How to use the knowledge of neuroscience for your own growth: Brain & Mind Growth Hacks

 The use of Prefrontal cortex (PFC) : The prefrontal cortex is the intelligent part of the brain. Never stop dreaming big. It will challenge your prefrontal cortex and it will search the way to find the solutions. It puts your intelligent part of brain on work. It can be done deliberately. Never restrain your dreams because of current situation. have a strong desire for some big goal, Visualise it, subconscious mind understands it so you can pursue it, enjoy the process. Manifestation can be practiced.

  Serotonin: A neurotransmitter which makes you happy. Increase your serotonin level.

  Endorphin is useful hormone. Its level can be increased. Exercise and adopting good lifestyle are easy way of increasing its level.

  Decrease serum cortisol level: avoid unnecessary stress. have good sleep.

   Decrease dopamine level: Avoid addiction forming bad habits.

   Avoid cerebral atrophy: consumption of alcohol and cigarette smoking increases cerebral atrophy. Avoid alcohol addiction and cigarette smoking.

 The most amazing phenomenon is neuroplasticity. The brain is an anatomical structure. Mind is physiological part. Thoughts, Mind, Conscious and subconscious mind are very interesting subjects.  Brain is made up of billion of brain cells (neurons) & trillions of connections (synapses).

Neurons consist of cell bodies (perikaryon), axon & dendrites. Dendrites (dendron means tree) are short,  branched & carry impulses toward the cell body. Axons are usually single and long. Nerve cells convey signals to one another at synapses by releasing chemicals or neurotransmitters.

Human Brain is Born Unfinished. It takes many years to transform from helpless newborn to become an independent person. New born child remains totally dependent on others for survival. Dolphins are born swimming, baby zebra can run within 45 minutes. Is it advantage or limitation? Baby animal brains are wired up for preprogrammed routine. Flexibility, capacity to adopt & ability to thrive in many different environments is possible with human brain because it is born remarkably unfinished.

       

Childhood pruning. The number of brain cells is same in children & adults. Secret lies in how these cells are connected.  At birth, a baby’s neurons are least connected & in first 2 years of life they begin connecting up extremely rapidly as they take in sensory information.In infant, 2 million new connections or synapses/second. By age 2, 100 trillion synapses (2X adult). then neural pruning, carving makes everyone unique.

      All experiences in our life shape the microscopic details of our brain & neural circuits. Because our experiences are unique, brain rewrites our own pattern of neural networks.

  Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively & is able to make a contribution to the community. The mental health moves up & down in response to the life circumstances, it is a state in which same person feels low, euthymic or excited depending upon situation. Not like normal or abnormal. Not like perfect or imperfect. Not like sane or insane.

Range of mental health

No one is perfect, no mental status is permanent, moves up & down with circumstances:

Happy, excited, elated, joyful, optimistic, fulfilment, gratitude

Low energy, feeling negative, disappointed, feeling lonely, sad

Feeling anxious, worried

Life skills

Self awareness, Empathy, Humor

Critical thinking, Decision making, leadership, Problem solving, Effective communication, Interpersonal relationship, Assertiveness

Resilience (Coping with stress and emotions, dealing effectively with challenges)

Ability for adaptive & positive behaviour to deal effectively with the demands & challenges of life (Psychosocial competency)

Value clarification (what is important to me), financial literacy

Habits (Basal ganglia & Prefrontal cortex)

Within 3 weeks a new habit is formed (or break old bad habit & get rid of it)

Tiny/small & incremental changes lead to significant improvement

1% change everyday : walk for 10 minutes, 5 minute aerobics will be enjoyable, requires little effort. So, choose easiest change and repeat. Gradually it will become a habit & create a system

Improve eating habits: balanced diet, eat vegetables, less sugar/salt/oil, less junk food

