1: a big skull flap, you let the brain swell, relieve
S1: the pressure so that the circulation in the brain is
S1: maintained
S4: until which time? The underlying problem that caused the swelling
S4: is able to heal and resolve, and then the brain
S1: shrinks back down into its normal
S4: cavity. How does something
S3: like that happen without terrible risk of infection in the brain?
S3: If you actually remove someone's top of someone's head,
S2: well, the scalp will be put back together.
S4: So the way to look
S2: at is almost like a three layer peanut butter and
S2: jelly sandwich. Right? You have your scalp, your bone in
S2: your brain. And so just because you remove the bone,
S2: the brain has a lot of room to swell, maybe
S2: a half an inch, let's say, but the scalp will
S2: be closed.
S4: And so the infection
S2: risk is really coming from the bacteria that's above your skin.
S2: But to Stephen's point, I'll give him an example of
S2: why I think skull implants are the future here to stay.
S2: Stephen's talking about what we describe as intracranial hypertension. Your
S2: brain is gelo floating in water filled within a structure,
S2: the box, the skull.
S4: OK, now, if you add
S2: blood to that, as Stephen said, or you make swelling
S2: occur in the brain, you're adding too much pressure in
S2: the box
S4: and that's risking life, period.
S2: So what we need is a pressure monitor. We need
S2: a pressure sensor.
S4: And so that's what we
S2: did three years ago. We did the world's first skull
S2: implant with a pressure sensor inside. Just let's say, like
S4: you cook a turkey
S2: in the oven and that little thing pops out of
S2: the turkey when it's done. That's the size of this
S2: little sensor that we put in a second plant. Now,
S2: to Stephen's point, he's going to say, why did you
S2: do this first world's case?
S4: And my answer is going to be that we had
S4: a 16
S2: year old
S4: woman who was shot
S2: in the head, unfortunately, wrong place, wrong time. And after
S2: the bullet transverse the side of her brain, the non
S2: important side, she had a long four or five month
S2: recovery where she was able to
S4: walk and speak again.
S2: However, her skull was never put back. And the reason
S2: why I had never been put back is because her
S2: brain never really got rid of the swelling. So the
S2: mother came to Baltimore with her daughter and said, Dr. Gordon,
S2: I'm here to get a skull reconstruction from my daughter
S2: because she wants to go back to a normal life
S2: not worrying about falling down.
S4: Her balance is a
S2: little off because her brain doesn't really have that box.
S2: But on the other hand, I'm thinking of running out
S2: of your office because I'm scared that when you go
S2: to put the
S4: skull implant on top of my
S2: daughter's brain that's swollen, you're going to cause her to
S2: herniate like Stephen described. You're going to. Pushing on her
S2: swollen brain, so I sat the mom down and said,
S2: how would you like it if we created the world's
S2: first
S4: skull implant with a pressure monitor
S2: inside that skull implant? It's just a piece of plastic.
S2: We have wireless technology that's already FDA approved. It's just
S2: nobody ever did it before. And how about I carve
S2: out a little space in that piece of plastic? I'll
S2: put a little pressure sensor right above your daughter's brain
S2: and we could test it wirelessly. Three days after surgery,
S2: three months after surgery, three years after surgery. So if
S2: your daughter was to have problems from her head, let's say,
S2: a headache or change in vision, you could look at
S2: me and say, is it because you put that skull
S2: implant that my daughter's having that problems? Or is it
S2: because she has math homework to do and she has
S2: a headache? And I could just wave a little wand
S2: over that smart
S4: implant, and that's what we did.
S2: And it was miraculous. It was just published in one
S2: of the main neurosurgery journals around the world last year.
S4: And it was the world's
S2: first smart cranial implant. And I think it's a tip
S2: of the iceberg.
S4: A look at your phone. Look how your phone
S2: changed your life. The single most important organ in your body, Bill,
S2: is your brain.
S4: The next one hundred years is about your brain.
