Neurosciences and insights into some truths
It was during my internship that I decided to take up Neurosurgery instead of Neurology, as I had wished as a schoolboy. I was always fascinated by the brain as a child and I was in awe of this supreme “machine” which could control emotions, intelligence and our personalities. I wanted to see whether I can learn more about it… and it also amused me that my brain should be knowing more about itself by doing so.
“Neurosurgery is probably better than being a ruthless Mafia boss on any day… and almost as exciting.”
Neurosurgery was a decision because the Professor of Surgery advised me to… I was good with my hands, I was ambidextrous and I could do precise work and I was intelligent more or less. I had patience and most importantly he thought, I never did lack the balls to do anything, however crazy it might be… He told me I would do very well, if I took up Neurosurgery and I guess it was a good advice. Neurosurgery is probably better than being a ruthless Mafia boss on any day… and almost as exciting.
So I started Neurosurgery at Christian Medical College, Vellore which in my knowledge was the finest place in South India to do the course.. Later on, I guess as I understand, it is certainly one of the finest places on earth to train in Neurosurgery.
During that time in CMC, I was something of a maverick and a misfit in a very disciplined and God fearing society and those balls of mine wreaked havoc… I am proud to have had done my Neurosurgery from CMC and I am glad I did not stay on to torture them beyond the six years that I was there… And I am sure they were relieved too…
Starting my career in Kerala, I was keen to do aneurysm surgeries and skull base surgeries and I wanted to learn how to open cisterns. By serendipity, I figured that opening cisterns in severe head trauma got those really tight brains to be lax… Decompressive hemicraniectomy was the surgery of choice in these cases of severe head trauma otherwise… This was in my opinion, a surgery, which is as ridiculous as it sounds, a hundred years old and has survived only due to the fact that most senior consultants does not want to come at 2 am in the morning to open cisterns in trauma… and the fact that you cannot really time motor vehicle accidents getting them to be elective… and the junior guys unabashed joy in seeing brain, although they start their lessons in getting scared about the myth of the abominable “Malignant brain swelling”… Decompressive hemicraniectomy, really cannot be classified as fine Microneurosurgery, was probably outdated by about eighty years and as every old practice, and I decided that it should be stopped as it continues to heap up damage upon damage.
I set about it and at present, I see that we are on the winning side and the people who support status quo and Decompressions are not doing very well for lack of logical reasons… and the usual enthusiasm of the younger generation to advance and improve which has sustained the so called evolution of mankind is winning too.
During this time, I started to realize that the cerebrospinal fluid which was about 120 ml of diluted saline like fluid, was located in the cisterns to suspend the brain and probably cushion it was not exactly for the same purpose as we were taught for a century or more… I understood that this CSF must be going inside the brain through the gaps around the vessels (these gaps are called Virchow Robin Spaces) and this was actually cooling and cleaning the brain. I also hypothesised that the air sinuses in the skull, lined with wet mucosa and air circulating through them was used to cool the region and would also cool the CSF just next to these sinuses in the suprasellar cistern.
“Decompressive hemicraniectomy, really cannot be classified as fine Microneurosurgery, was probably outdated by about eighty years and as every old practice, and I decided that it should be stopped as it continues to heap up damage upon damage”
So we figured out and proposed how the brain was cooled and cleaned. We also put forward the theory of “CSF shift edema” which explained the brain swelling and how opening of cisterns in head trauma and aneurysm surgery, helped. I also understood that most senior people cannot even spell the word “c-h-a-n-g-e”, forget about supporting change. They seemed afraid to embrace change and probably this has to do with our evolution and we can discuss it some other day.
When I realized that the pulsations of the blood vessels drove the CSF into the brain and the breathing cooled the brain and during sleep, certain gates opened so that the brain could be cleaned of all the metabolic by-products, my awe for the brain could know no limits… Here I was, looking at just the radiator of a race car engine and the radiator itself was so magnificent in design.