Practice gratitude, practice appreciation

Maintain Sleep hygiene, Try to wake up early

Practice mindfulness 

Good mental health & subconscious mind

CREATE SYSTEM THROUGH SUBCONSCIOUS MIND 

Emotionally stable

Healthy relationship/connected with other people

Positive outlook, positive self perception

Sound & effective decisions 

Having good sleep

Mindfullness/at peace

Good self care

Feeling happy most of the time

Optimistic, hopeful

Sense of meaning/purpose

Resilient

Pre-frontal cortex

Logical mind 

Planning, decision making, reasoning

Genius of the brain

Put your prefrontal cortex on work ( I cannot afford/ how I can afford? I don’t know/ How I can be expert? )

Amygdala: Emotional control center of brain

Stress, anxiety, fear activate it, which increases cortisol level.

Resilience

        Success is not final, failure is not fatal

• There is no failure. You either win or learn.
• If you survive through  a tough situation, your brain becomes more resilient
• Bounce back, “Rise from the dust.” Recover from setbacks & learn from them
• Turn your failures into stepping stones for success

 You can build resilience

Resilience can be developed, 

Fail fast & learn faster, rapidly testing ideas, learn from mistakes, innovate, encourage mistakes & even celebrate

Helps to face stresses & challenges

Helps to adjust in adverse situations

Bullet proof mindset, act if nothing bothers you

You can outgrow your problems

Neuroplasticity

    Ability of brain to change, adapt & learn new skill  

Billion of neurons & synapses (neuronal connections) make functional networks which change through growth

Dynamic & ever evolving nature of brain

New experience creates new synaptic connections, it helps in personal growth. 

Rewire your brain, fortify your brain, you can consciously & intentionally create new neural connection & level up the mental strength by learning new skills, exposing yourself to new challenges

Brain hacks: Re-train your nervous system : start the day relaxed, meditation, prayer, exercise, watch sun rise, talk to friend or family, choose to slow down little, eat slowly, be relaxed, walk slowly, activates parasympathetic system, learn a new skill/language/musical instrument, non dominant hand exercise ( neurobics ), travel

Neuroplastic rewiring: brain repairs itself, it is core of neuro-rehabilitation concept & practice

  Happy hormones make us happy 

Dopamine

Serotonin

Endorphin

Oxytocin

Mindfulness

Recognise & appreciate things around you & connect to the present moment

Pause, Stillness, calm spend sometime without bothering for anything

Fixed mindset vs growth mindset

   Survive/Thrive 

Linear growth vs exponential growth (compounding)

Most people overestimate what they can achieve in a year and underestimate what they can achieve in 10 years.

“ Your life is a result of the choices you have made. If you don’t like your life, start making better choices ”Zig Ziglar

Risk mitigation & management of neurosurgical complications

The common risk in neurosurgical procedure if occurrence of neurological deficit, bleeding during surgery, oedema due to retraction of the brain tissue, CSF leak, surgical site infection, inadequate decompression of the tumour, brain herniation, etc.

A proper preoperative surgical planning is an important step for risk mitigation.

So, risk mitigation starts with initial clinical work up of the patient. Identification of the co-morbid conditions like diabetes, hypertension, ischemic heart disease, hypothyroidism, endocrinopathy, is the priority of both anesthetist and neurosurgeon. Many co-morbid conditions are not even known to the patient. For example a patient with pituitary tumour may have visual deficits, hemianopia, hypothyroidism, diabetes insipidus of which patient may not be aware. Similarly, patients with brain metastasis may have systemic cancer which remains undetected. 

All exigencies must be considered by a neurosurgeon before operating. For example, during surgery of the spinal cord there is chance of CSF leak. So, dural repair with artificial dura and its reinforcement with fibrin glue must be considered prior to surgery.

In neurosurgery nothing is unexpected. All the steps are well planned. It is like standard operating procedure. It is like checklist of each neurosurgical procedure. 

