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Michael T. Lawton, MD

@mtlawton • 24,106 subscribers

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

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Colors of the sky are most striking at sunrise & sunset; so too for spinal cord tumors at the operation’s beginning & end. What’s more brilliant than the orange of untouched hemangioblastoma? And bleeding during debulking darkens ependymoma’s pale gray to differentiate it from off-white cord, helping to see the separation plane…

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Colors of the sky are most striking at sunrise & sunset; so too for spinal cord tumors at the operation’s beginning & end. What’s more brilliant than the orange of untouched hemangioblastoma? And bleeding during debulking darkens ependymoma’s pale gray to differentiate it from off-white cord, helping to see the separation plane…

Michael T. Lawton, MD

257,627 次观看 • 5 天前

I’ve long said, “successful bypass surgery is 1,000 perfect moves.” But perfection isn’t always attainable, which means we must know how to correct our mistakes. The mark of great surgeons isn’t perfection, but knowing those key moves that salvage a tough situation & get to success. Here, the “through stitch”….

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I’ve long said, “successful bypass surgery is 1,000 perfect moves.” But perfection isn’t always attainable, which means we must know how to correct our mistakes. The mark of great surgeons isn’t perfection, but knowing those key moves that salvage a tough situation & get to success. Here, the “through stitch”….

Michael T. Lawton, MD

3,489,350 次观看 • 2 个月前

Though not the biggest, carotid artery is arguably the most critical pipeline b/c it supplies brain. Once upon a time, bypasses from carotid in the neck to MCA in brain were the answer for giant cavernous aneurysms; I performed >100. While flow diverters turned this bypass into a rare oddity, we maintain the know-how to reconstruct carotids when needed…

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Though not the biggest, carotid artery is arguably the most critical pipeline b/c it supplies brain. Once upon a time, bypasses from carotid in the neck to MCA in brain were the answer for giant cavernous aneurysms; I performed >100. While flow diverters turned this bypass into a rare oddity, we maintain the know-how to reconstruct carotids when needed…

Michael T. Lawton, MD

58,879 次观看 • 3 天前

It’s surprising how misleading spinal MRI can be at predicting surface presentation of spinal cord cavernomas, which is why I always visually inspect all surfaces. It’s always a relief when I find a spot where it comes to the pia & be accessed w/out traversing normal cord tissue...

It’s surprising how misleading spinal MRI can be at predicting surface presentation of spinal cord cavernomas, which is why I always visually inspect all surfaces. It’s always a relief when I find a spot where it comes to the pia & be accessed w/out traversing normal cord tissue...

Michael T. Lawton, MD

119,218 次观看 • 12 天前

Of all the tumors I work on, acoustic neuroma is the one that taps the vascular microsurgical skillset most, freeing AICA adhesions & Dandy’s vein, rolling tumor off brainstem, dissecting trigeminal and, of course, facial nerve from tumor, all in the deep sanctum of the posterior fossa…

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Of all the tumors I work on, acoustic neuroma is the one that taps the vascular microsurgical skillset most, freeing AICA adhesions & Dandy’s vein, rolling tumor off brainstem, dissecting trigeminal and, of course, facial nerve from tumor, all in the deep sanctum of the posterior fossa…

Michael T. Lawton, MD

209,778 次观看 • 26 天前

Everybody’s talking robotics. But robots are built to do one task w/precision, need simple, consistent anatomy to operate surgically, like w/cholecystectomy. This brain AVM extends from cortex to ventricle, is supplied by convexity arteries + deep perforators, sits next to motor strip. Good luck Optimus….

Everybody’s talking robotics. But robots are built to do one task w/precision, need simple, consistent anatomy to operate surgically, like w/cholecystectomy. This brain AVM extends from cortex to ventricle, is supplied by convexity arteries + deep perforators, sits next to motor strip. Good luck Optimus….

Michael T. Lawton, MD

625,423 次观看 • 2 个月前

You’ve seen this surgery before. This approach to cavernomas in the central pons thru middle cerebellar peduncle is the workhorse for brainstem cavernomas: easy retrosigmoid craniotomy, well tolerated entry thru the peduncle. The challenge is seeing all the way around this large & deep cavity thru the tiny keyhole….

