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The Wonders of the Unknown Brain

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Tuesday, February 28, 2017 - 18:30

Philip E. Stieg, PhD, MD

The past few decades have seen a dramatic increase in our understanding of the brain and how it works – new findings about plasticity, for example, have allowed us to revise our expectations about recovery after traumatic injury or stroke — and advanced technologies have greatly expanded our ability to treat a wide range of disorders. We know so much more now than we did 20 or 30 years ago, and yet every so often I’m struck by how much we still don’t know.

In a recent meeting, one of the neurosurgeons here at the Weill Cornell Medicine Brain and Spine Center told me about a patient he’d just treated. The 65-year-old woman had been diagnosed with a tumor in the meninges, the membranes on the outside of the brain under the skull. Any brain tumor is a serious diagnosis, of course, but a meningioma’s location just under the bone makes it relatively straightforward to access and doesn’t require excessive intrusion into the brain to remove it. The neurosurgeon removed it successfully, and the patient went to the recovery room with everyone expecting a good, unremarkable return to health.

But soon after the patient awoke after surgery, she noticed something that was quite remarkable indeed. As a child, she had lost her color vision. Now, five decades later, it had returned – she could see color again. Overjoyed, she thanked her neurosurgeon for this unexpected bonus. But the doctor was stumped. The tumor had not been located near the optic nerve, and there was no medical reason he could think of that might have caused this outcome. I talked over the case with him and I have to admit that I’m stumped as well. There really isn’t any connection we know of between a meningioma and the eyes, no reason any of us can think of why this would have happened.

And yet it did. As curious as I am about what possibly could have caused this to happen, I also revel in knowing that there are still mysteries in the brain. This remarkable organ, the control center of our physical and mental health, has secrets it’s not quite ready to give up.

I heard another mysterious brain story recently, this one from a veterinary neurosurgeon. This surgeon handles a variety of neurological and neurosurgical issues in cats and dogs, including brain tumors. There are many similarities between human brain tumors and canine and feline ones, which is not terribly surprising. We are all mammals, after all, and we share many elements of the same basic brain structure. Our genetic codes are quite different, though, so whatever genetic mutations allow a tumor to arise could also be different. But that’s not what surprised me.

The veterinarian told me that dogs with long snouts, like Labrador Retrievers and German shepherds, tend to develop tumors like the one that affected the patient who regained her color vision – on the surface of the brain. But dogs with flatter faces, like bulldogs, are more likely to develop tumors much deeper in the brain. Why? We simply don’t know. We do know those deep tumors are more difficult and more dangerous to access and remove, in both dogs and people. But what does skull shape have to do with that, if anything? Is there something else going on that we still need to learn?

There is so much still to uncover, and we continue to find clues in places as unexpected as a veterinary hospital. I cannot tell you how much I relish the ongoing opportunity to explore our most critical, most mysterious organ.


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