29 - Smart Cranial Implants - The Brain 2.0

From Kerkow media coming up on the show,

I bet you that one day you're going to look back at this interview in 30 years and you're going to walk into somebody's office. They're going to make a little cut your skin. They're going to pop out a little micro SD card out of your skull implant. And it's because you said your memory's a little bad. You're just going to get a new chip. You're going to upgrade from eight megabytes to 16 megabytes. Dr..

This episode concludes our series with one of the top rated medical institutions in the country. Johns Hopkins Medicine. When patients find themselves needing highly specialized, researched and practiced procedures, it's just assumed that someone has dedicated their career to optimizing outcomes in that narrow specialty. And one of the points to this show is recognizing that sometimes we can't

Hey, Bill, good to see you.

And our special guest, Dr. Chad Gordon, he is the internationally recognized expert and pioneer behind the emerging field known as neuroplastic and reconstructive surgery. He is chief of Neuroplastic and reconstructive surgery and director for Johns Hopkins

Medicine,

professor of plastic and reconstructive surgery and neurological surgery at Johns Hopkins. And he also chairs the Harvard Hopkins Neuroplastic Surgery Symposium. And he's the president of the Society of Neuroplastic Surgery. Thanks for joining us, Dr. Gordon.

Thank you, Bill.

First of all, Doctor, what leads to the need for

from a high level view? What really drives my passion,

the patients and the

team for which I work with

is that all patients

that require brain surgery

should not look like they had brain surgery.

And that really summarizes it to the point of what we learned over 50 years ago when it comes to breast cancer surgery. As you can imagine, if a woman suffers from breast cancer surgery in the 1950s, it was really about treating the cancer, not really treating the patient. And what's ironic is that we're here in twenty

twenty and brain

cancer and skull tumors and skull defects are really treated by brain surgeons who are concentrating on the brain. They're not really concentrating on the restoration of someone's appearance

to make it look like

they have no deformity or ever had surgery. And that really encompasses our goal.

So is this largely

a cosmetic process after you have dealt with the challenges of brain surgery, or is this something you do actually during the brain surgery itself?

Yes. So I love that you use the word cosmetic because I absolutely despise that word because the word cosmetic in plastic surgery is defined as taking someone who looks, quote unquote, normal and making them more pretty or handsome. And that's what drives me crazy.

People that have

brain surgery or need

brain surgery, they're not trying to

look more prettier, more handsome. They're just trying to look like themselves after surgery. And that's our mission. We're not trying to make you look better. We're trying to make it look like you never required somebody to open up your scalp, remove part of your skull and operate on your brain and put things back

together so that you have no deformity. Imagine going on a

first date or your brother comes home and has a den on the side of his head after having brain

surgery. Do you look at them the same way? Do you think they have the

same mental capacity they used to have? A lot of times we get this social stigma passed on to us by having brain surgery because our head doesn't look the same. But really it's just an appearance thing. And so I cringe when I hear the word cosmetic because I feel that I need to defend all the patients in the world that either need brain surgery or have had brain

surgery and that don't

look like themselves anymore.

I noticed during one of your online videos that you talked about having performed about 500 surgeries, what is the

original and critical

need for the brain surgery that usually leads to them coming to you?

So most often

they're coming because they've either

suffered trauma.

When you have an injury

to your head, the thing that

will kill you is

brain swelling. And the way to

make you survive is to remove part of your

skull that allows your

brain to swell without herniated and causing your

death or impairment forever. Now, when that bone comes off, a lot of times the

swelling will go away after weeks or months and then needs to be put back

in. But if it takes too

long, then the bones are no longer viable. The other scenario is just related to common day brain surgery. It doesn't really matter why you needed brain surgery.

The access

to the

brain is 75

percent on the side of your head. We don't go through your forehead and we don't go through the back of your head because the bone is either thicker or going right through your forehead would leave a deformity in and a scar in itself. So seventy five per. Cent of all brain surgeries through the side, unfortunately, you have a large chewing muscle there,

you have a temporal fat

pad there, you have a delicate scalp there, and not all that area is covered by hair. And so the simple matter of having brain surgery

requires removing

part of the bone like a bottle cap and putting that bottle

cap back.