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You’ve seen this surgery before. This approach to cavernomas in the central pons thru middle cerebellar peduncle is the workhorse for brainstem cavernomas: easy retrosigmoid craniotomy, well tolerated entry thru the peduncle. The challenge is seeing all the way around this large & deep cavity thru the tiny keyhole….

Michael T. Lawton, MD

128,531 次观看 • 19 天前

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

947,375 次观看 • 6 个月前

Even the name is hard to pronounce. Glomus jugulare tumors sit in an anatomical jewel box in or around sigmoid sinus, jugular vein & bulb, petrous carotid artery, lower cranial nerves, facial nerve, and the labyrinthine of petrous bone. They may just be the most complex skull base tumors of them all…

Even the name is hard to pronounce. Glomus jugulare tumors sit in an anatomical jewel box in or around sigmoid sinus, jugular vein & bulb, petrous carotid artery, lower cranial nerves, facial nerve, and the labyrinthine of petrous bone. They may just be the most complex skull base tumors of them all…

Michael T. Lawton, MD

68,797 次观看 • 17 天前

Some say medicine is not creative, but there are problems to be solved everywhere. Take this vertebral artery dolichoectasia compressing brainstem. Yrs ago, I devised this rig to pull the offending artery away from brainstem w/a sling, or “macrovascular decompression.” And being an aneurysm surgeon, of course I used clips to anchor the sling to clivus & adjust tension…#SurgicalCreativity

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Some say medicine is not creative, but there are problems to be solved everywhere. Take this vertebral artery dolichoectasia compressing brainstem. Yrs ago, I devised this rig to pull the offending artery away from brainstem w/a sling, or “macrovascular decompression.” And being an aneurysm surgeon, of course I used clips to anchor the sling to clivus & adjust tension…#SurgicalCreativity

Michael T. Lawton, MD

293,293 次观看 • 2 个月前

Reading the subtle difference in color between grayish tumor and white matter is the key to separating spinal ependymoma from normal spinal cord, plus a delicate touch to gently work the pathology free. Sight and feel working in harmony with high stakes - this is the essence of microneurosurgery...

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Reading the subtle difference in color between grayish tumor and white matter is the key to separating spinal ependymoma from normal spinal cord, plus a delicate touch to gently work the pathology free. Sight and feel working in harmony with high stakes - this is the essence of microneurosurgery...

Michael T. Lawton, MD

168,935 次观看 • 1 个月前

What you see preop isn’t always what you get intraop. With thrombotic aneurysms, dye only fills the aneurysm’s lumen to show its inner size on angiography. At surgery, you encounter the entire aneurysm, including the non-filling part, between the lumen and outer wall. Don't be surprised...

What you see preop isn’t always what you get intraop. With thrombotic aneurysms, dye only fills the aneurysm’s lumen to show its inner size on angiography. At surgery, you encounter the entire aneurysm, including the non-filling part, between the lumen and outer wall. Don't be surprised...

Michael T. Lawton, MD

185,247 次观看 • 2 个月前

Brainstem is like a circuit board & the more wiring you know, the better your bedside acumen. Cavernomas can be localized at the bedside, before getting the MRI, with a good exam, just like stroke syndromes learned in neurology clerkships in med school. Remember Wallenberg? This cuneate/trigonal medullary cavernoma presented w/ posterior Wallenberg syndrome…

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Brainstem is like a circuit board & the more wiring you know, the better your bedside acumen. Cavernomas can be localized at the bedside, before getting the MRI, with a good exam, just like stroke syndromes learned in neurology clerkships in med school. Remember Wallenberg? This cuneate/trigonal medullary cavernoma presented w/ posterior Wallenberg syndrome…

Michael T. Lawton, MD

68,280 次观看 • 1 个月前

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 次观看 • 7 个月前

Sometimes color is so unique, you know the diagnosis the instant you see it. It’s a good thing w/hemangioblastoma, because these intensely orange & vascular tumors are handled differently than others - circumdissecting, staying extracapsular, interrupting feeding arteries like an AVM, rather than debulking it…