S2: Guess what? You have a bad heart. You have a
S2: bad lung. You have
S4: bad liver. You have bad kidneys.
S2: We got stuff for that. Transplants, machines, whatever you need.
S2: We got it. You have a bad brain. We have nothing.
S2: And we will never transplant you a new brain. We
S2: can only modify the brain that you were born with. Now,
S2: how are we going to modify your brain over the
S2: next one hundred years? Guess what? Surgeons from around the
S2: world have spent billions of dollars developing techniques and
S4: technologies to put above your skin. OK, nobody wants to
S2: walk around like Frankenstein with something on their head. They've
S2: also developed technology that sits above your
S4: skull, under your skin,
S2: but you have a bump still on your head and
S2: it can actually poke up through the skin. With respect
S2: to time, no one's ever stopped and said, why don't
S2: we use the space inside
S4: the skull to modify the brain?
S2: And that's what we started five years ago. And that's
S2: why we're super excited, because
S4: we believe we've solved the Holy Grail.
S2: The Holy Grail is for the next one hundred years
S2: to develop
S4: technologies that will
S2: modulate
S4: your brain, whatever disease
S2: you, God forbid, develop as you get into the 60s, 70s, 80s, 90s.
S2: We will have an answer for that and we will
S2: miniaturize it to the point of where on the side
S2: of your cell phone, you know, you have that little
S2: micro SD card that popped out of the side of
S2: your cell phone. I bet you that one day you're
S2: going to look back at this interview in thirty years
S2: and you're going to walk into somebody's office. They're going
S2: to make a little cut your skin. They're going to
S2: pop out a little micro SD card out of your
S2: skull implant. And it's because you said your memory's a
S2: little bad. You're just going to get a new chip.
S2: You're going to upgrade from eight megabytes to 16 megabytes.
S3: So I have to ask you about some side effects here.
S3: When you're replacing the skull with a plastic, do you
S3: find that you've had to manage debilitating headaches? What are
S3: the side effects and ramifications of some of these surgeries?
S2: In nineteen sixty eight, there was a orthopedic surgeon that
S2: stood up in front of all his colleagues and said,
S2: we're doing it completely wrong. And everybody said, what? What's
S2: he talking about? This orthopedic surgeon
S4: said that the way we
S2: treat osteoarthritis or joint disease of the knee is we
S2: used to put a metal rod or metal plate across
S2: the knee and fused the knee so you don't bend
S2: your knee is that we're doing it wrong? We need
S2: to cut the knee
S4: out, literally cut the
S2: knee out that you were born with and take a
S2: box and open up a piece of plastic or a
S2: plastic joint and replace that joint in nineteen sixty eight.
S2: He got booed off the stage and was told he's crazy.
S2: Well guess what, in twenty twenty one if you have
S2: a bad knee, nobody's going to question the fact that
S2: we're going to replace your joint that you were born
S2: with for a piece of plastic out of a box.
S2: When they started doing joint replacements, they had
S4: high problems with complications, infections and bleeding.
S2: But what happens was there was a subset of surgeons
S2: in orthopedic surgeons
S4: that said, you know what, I'm going to
S2: dedicate
S4: my life to doing knee
S2: replacement or I'm going to dedicate my life to shoulder replacement.
S2: And instead of doing one knee replacement a year, I'm
S2: going to do one hundred knee replacements a year. If
S2: you do something much more than the average person, your
S2: outcomes will be much better. Your complication rates will be
S2: much less. And that's why I developed neuroplastic surgery. The
S2: surgeons that we're
S4: training are saying,
S2: you know what, I'm going to dedicate my life to
S2: doing skull implants and doing skull
S4: reconstruction and getting less
S2: complications and better outcomes.
S1: Do you see in the future that ever there be
S1: a reason to have an implant in a healthy brain
S1: in order
S4: to predict potentially
S1: future
S2: problems? Yes. So let me take it
S4: one step further.