That is actually dead bone. Once you've disconnected it, problems can happen with that bone. It can shrivel up like a grape goes to a raisin. It can get infected because it was taken off and

then put back

chemotherapy, radiation, smoking, diabetes. All these comorbidities can lead to problems. So no one having trauma to your head, no to ever requiring brain surgery. A lot of times they don't look like themselves ever again because the person who did their brain surgery was trained for seven years in a residency to operate on the brain. They weren't trained to reconstruct the skull or to do the operation in a way to preserve an appearance. And then the third thing

So they've lost their

skull because of a tumor of the brain invading it or people actually can develop skull tumors.

I have to ask you, Dr.

Gordon, what's

the difference between what you're going to do in closing

So you just said it yourself. They're focused on the brain.

It all comes down

to attention, to detail. When I'm opening up the scalp. I'm not worried about the brain. I'm opening up the scalp and using delicate maneuvers for the muscle and the fat, getting down to the bone, then turning the operation over to the brain surgeon. When the brain surgery is involved and when they're done doing the part that they so much care about, they can leave the operating room. And then I put everything back together again, just like a hood

on a car. You wouldn't want

to scratch your debt on your Bentley or Ferrari. And that's what these patients, unfortunately, are getting. Try running a company as a CEO or try being a teacher or doctor with a debt on

the side of your head or a scar

that healed pretty wide because it was closed under high tension or missing some of your hair on the side of your head. Because the best clarity of the scalp isn't that good like it was.

These are small details. And to you,

it might sound funny because you're having brain surgery. What do you care about a bad scar? What do you care about a dent? But guess what, it's not nineteen seventy anymore. It's not nineteen eighty anymore.

Bill, patients

deserve a

bar that is very,

very high. Now neurosurgeons are doing complex operations like they've never been done before and getting amazing outcomes. And that's why this field is growing so fast.

Speaking about that, I can't help but ask. The annoying

Every single one

that six hundred and fifty school reconstructions that I've performed have been covered every

single time. All I have

to do is simply take a picture and write a letter and state the exact thing us in the beginning of this show. This is not cosmetic surgery. That's my opening line. This is making the patient look like

themselves before they

had brain surgery.

Question for, you know, in my realm with neuro critical care,

adding more to to your numbers out there in Johns Hopkins?

Stephen, you're exactly right. The literature is showing now that when you have a major injury to your

brain, the best thing

to do is to get the bone off. And big is better. The more bone you take off in that critical window of injury, the more chance that the brain has room to

survive and swell safely.

10, 20, 30 years ago, that

was a, let's say, a

controversial topic. But the answer is now clear. And by taking that bone off,

like you said, requires

the bone to be either stored in a

freezer or stored sometimes

under the skin of your abdominal wall. And that leads risk for infection. Just like if you leave something in your refrigerator for too long, it's not good anymore. And that bone shrivels up or gets infected. And that's where I come into play. So I've been placing skull implants for the last 10 or 11 years.

I place a lot more than the average surgeon.

I've invented different design algorithms. Unlike the original design algorithm for skull implants, when skull implants were started around the year 2000,

they were built and only

manufactured to replace the missing bone. But when that bone comes

off, you also have muscle

and fat that shrinks away. And so if you don't design the implant the right way, you'll still end up having a dent because it's not filling in the muscle and the fat that you're missing. The other thing that we've invented recently, our smart cranial implants, just like your phone has changed your life, there is no reason why

skull implant and nobody knows there's

things inside

by smart. Do you mean, Doctor, that it actually allows for expansion at certain times?

No, that's a good question, Bill. By meaning smart, I mean, it has an inherent function inside rather than being a solid piece of plastic that was made with a 3-D

printer to reconstruct

your missing bone. Why wouldn't I put a device in there that helps the brain that's injured three or four millimeters away? So either a computer

in there, a

biosensor in there that tells you the pressure's high, a shutoff valve in there, maybe have too much fluid on your brain like a hydrocephalus. The most exciting thing that we're developing

right now, and we're actually

in the middle of animal trials similar to Elon Musk with his animal trials is we're creating the world's first full implant with a medicine reservoir that will deliver medicine through multiple catheters to your brain. To Stephen's point, he has dozens of patients that come through the NICU with brain problems related to their brain tumors.

