Brain Surgery in the Dark?

June 9, 2021 12:44 PM

On Grey's Anatomy, there's a scene where they do brain surgery with the lights dimmed low and use head lamps/glow sticks attached to their heads. Is that an actual thing or does it just look cool for tv?
posted by starfishprime to Health & Fitness (8 answers total)

This is a thing for a lot of surgery. It’s not just for patient comfort. It’s usually more dramatic on TV. But you can look at real procedures on YouTube and see it. Usually the lights are dimmed in the OR so the surgical lights can properly illuminate the area of surgery and to reduce glare and increase visibility screens as cameras are often used during surgery and projected to a screen and screens are used for surgical plans and patient info. A bright room and screens don’t mix well.

ORs may or may not be dim when you enter them as a patient. I’ve had a mix of both.
posted by Crystalinne at 1:03 PM on June 9, 2021 [2 favorites]

I know nothing about this whatsoever, but one second of googling led to this interesting article (Daily Mail, so take with as many grains of salt as you wish):

The challenge is that they are often very large and it is impossible to remove the tumour and also take out a safe margin of healthy tissue around its edges because of the significant risk of causing permanent disability, such as limb weakness, loss of speech, vision or memory.

The nature of the tumour itself is also a problem. The edges and outer margins often look identical to normal brain tissue, which means a significant amount of the cancer can be left behind. . . .

One major advance is the use of a drug called Gliolan. Given to patients before the operation in the form of a drink, it is absorbed by brain tumour cells and enables us to see all the tumour, including the edges, during an operation.

The drink contains an active ingredient called 5-aminolevulinic acid (5-ALA). The trick is that brain tumour cells process 5-ALA differently from the way other cells do, turning it into a compound which causes the tumour cells to glow pink when exposed to blue light. . . .

The next step was turning out the lights in the theatre before switching on a blue light (emitted from a microscope) to identify the residual tumour cells. When exposed to blue light, the tumour glows pink and stands out against the healthy tissue.

posted by flug at 1:09 PM on June 9, 2021 [20 favorites]

I'm not an MD but I've observed a couple functional brain surgeries. I don't know the scene you mention, but if the patient was awake, that would align with my experience-- patient is under twilight anesthesia for the beginning, then lights are dimmed while they're woken up for the functional bits, then put back under and lights back up.

They get woken up for localizing things like effective areas for stimulation in Parkinson's DBS surgery (the electrodes are placed and stimulation is tested to see if tremors go away). Or if the surgery is resection for epilepsy treatment (or tumor excision probably) the surgeons electrically stimulate to temporarily "knock out" areas of cortex to make sure things like language and memory won't be impaired following resection. During the functional testing, the room lights are often turned out for patient comfort since they're often looking at the ceiling.
posted by supercres at 1:36 PM on June 9, 2021 [1 favorite]

OR nurse here. Headlights are absolutely a thing and are used often during many kinds of surgeries by many different surgical specialties. They are especially helpful in open abdominal and pelvic surgeries when a focused light points in the same direction as the surgeon's eyes and moves with the surgeon's head--they illuminate deeper structures in the body that room lighting doesn't reach well.

That being said, I have never seen an open surgery performed with dimmed room lighting, headlights or no headlights, and I would be very, very confused by and concerned about such a setup.

Surgeries during which a camera is inserted into the body and the resulting view is seen on a screen (laparoscopic procedures, angiograms, endoscopic urology procedures, etc.), or surgeries involving the use of a surgical microscope, involve dimming the room lighting to avoid glare. My hospital's ORs are equipped with green bulbs in some of the room fixtures to provide some ambient light in the room without compromising the surgeons' ability to see the screen clearly.

During endoscopic or micro cases, often one of the moveable ceiling-mounted surgical lights is still on and pointed at the instrument table so the scrub tech/scrub nurse can see their instruments and supplies. Handling sharp things in the dark is not safe.

My hospital doesn't do functional brain surgeries so I can't speak to that, but we frequently do surgeries during which the patient has a nerve block or some other form of local anesthetic and is otherwise awake. If the light bothers them, we don't make the room dark--we give them an eye mask.
posted by jesourie at 3:58 PM on June 9, 2021 [12 favorites]

(Just to clarify because I'm pedantic and don't want people to think I'm an idiot: angiograms don't involve cameras. The lights are down so the surgeon can see the fluoroscopy screen.)
posted by jesourie at 9:35 PM on June 9, 2021

If the light bothers them, we don't make the room dark--we give them an eye mask.

This may be the difference-- visual cortex stimulation/response can be important for intraoperative mapping. It's not like cutting is going on in a dark room, more just fiddling with dials for DBS (often not even the surgeon doing this, instead a neurophysiologist), or touching a stimulating electrode to the surface of cortex.

Anyway, depends on specifics of the scene. All in all, probably just done for a dramatic feel :)
posted by supercres at 10:54 PM on June 9, 2021

When my husband was getting broncospies, they always did it in a dark room (I was next door looking through an observation window). In that case it was because they were looking at screens, and maybe a little because of the twilight sedation. They were trialing a new way of guiding the scope so they had extra screens around, and some sort of markers painted all over his chest that glowed in the dark.
posted by buildmyworld at 8:14 AM on June 10, 2021

An aside: my last company made a headlamp that was frequently worn on Grey's Anatomy (possibly the scene in question), and everyone in the office would share screencaps of the show when it appeared.
posted by spikeleemajortomdickandharryconnickjrmints at 11:39 AM on June 10, 2021 [3 favorites]