S2: I believe that we are going to start removing normal skulls.
S2: I believe there's patients, just like you said, whether it's
S2: normal skull, healthy skull or healthy brain. So if you
S2: come to me and
S4: you say, my mom and dad
S2: both had Alzheimer's and they both developed it in their
S2: fifties and I'm 30 years old and we have medicine
S4: nowadays that is affected
S2: to Alzheimer's. But when I give it to you in
S2: a pill form or inject it into your arm, it
S2: really doesn't get to your brain. So if I said
S2: to you at age 30.
S4: Five, that I
S2: have something that I can remove your totally normal skull
S2: and put in a little thing the size of a
S2: half dollar with a catheter into your brain and remove
S2: your normal skull. And for the next 15 years, I'm
S2: going to pump in medicine into your brain
S4: that can prevent Alzheimer's. And it's the size
S2: of a half dollar. Are you going to take that, Stephen?
S1: Yeah, you bet.
S2: There you go. So that's where we're going to be
S2: thinking about the military. Think about our military, our wounded warriors,
S2: see how much powerful things we could do to them.
S2: We could remove part of their normal skull. We could
S2: put medicine in there. So God forbid they're injured on
S2: the battlefield. You could take out your Bluetooth wireless cell
S2: phone and activate some pain medicine, some seizure medicine, whatever
S2: you need for your wounded warriors can be delivered in
S2: real time wirelessly from around the world. How about if
S2: I take out your normal
S4: skull and I put a little camera or ultrasound device
S4: into your skull space
S2: and let's say you had an aneurysm clipping, but the
S2: doctor who did the atavism clip thing tells you there's
S2: really a significant risk that the other side might have
S2: a problem one day and explode and cause bleeding. How
S2: cool would it be if I put a little camera
S2: inside your skull and you could check your cell phone
S2: once a day to see if you have blood inside
S2: your head or your doctor could check inside your skull?
S2: This is where we're going.
S4: I have no doubt we're going there.
S2: The question I have is how fast can we work
S2: and how big of a team can we create? Because
S2: these patients need it. They need it.
S3: Now, all I can say is, thank God we have
S3: people like you who are willing to dedicate yourself to
S3: something that initially feels like it's off the beaten path
S3: until you need it. We appreciate what all you guys do,
S3: but it sounds like you're really breaking tremendous new ground.
S1: How can they reach you? How can our neurosurgeons get
S1: in touch with you to possibly get some information that
S1: can help them with their initial surgical approaches? And then
S1: how do they reach you after the fact when perhaps
S1: they need your help with reconstruction?
S2: So the most simplest way, Stephen, is to go on
S2: Google and type in neuro plastic surgery. Chad Gordon, and
S2: you'll see everything we've done over the last 10 years.
S2: That would literally be the simplest way. If you want
S2: to take it one step further, you could type in
S2: Hopkins Medicine, Dogpatch Signora Plastic Surgery, and you'll get to
S2: answer a plastic surgery website with my office coordinator, our
S2: physician's assistant, and you'll get all our phone numbers and emails.
S3: Dr. Gordon, thank you very much for joining us today. Very,
S3: very enlightening. And of course, Dr. Tayback, my good friend,
S3: thank you as always, for joining after a long day
S3: of work, a special thanks to Johns Hopkins for providing
S3: us a tour of some of the most accomplished and
S3: dedicated specialists in medicine. I have no doubt we'll be
S3: back again next year diving into specialists we don't know
S3: we need until we need them. And Johns Hopkins is
S3: an incredible institution. Medicine We're Still Practicing is produced and
S3: edited by A.J. Mosley, mastering by Steve Rexburg Music for
S3: We're Still Practicing, as composed and performed by Celeste Anorectic.
S3: Don't forget to hit that follow button so you don't
S3: have to hunt around for our next episode. We'll catch
S3: you next week. Everybody stay healthy.
S5: From Kerkow media
S2: media for your mind.