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Michael T. Lawton, MD

@mtlawton • 21,253 subscribers

Neurosurgeon. Innovator. Author. Teacher. President & CEO @BarrowNeuro. Spetzler Chair of Neurosurgery. Co-Founder @MissionBrainOrg.

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Manual craftsmanship…it’s what makes performing a bypass so satisfying and what gives me confidence that microneurosurgery’s future is safe (for now). Bypass is “the hardest problem in surgical robotics” and has yet to be fully performed by a robot. Surgeons, suture on…

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Manual craftsmanship…it’s what makes performing a bypass so satisfying and what gives me confidence that microneurosurgery’s future is safe (for now). Bypass is “the hardest problem in surgical robotics” and has yet to be fully performed by a robot. Surgeons, suture on…

Michael T. Lawton, MD

945,481 views • 1 month ago

Neuroanatomy teaser: This patient presents w/atypical face pain unresponsive to microvascular decompression & C1 spinal cord stimulator. Weird!? Turns out a cuneate medullary cavernoma was triggering spinal trigeminal nucleus on its descent to C3 & its resection cured her…

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Neuroanatomy teaser: This patient presents w/atypical face pain unresponsive to microvascular decompression & C1 spinal cord stimulator. Weird!? Turns out a cuneate medullary cavernoma was triggering spinal trigeminal nucleus on its descent to C3 & its resection cured her…

Michael T. Lawton, MD

93,682 views • 20 days ago

AVMs are endlessly variable, which is why taxonomy simplifies the confusion to 32 recognizable subtypes, each w/definable anatomy & surgical strategy. Types are the lobes/brain regions, subtypes are surfaces on which the nidus is based. Taxonomy informs learning, guides resection…

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AVMs are endlessly variable, which is why taxonomy simplifies the confusion to 32 recognizable subtypes, each w/definable anatomy & surgical strategy. Types are the lobes/brain regions, subtypes are surfaces on which the nidus is based. Taxonomy informs learning, guides resection…

Michael T. Lawton, MD

315,289 views • 2 months ago

Once in a while, unique pathology appears & you look forward to seeing it, studying it in the operating room – like this spinal cord AV fistulous connection. When it unexpectedly ruptures while beginning the case, that clean pathology gets buried in blood. Fortunately, we were there to fix it quickly….

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Once in a while, unique pathology appears & you look forward to seeing it, studying it in the operating room – like this spinal cord AV fistulous connection. When it unexpectedly ruptures while beginning the case, that clean pathology gets buried in blood. Fortunately, we were there to fix it quickly….

Michael T. Lawton, MD

34,723 views • 1 month ago

Sometimes in this job, life hangs in the balance & you must act on intuition, w/out the usual studies confirming your diagnosis. Here, fistulous connections b/w meningeal arteries & a cortical vein produced hypertension, venous dilation, rupture. DAVFs can be treated endovascularly, but hemorrhage often requires emergency surgery to close the fistula, evacuate clot, save a life….

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Sometimes in this job, life hangs in the balance & you must act on intuition, w/out the usual studies confirming your diagnosis. Here, fistulous connections b/w meningeal arteries & a cortical vein produced hypertension, venous dilation, rupture. DAVFs can be treated endovascularly, but hemorrhage often requires emergency surgery to close the fistula, evacuate clot, save a life….

Michael T. Lawton, MD

23,431 views • 25 days ago

I recently reached a significant spinal cavernous malformation milestone: #100 resected microsurgically. These are the most common vascular malformation in my practice & teach so much about zones of entry into cord tissue, safe resection techniques, and handling of cord tracts…

I recently reached a significant spinal cavernous malformation milestone: #100 resected microsurgically. These are the most common vascular malformation in my practice & teach so much about zones of entry into cord tissue, safe resection techniques, and handling of cord tracts…

Michael T. Lawton, MD

114,390 views • 7 months ago

Teslaconomics Seriously Elon, do you actually think a robot can do this? Keep believing in humanity...

Teslaconomics Seriously Elon, do you actually think a robot can do this? Keep believing in humanity...

Michael T. Lawton, MD

99,253 views • 7 months ago

Complications when clipping basilar apex aneurysms come from compromising thalamoperforators, which arise from superior walls of P1 segments, away from SCA aneurysms. These are safer to clip w/better outcomes, but proximal control may be deeper down & SCA origin from the base may be harder to reconstruct….