It's hard to

fix brain tumors because of the blood brain barrier. We just can't get medicine to the brain.

The brain is designed

to keep out toxins just like chemotherapy agents. And so we're going to try to bypass the blood brain barrier like never before. And we're going to put these skull implants in and it's going to have a gas tank and it's going to have catheters and it's going to revolutionize the world.

So question for you, because

obviously, I mean, I'll have to just deduce that if somebody is having any kind of neurosurgery, it would be ideal to have a

plastic's approach initially

rather than just to have an plastic's approach after

the fact and with the few

thousand institutions that perform neurosurgery. My understanding is that there's only one.

Dr. Gordon, what do we do

at our local community hospital that needs neurosurgery? What can we tell our neurosurgeons? How can we alter their

approach so that

your work is much less invasive or

intensive three months

down the road, six months down the road, when they actually have to come to you?

There's not enough we can do. And the way we do this is we approach it from multiple angles. Number one, we started a fellowship at Johns Hopkins. So we train one or two surgeons a year that come in from around the world, around the country, and they spend one or two years with us and they do one hundred and thirty skull reconstructions in one year. And I teach them all the fine details. So that allows them to leave Baltimore and go start their

own program with another

amazing brain surgery program. And so that's one angle. But as you could see, that's puny.

That's going to

take a millennium to really reach the world. The other thing we do is we do a symposium every year, as you touched on in the beginning of the show, we've gone back and forth between Johns Hopkins and Harvard Medical School for the last six years.

And we bring

together neurosurgeons and plastic surgeons and experts from

around the world. And we try to

open up the other side of the brain and say, put the ego aside as a neurosurgeon and say maybe I should work more with my plastic surgeon. And then for the plastic surgeon that attends the conference, we show him these new techniques that I employ in Baltimore

and to show them, yes, as a

plastic surgeon doing hand surgery or breast cancer, maybe open your eyes to the idea or conception that you can work more closely with your neurosurgeon.

Most of the plastic reconstructive surgeons I know have gone into the big money fields, the cosmetic fields, to use

academic and much more

altruistic endeavor? What was it that motivated you?

The real answer

is that when I went to

college, I started off as a

chemistry major and they

made me take either a language or an art class. So I took art and it was drawing one to one and I fell in love with it. And by sophomore year, I went back to my premed advisor and I said, you know, I really love this drawing and sculpture. I said, I'm thinking of going as a fine arts major with a minor in chemistry. And they said, you're absolutely crazy. You'll never go to medical school. This is the stupidest thing I've heard in a long time. And

the beautiful thing about

being a fine arts majors. They teach you something called a mind's eye, which is the ability to see it before you create it. And I think what that helped me do was to give me a new perspective for school reconstruction that the neurosurgeons had and developed. A neurosurgeon most often is

coming to a

skull reconstruction as an afterthought. They've already done the part that they care most about. This is just something that needs to be done so the patient can wake up and move on. That's not what it is for me. For me, it's fixing the

patient and let's

say an artistic way point blank so it doesn't look like you ever had. Skull reconstruction,

and I think in the right way,

done

safely, we can get you there.

So, Dr. Gordon, I understand you've also received some awards

assisted and robot

assisted technologies. What are you doing there?

When I came to Hopkins, it was actually part of a team they were building for reconstruction of face patients who needed face transplantation.

You were actually involved

in one of the first ones that Cleveland was?

Yes. So the first face transplant, the United States was done in December 2008. I was on the team. It was an extremely amazing time in my life.

And after I

had gone to Boston and finished training, I was recruited to Hopkins to help with face transplant program.

And when I got

here, I realized that the first one we did in the United States took us twenty two hours. But when we spent maybe eight hours dissecting a face off of

the donor who was brain dead

but still with a beating heart, and we had a wonderful recipient,

kind of cold, who needed a

face after being shot in the face by her husband.