I started thinking what the brain stood for, actually… Was it about having a job, eating, sleeping, fucking and being cunning and smart…? Would you need 100 billion Neurons in dynamic quantum computing state to do that…? The more I thought, I realized that we hardly know the brain. I realized that the brain is a universe in itself… and more than it being a part of us, we all were a part of it.
Our brain, it seemed to me was a receiver and also a part of the Universal consciousness… So while it makes up a larger universal or cosmic brain, it also opens a window for us to access this universe through our brain, much like a hacker getting access to the server by a small cookie which is accepted as part of the software…
I also realized that religions and other divisions like countries were nothing but a frivolity in mans quest in stupidity trying to divide ourselves based on caste, color, accent, religion and so many more things… Sometimes I think, true gravity probably can be explained by the fact that descending into the so called stupidity of culture and religions and beliefs and divisiveness and then running around in circles being unkind and cunning till we die, is easier instead of opening the window to the universe using our remarkable brains.
“Our brain, it seemed to me was a receiver and also a part of the Universal consciousness… So while it makes up a larger universal or cosmic brain, it also opens a window for us to access this universe through our brain, much like a hacker getting access to the server by a small cookie which is accepted as part of the software…”
In fact the religions were trying to highlight this fact… Yahweh for example, when he replied” I am” to Abraham’s question, I believe, was not being impatient and irritated that the bearded guy was not looking very bright… “I am” is a status or a state, much like solid, liquid past or present… rather than a statement.
Shiva in sanskrit means nothingness and Aum stands for infinity. These two states, infinity and zero seems actually to be one and true realization of this either by mathematics or by religion, gets us to understand the beauty of a time stripped and mass stripped universe where you are part of it, yet you are actually complete.
Logic and reason and cunning disappears and opposites become one. Kindness and compassion and tears come to the forefront and we understand that these are the qualities of a living universe which we are part of… And time is just another dimension which we can cross just like the other three…
I hope during this time of lockdown, we have the time to listen to our brains and our true nature comes to the fore… and we understand that trying to have more of what will weigh us down does not help.
Wishing you happy Easter and also in case you are wondering “What the fuck are you smoking dude?”, let me assure you, I was in my senses when I wrote this.
Iype Cherian April 12, 2020
2. Cherian I, Beltran M. A unified physical theory for CSF circulation, cooling and cleaning of the brain, sleep, and head injuries in degenerative cognitive disorders. In: Opris I, Casanova M, editors. The Physics of the Mind and Brain Disorders. Springer Series in Cognitive and Neural Systems. Vol. 11. Cham: Springer; 2017
3. Cherian, I, Beltran, M, Landi, A, Alafaci, C, Torregrossa, F, Grasso, G. Introducing the concept of “CSF‐shift edema” in traumatic brain injury. J Neuro Res. 2018; 96: 744– 752. https://doi.org/10.1002/jnr.24145
4. Hira Burhan and Iype Cherian (February 21st 2020). Brain Cooling and Cleaning: A New Perspective in Cerebrospinal Fluid (CSF) Dynamics [Online First], IntechOpen, DOI: 10.5772/intechopen.90484. Available from: https://www.intechopen.com/online-first/brain-cooling-and-cleaning-a-new-perspective-in-cerebrospinal-fluid-csf-dynamics
5. Cherian, I., Burhan, H., Kaur, H., & Shreewastav, R. (2018). The unified theory – Neurology of emotions and how to control them. Journal of Nobel Medical College, 6(2), 29-34. https://doi.org/10.3126/jonmc.v6i2.19567
Neurosurgery in the Himalayas ...
The health scenario of western Nepal is bleak and especially the Neurosurgical facilities are poor. We started the Department of Neurosurgery in April 2008 and has been improvising to do various cases with good success rate. Although not very well equipped, we have tried to do our best and the results have been encouraging.
It was on a September afternoon that I took the decision to go to Nepal. When Dr. Mathai (who is now the senior-most Neurosurgeon in India) asked me over a cup of coffee at his home, even he did not expect me to say yes. And along with him, and my wife, I was also shocked at my response …