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Complications when clipping basilar apex aneurysms come from compromising thalamoperforators, which arise from superior walls of P1 segments, away from SCA aneurysms. These are safer to clip w/better outcomes, but proximal control may be deeper down & SCA origin from the base may be harder to reconstruct….

Michael T. Lawton, MD

25,231 views • 1 month ago

Today’s big news is not this bypass, but the announcement by Neuralink that BarrowNeurological is the clinical partner in PRIME Trial. In January, we successfully implanted the N1 brain-computer interface device in 1st human patient, ushering in a future where this technology will change lives of countless patients & transform neurosurgery…

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Today’s big news is not this bypass, but the announcement by Neuralink that BarrowNeurological is the clinical partner in PRIME Trial. In January, we successfully implanted the N1 brain-computer interface device in 1st human patient, ushering in a future where this technology will change lives of countless patients & transform neurosurgery…

Michael T. Lawton, MD

264,527 views • 2 years ago

Many would call this intraventricular AVM inoperable. The secrets to its safe removal from temporal horn & atrium are: throttling ant. choroidal artery early, finding other MCA feeders supplying it medially, preserving memory structures in the hippocampus/medial temporal lobe…

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Many would call this intraventricular AVM inoperable. The secrets to its safe removal from temporal horn & atrium are: throttling ant. choroidal artery early, finding other MCA feeders supplying it medially, preserving memory structures in the hippocampus/medial temporal lobe…

Michael T. Lawton, MD

19,795 views • 1 month ago

Important tip: contralateral transcallosal-contralateral transchoroidal approach is the way to medial thalamic cavernomas but travels under fornix & requires forniceal retraction; Contralateral transcallosal-ipsilateral transchoroidal travels over fornix & avoids this retraction for better memory outcomes….

Important tip: contralateral transcallosal-contralateral transchoroidal approach is the way to medial thalamic cavernomas but travels under fornix & requires forniceal retraction; Contralateral transcallosal-ipsilateral transchoroidal travels over fornix & avoids this retraction for better memory outcomes….

Michael T. Lawton, MD

260,135 views • 2 years ago

Basilar trunk aneurysms are a long way in; we are called on to clip these only rarely. But we have the know-how for the young patient seeking a durable cure: extended retrosigmoid craniotomy, open the cistern + its triangles, & in this case, free dense adhesions around the aneurysm to place the clip blades…

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Basilar trunk aneurysms are a long way in; we are called on to clip these only rarely. But we have the know-how for the young patient seeking a durable cure: extended retrosigmoid craniotomy, open the cistern + its triangles, & in this case, free dense adhesions around the aneurysm to place the clip blades…

Michael T. Lawton, MD

28,485 views • 2 months ago

“Dome protection,” or placing coils in the dome of a ruptured aneurysm, can prevent rehemorrhage but can complicate subsequent clipping. Coils ramp clips down onto the neck & constrict/block the parent artery. Here, I used posterior clinoid to anchor the clip & keep it from sliding…

“Dome protection,” or placing coils in the dome of a ruptured aneurysm, can prevent rehemorrhage but can complicate subsequent clipping. Coils ramp clips down onto the neck & constrict/block the parent artery. Here, I used posterior clinoid to anchor the clip & keep it from sliding…

Michael T. Lawton, MD

20,998 views • 2 months ago

We like to be there when trouble strikes, as with this carotid injury during nasal polyp removal @ outside office. After control w/Foley balloon catheter in the nose, we performed bypass/carotid sacrifice, which treated the carotid-cavernous fistula and enabled safe removal of the balloon…

We like to be there when trouble strikes, as with this carotid injury during nasal polyp removal @ outside office. After control w/Foley balloon catheter in the nose, we performed bypass/carotid sacrifice, which treated the carotid-cavernous fistula and enabled safe removal of the balloon…

Michael T. Lawton, MD

171,686 views • 2 years ago

It may sound crazy, but a large venous varix or encephalomalacia from prior hemorrhage can create working space within the spinal cord to circumferentially dissect a spinal AVM nidus and reach anterior spinal artery feeders coming from the ventral cord surface. Check this out...