We literally brought the

face out of room number four and went into room number five. And we went like this. How do they go together?

You know, it was literally a guesstimate.

And when I got to Baltimore, I realized there were so many smart people around me. If I could take out my cell phone and get to the market much better, I'm sure we could design computers and robots programs to either help with face transplant or to even help with skull reconstruction. And that's what we've done and we've gotten many patents on that.

Is that like a 3-D mapping of the face and skull structure?

That's exactly right. So imagine something in space and something that needs that floating object and having a computer guided program that changes from green to blue when it lands in the right spot. You know, it's something as simple as that. And what's ironic is when we developed that for face, we realized, well, this object could be a skull implant and the recipient could just be a skull missing part of his skull.

And so a face go into

a face

recipient is almost like a skull

implant going to skull recipient. So there was a lot of overlap. Again, the most exciting ones I like to talk about are the skull implants of the future. We literally are designing skull implants that will be around in 20, 30, 20, 40. And you're going to remember tonight's radio show and you're going to say, man, I thought that guy was crazy when he was talking about putting things aside, solid pieces

As soon as we

turn sixty five, one in five of us will have a brain problem that will require surgery. And one, when you require

surgery, you're going to want

to look like yourself and you're going to want to go back to your amazing

job and you're going to want to

go out for dinner without the waiter looking at the side of your head and saying, why is he a dent on the side of your head or why does he have a bump on the side of his head? Because they put some technology above his skull. We're going to create these things that fit in right into the bone space, connect to your brain, close the scalp up and nobody will know you're either getting

battery powered

electric waves to your brain. It's pretty much what Apple

and Google and

all these cell phone companies did over the last thirty years. We're going to do with skull implants.

We're going to take 30 seconds and we'll be right back.

A moment of your time, a new podcast from Kerkow Media, currently 21 years old and today, like magic, extended from her fingertips down to the blood to take

care of yourself because the world needs

you and you meet

every do gooder that asked about me was ready to spit on my dream. Fingers were facing. You can feel like your purpose in your worth is

really being done to stop me from playing the piano.

She buys walkie talkies, wonders to whom she should give the second. I don't

love

humans. We never did. We never. Well, we just find

what you do.

Rock climbing is that you can only focus on what's right in life. And so our American life begins. We may need to stay apart, but let's create together available on all podcast platforms. Submit your piece at Kerkow dot com, slash a moment of your time.

Dr. Steve, I wonder if you could tell me you were certified in your neuro critical care sometime in the

Well, that's actually why I asked Dr. Gordon. The question relative to craniectomy is because I was the medical director of a trauma center for 20 years. But my current hospital is not a trauma center.

So on the

trauma side, there were a lot of patients with gunshot wounds, crush injuries from motor vehicle accidents, periodic explosions where there would be just penetrating trauma to the skull that that created its own defects in my current institution. Now, in the neuro

ICU, we're still clipping

some aneurysms. Most of them are being coiled, but those do require removal of a skull

flap so that

the blood vessel that has a defect can be corrected, but then that it does leave a defect that needs to be replaced. Often in our institution

with the native bone,

we do a fair number of emergency craniectomy where the brain is so swollen that in order to

save the patient, you must

remove a large

bone flap to allow the

brain to swell. The brain cannot

swell very much

without permanent damage because it's an enclosed space. The beauty of the skull is that it keeps the brain very well protected. It's sort of buoyant in cerebrospinal fluid. So it has internal fluid where the brain can sort of bounce around. But there's only room for some fluids, some blood and brain tissue. And as soon as you exceed

your limit, the brain has nowhere

to go. If you have swelling in your abdomen, you can get massively distended without causing major problems. Once your brain starts to swell, you have only a little bit of

leeway before that swelling starts

compressing blood vessels and occludes the blood supply and does even more damage to the brain. So you can have your initial injury. But then it's the

swelling that puts so

much pressure within the brain itself that it starts clamping off its own vasculature and then the more brain dies

because of the brain swelling

and then the brain has nowhere to go. So it tends to go down the center hole where the spinal cord is. And so that's what's called a herniation. And you cannot come back from that once you get to a certain point. So to prevent the swelling from being

catastrophic and causing brain injury, one of the

heroic emergency procedures that we see in my institution would be an emergency

craniectomy where the brain is swelling. Now, you give

it a point of egress

that will not be harmful. So you open up

a big skull flap, you let the brain swell, relieve the pressure so that the circulation in the brain is maintained

until which time? The underlying problem that caused the swelling is able to heal and resolve, and then the brain

shrinks back down into its normal

cavity. How does something

like that happen without terrible risk of infection in the brain? If you actually remove someone's top of someone's head,

well, the scalp will be put back together.