Prevention and reduction of infection in surgery was possible by introduction of antiseptic principles described by Joseph Lister in 1867. So, the antisepsis must be maintained in operation theatre and also during any invasive procedure in any neurosurgical patient. The use of prophylactic antibiotic significantly reduces the risk of infection in a neurosurgical patient. Part preparation should be done properly and enough time to be given for part preparation. It is surgeon's responsibility to ensure that all staff involved in surgical procedure adheres to the set principles of antisepsis. 

The patients of intracranial brain lesions often present with seizures. Some patients with brain tumours do not present with seizures but are very much likely to develop epilepsy, especially patients with lesions in basifrontal region, at rectus gyrus after surgery. Meningiomas are also epileptogenic. In such patients prophylactic anti epileptic drug be started.

Some intracranial brain lesions have associated vasogenic oedema. So, in high grade gliomas or meningiomas, steroid ( Dexamethasone) to be started before neurosurgical procedure to avoid sudden increase in oedema and any chance of brain herniation.

Sometimes, during surgery, intraoperative Mannitol is given to reduce intracranial pressure. 

Blood loss is a risk during a neurosurgical procedure. So, to reduce blood loss during surgery head end elevation is done during surgery. It reduces intracranial procedure. Enough blood is arranged before surgery depending upon the procedure. 

All neurosurgical procedures are designed in such a manner that there should be minimal retraction of the brain. It reduces need for retraction of the brain and any possibility of post operative edema and subsequent brain schema or brain herniation. It is the basis principle of practising skull base surgical approaches.

Surgical approach to the lesion is always through non-eloquent area of the brain. So, there is immense significance of surface marking and pre-operative surgical planning. Most of the intraparenchymal frontal lobes lesions like frontal lobe gliomas are approached through right middle frontal gyrus just anterior to the coronal suture. Similarly, posteriorly placed intraparenchymal parietal lobe lesions are approached through right sided superior parietal lobe. It is very common practice that ventricular end of the ventriculo-peritonal surgery is introduced either through right middle frontal gyrus just anterior to the coronal suture or through the right superior parietal lobule. The endoscopic third ventriculostomy (ETV) is also done through right middle frontal gyrus by making a bur hole just anterior to the coronal suture in the mid pupillary line.

While planning excision of the cerebral convexity meningioma, the arrangement should be made for dural repair if it involves excision of the tumour along with involved dura.

Since microneurosurgery involves working through narrow surgical corridors a rigid head fixation is essential in order to maintain the desired head position and also even slight head movement may cause damage. So, either Mayfield's head-holder system or Sugita head-holder is used in such neurosurgical procedures. 

Operating surgical chair is to used by neurosurgeon to avoid fatigue and tremors during surgery for better control of cautery, microscope, endoscope, drill, etc.

Neurosurgeon should be the first person to reach the operation theatre and be the last person to leave the operation theatre (If best outcome is expected). never outsource the position of the patient on operation table, marking of the incision, corticectomy to the subordinate. If not sure from the beginning, it will definitely haunt him during the entire neurosurgical procedure. Only after extubation and seeing the expected neurological outcome immediately at the end of neurosurgery ensures homeostasis of any neurosurgical procedure. Only then neurosurgeon becomes sure that operation was done perfectly. It looks a very tough task to spend so much time in surgery and also spending much more time than any body else in your team, but it is true. It must be practised without any exception. It is for perfection. Nobody is perfect but in pursuit of perfection you achieve excellence. 

During spinal surgery bone nibbler is used . it should be used carefully as it may cause damage to the spinal cord. It should just nibble. Don't rotate or tear anything. Don't pull any structure unnecessarily. Use Kerrison ronguers of appropriate numbers, for nibbling small parts of the lamina.

All neurosurgeons are well versed with brain and spinal surgery. Only difference is the expertise in extent excision of the lesion without causing any complication or neurological deficit in a neurosurgical patient. So, risk mitigation is the most important task of neurosurgeon.