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It may sound crazy, but a large venous varix or encephalomalacia from prior hemorrhage can create working space within the spinal cord to circumferentially dissect a spinal AVM nidus and reach anterior spinal artery feeders coming from the ventral cord surface. Check this out...

Michael T. Lawton, MD

17,786 views • 2 months ago

There aren’t many surgical cases more harrowing than a high-cervical spinal cord AVM in a teenager. Intramedullary AVMs that push thru the pial surface offer opportunity for in situ occlusion to protect patients from repeated bleeding in their future…

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There aren’t many surgical cases more harrowing than a high-cervical spinal cord AVM in a teenager. Intramedullary AVMs that push thru the pial surface offer opportunity for in situ occlusion to protect patients from repeated bleeding in their future…

Michael T. Lawton, MD

71,812 views • 1 year ago

The spinal cord is a scary thing to incise. The cord has a midline fissure that makes it easier there, but paramedian cord does not. However, myelotomy along dorsal root entry zone (DREZ) is safe for dorsal spinal cord cavernous malformations, entering posteromedial to descending corticospinal tract & dancing around posterior spinal artery…

The spinal cord is a scary thing to incise. The cord has a midline fissure that makes it easier there, but paramedian cord does not. However, myelotomy along dorsal root entry zone (DREZ) is safe for dorsal spinal cord cavernous malformations, entering posteromedial to descending corticospinal tract & dancing around posterior spinal artery…

Michael T. Lawton, MD

33,077 views • 7 months ago

From #SevenBypasses: “Infinitesimal forces drive the needle forward and the wall backward, the needlepoint pierces the tissue with a haptic “pop” that transmits through the instruments, fires the fingertips’ sensory receptors, and stimulates the faintest of perception of a bite. The needle glides through the tissue until the driver meets the microforceps to fully consume the bite. The microforceps then exits the arterial lumen, gently lifts the second wall with its fine tips, and the cycle repeats. Another collision of infinitesimal forces and another haptic pop as the needle pierces and glides and bites. With a squeeze of the microforceps and a release of the driver, the driver circles around to counter-sweep the tissue off the back end of the needle and the needle completes its bite...”

From #SevenBypasses: “Infinitesimal forces drive the needle forward and the wall backward, the needlepoint pierces the tissue with a haptic “pop” that transmits through the instruments, fires the fingertips’ sensory receptors, and stimulates the faintest of perception of a bite. The needle glides through the tissue until the driver meets the microforceps to fully consume the bite. The microforceps then exits the arterial lumen, gently lifts the second wall with its fine tips, and the cycle repeats. Another collision of infinitesimal forces and another haptic pop as the needle pierces and glides and bites. With a squeeze of the microforceps and a release of the driver, the driver circles around to counter-sweep the tissue off the back end of the needle and the needle completes its bite...”

Michael T. Lawton, MD

53,074 views • 1 year ago

“There is a thrill that comes from joining two arteries in an anastomosis with the simplest of tools: suture, a few microinstruments, and a microscope. There is a thrill that comes from applying skill, dexterity, and determination to complete a challenging bypass. There is a thrill that comes from constructing something, rather than deconstructing something, in a place already so magnificent.” #SevenBypasses

“There is a thrill that comes from joining two arteries in an anastomosis with the simplest of tools: suture, a few microinstruments, and a microscope. There is a thrill that comes from applying skill, dexterity, and determination to complete a challenging bypass. There is a thrill that comes from constructing something, rather than deconstructing something, in a place already so magnificent.” #SevenBypasses

Michael T. Lawton, MD

38,642 views • 1 year ago

Bypass & flow reversal is a powerful strategy for treating giant aneurysms: it deals w/their unclippability; uses natural thrombosis to close the aneurysm completely; indicates some fancy & fun bypasses, like this side-to-side bypass w/ant. temporal artery (ATA-M2 MCA) + STA-MCA…

Bypass & flow reversal is a powerful strategy for treating giant aneurysms: it deals w/their unclippability; uses natural thrombosis to close the aneurysm completely; indicates some fancy & fun bypasses, like this side-to-side bypass w/ant. temporal artery (ATA-M2 MCA) + STA-MCA…

Michael T. Lawton, MD

14,451 views • 5 months ago