So the way to look

at is almost like a three layer peanut butter and jelly sandwich. Right? You have your scalp, your bone in your brain. And so just because you remove the bone, the brain has a lot of room to swell, maybe a half an inch, let's say, but the scalp will be closed.

And so the infection

risk is really coming from the bacteria that's above your skin. But to Stephen's point, I'll give him an example of

OK, now, if you add

blood to that, as Stephen said, or you make swelling occur in the brain, you're adding too much pressure in the box

and that's risking life, period.

So what we need is a pressure monitor. We need a pressure sensor.

And so that's what we

did three years ago. We did the world's first skull implant with a pressure sensor inside. Just let's say, like

you cook a turkey

in the oven and that little thing pops out of the turkey when it's done. That's the size of this little sensor that we put in a second plant. Now, to Stephen's point, he's going to say, why did you do this first world's case?

And my answer is going to be that we had a 16

year old

woman who was shot

in the head, unfortunately, wrong place, wrong time. And after the bullet transverse the side of her brain, the non important side, she had a long four or five month recovery where she was able to

walk and speak again.

However, her skull was never put back. And the reason why I had never been put back is because her brain never really got rid of the swelling. So the mother came to Baltimore with her daughter and said, Dr. Gordon, I'm here to get a skull reconstruction from my daughter because she wants to go back to a normal life not worrying about falling down.

Her balance is a

little off because her brain doesn't really have that box. But on the other hand, I'm thinking of running out of your office because I'm scared that when you go to put the

skull implant on top of my

daughter's brain that's swollen, you're going to cause her to herniate like Stephen described. You're going to. Pushing on her swollen brain, so I sat the mom down and said, how would you like it if we created the world's first

skull implant with a pressure monitor

inside that skull implant? It's just a piece of plastic. We have wireless technology that's already FDA approved. It's just nobody ever did it before. And how about I carve out a little space in that piece of plastic? I'll put a little pressure sensor right above your daughter's brain and we could test it wirelessly. Three days after surgery,

implant, and that's what we did.

And it was miraculous. It was just published in one of the main neurosurgery journals around the world last year.

And it was the world's

first smart cranial implant. And I think it's a tip of the iceberg.

A look at your phone. Look how your phone

changed your life. The single most important organ in your body, Bill, is your brain.

The next one hundred years is about your brain.

Guess what? You have a bad heart. You have a bad lung. You have

bad liver. You have bad kidneys.

We got stuff for that. Transplants, machines, whatever you need. We got it. You have a bad brain. We have nothing. And we will never transplant you a new brain. We can only modify the brain that you were born with. Now,

technologies to put above your skin. OK, nobody wants to

walk around like Frankenstein with something on their head. They've also developed technology that sits above your

skull, under your skin,

but you have a bump still on your head and it can actually poke up through the skin. With respect to time, no one's ever stopped and said, why don't we use the space inside

the skull to modify the brain?

And that's what we started five years ago. And that's why we're super excited, because

we believe we've solved the Holy Grail.

The Holy Grail is for the next one hundred years to develop

technologies that will

modulate

your brain, whatever disease

you, God forbid, develop as you get into the 60s, 70s, 80s, 90s. We will have an answer for that and we will miniaturize it to the point of where on the side of your cell phone, you know, you have that little micro SD card that popped out of the side of your cell phone. I bet you that one day you're going to look back at this interview in thirty years and you're going to walk into somebody's office. They're going

So I have to ask you about some side effects here. When you're replacing the skull with a plastic, do you find that you've had to manage debilitating headaches? What are the side effects and ramifications of some of these surgeries?