Sometimes color is so unique, you know the diagnosis the instant you see it. It’s a good thing w/hemangioblastoma, because these intensely orange & vascular tumors are handled differently than others - circumdissecting, staying extracapsular, interrupting feeding arteries like an AVM, rather than debulking it…

Michael T. Lawton, MD

70,591 次观看 • 1 个月前

The best surgical bypasses mimic nature’s design, like anterior & posterior communicating arteries in the circle of Willis, drawing flow on demand. Arteries that run parallel and in close proximity can be joined w/ side-to-side anastomosis to create an intracranial-to-intracranial bypass, like this A3-A3 construct…#SevenBypasses

The best surgical bypasses mimic nature’s design, like anterior & posterior communicating arteries in the circle of Willis, drawing flow on demand. Arteries that run parallel and in close proximity can be joined w/ side-to-side anastomosis to create an intracranial-to-intracranial bypass, like this A3-A3 construct…#SevenBypasses

Michael T. Lawton, MD

73,876 次观看 • 1 个月前

There’s more to “resection” than just removal. For example, skeletonization = technique for managing transit arteries that feed an AVM & continue past to supply normal brain. Branches feeding the nidus are occluded one by one, dissecting from distal to proximal, preserving the trunk & its arterial territory distally. An essential technique w/sylvian AVMs….

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There’s more to “resection” than just removal. For example, skeletonization = technique for managing transit arteries that feed an AVM & continue past to supply normal brain. Branches feeding the nidus are occluded one by one, dissecting from distal to proximal, preserving the trunk & its arterial territory distally. An essential technique w/sylvian AVMs….

Michael T. Lawton, MD

55,846 次观看 • 1 个月前

Pulled out all stops for this basilar aneurysm: rapid ventricular pacing to soften aneurysm; tandem curved clipping to reduce its girth; tentorium disassembly to increase transsylvian exposure for proximal control lateral to trochlear n.; aneurysm clipping thru 3 triangles: optic-carotid, carotid-oculomotor, oculomotor-tentorium…

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Pulled out all stops for this basilar aneurysm: rapid ventricular pacing to soften aneurysm; tandem curved clipping to reduce its girth; tentorium disassembly to increase transsylvian exposure for proximal control lateral to trochlear n.; aneurysm clipping thru 3 triangles: optic-carotid, carotid-oculomotor, oculomotor-tentorium…

Michael T. Lawton, MD

115,161 次观看 • 4 个月前

What’s the secret to good outcomes w/brain AVM surgery? Choosing your battles wisely, and supplemented AVM grading - sum of Spetzler-Martin + Lawton-Young grades - is the starting point for patient selection. I draw the line at grade 6 and usually don’t operate > grade 7, but here’s an exception. Check out one of the best views of lateral recess & foramen of Luschka I’ve ever seen…

What’s the secret to good outcomes w/brain AVM surgery? Choosing your battles wisely, and supplemented AVM grading - sum of Spetzler-Martin + Lawton-Young grades - is the starting point for patient selection. I draw the line at grade 6 and usually don’t operate > grade 7, but here’s an exception. Check out one of the best views of lateral recess & foramen of Luschka I’ve ever seen…

Michael T. Lawton, MD

70,644 次观看 • 2 个月前

Militarily, the “surgical strike” is a precise attack at a specific target with no damage to surrounding people or structures. Clipping a dural arteriovenous fistula is the definition of surgical strike, plus simplicity. And DAVFs around the medulla and foramen magnum are spectacular for their varicosity & tortuosity. Check it out…

Militarily, the “surgical strike” is a precise attack at a specific target with no damage to surrounding people or structures. Clipping a dural arteriovenous fistula is the definition of surgical strike, plus simplicity. And DAVFs around the medulla and foramen magnum are spectacular for their varicosity & tortuosity. Check it out…

Michael T. Lawton, MD

41,612 次观看 • 1 个月前