In nineteen sixty eight, there was a orthopedic surgeon that stood up in front of all his colleagues and said, we're doing it completely wrong. And everybody said, what? What's he talking about? This orthopedic surgeon

said that the way we

treat osteoarthritis or joint disease of the knee is we used to put a metal rod or metal plate across the knee and fused the knee so you don't bend your knee is that we're doing it wrong? We need to cut the knee

out, literally cut the

knee out that you were born with and take a box and open up a piece of plastic or a plastic joint and replace that joint in nineteen sixty eight. He got booed off the stage and was told he's crazy. Well guess what, in twenty twenty one if you have a bad knee, nobody's going to question the fact that we're going to replace your joint that you were born with for a piece of plastic out of a box. When they started doing joint replacements, they had

high problems with complications, infections and bleeding.

But what happens was there was a subset of surgeons in orthopedic surgeons

that said, you know what, I'm going to

dedicate

my life to doing knee

replacement or I'm going to dedicate my life to shoulder replacement. And instead of doing one knee replacement a year, I'm going to do one hundred knee replacements a year. If you do something much more than the average person, your outcomes will be much better. Your complication rates will be much less. And that's why I developed neuroplastic surgery. The surgeons that we're

training are saying,

you know what, I'm going to dedicate my life to doing skull implants and doing skull

reconstruction and getting less

complications and better outcomes.

Do you see in the future that ever there be

to predict potentially

future

problems? Yes. So let me take it

one step further.

I believe that we are going to start removing normal skulls. I believe there's patients, just like you said, whether it's normal skull, healthy skull or healthy brain. So if you come to me and

you say, my mom and dad

both had Alzheimer's and they both developed it in their fifties and I'm 30 years old and we have medicine

nowadays that is affected

to Alzheimer's. But when I give it to you in a pill form or inject it into your arm, it really doesn't get to your brain. So if I said to you at age 30.

Five, that I

have something that I can remove your totally normal skull and put in a little thing the size of a half dollar with a catheter into your brain and remove your normal skull. And for the next 15 years, I'm going to pump in medicine into your brain

that can prevent Alzheimer's. And it's the size

of a half dollar. Are you going to take that, Stephen?

Yeah, you bet.

There you go. So that's where we're going to be thinking about the military. Think about our military, our wounded warriors, see how much powerful things we could do to them. We could remove part of their normal skull. We could put medicine in there. So God forbid they're injured on the battlefield. You could take out your Bluetooth wireless cell phone and activate some pain medicine, some seizure medicine, whatever you need for your wounded warriors can be delivered in

skull and I put a little camera or ultrasound device into your skull space

and let's say you had an aneurysm clipping, but the doctor who did the atavism clip thing tells you there's really a significant risk that the other side might have a problem one day and explode and cause bleeding. How cool would it be if I put a little camera inside your skull and you could check your cell phone once a day to see if you have blood inside your head or your doctor could check inside your skull? This is where we're going.

I have no doubt we're going there.

The question I have is how fast can we work and how big of a team can we create? Because these patients need it. They need it.

Now, all I can say is, thank God we have

How can they reach you? How can our neurosurgeons get in touch with you to possibly get some information that can help them with their initial surgical approaches? And then how do they reach you after the fact when perhaps they need your help with reconstruction?

So the most simplest way, Stephen, is to go on Google and type in neuro plastic surgery. Chad Gordon, and you'll see everything we've done over the last 10 years. That would literally be the simplest way. If you want to take it one step further, you could type in Hopkins Medicine, Dogpatch Signora Plastic Surgery, and you'll get to answer a plastic surgery website with my office coordinator, our physician's assistant, and you'll get all our phone numbers and emails.

Dr. Gordon, thank you very much for joining us today. Very, very enlightening. And of course, Dr. Tayback, my good friend, thank you as always, for joining after a long day of work, a special thanks to Johns Hopkins for providing us a tour of some of the most accomplished and dedicated specialists in medicine. I have no doubt we'll be back again next year diving into specialists we don't know we need until we need them. And Johns Hopkins is

From Kerkow media

media for your mind.