Opening up Neurosurgery to the World
By Alex Alamri and Ciléin Kearns, guest contributors
When people think of brain surgery, they often think of scary operations, deep brain stimulation, and arrogant surgeons that are unapproachable. Neurosurgery is far more diverse than this and neurosurgeons themselves are not all stuffy chaps like Dr. Strange! Instagram and Google searches can provide pictures of brain operations and horrific neurological injuries, but the vast majority of these weren’t created to educate or engage. More often than not they serve to worsen the ‘neurophobia’ that makes patients and medical professionals fear and avoid this topic.
Patients can experience a lot of anxiety before undergoing neurosurgery, especially where the brain is concerned. The lack of explanation in YouTube videos and snaps of gory operations doesn’t help this. The science-interested public including patients, students, and other healthcare professionals end up with an altered perception of our field that is damaging. There are few resources for those who want to learn more about neurosurgery, and they are often text-heavy and unengaging.
This is what drove us to create a public engagement resource dedicated to busting the myths surrounding our field and building bridges between public and professional audiences.
‘Brainbook’ is run by a team of neurosurgeons out of The Royal London Hospital, London, UK, which is one of the busiest major trauma centres in Europe (Figure 1). We collaborate with unique medical illustrators like Dr. Ciléin Kearns (Artibiotics, www.artibiotics.com) to create short illustrated films of patient journeys that open Neurosurgery to wider audiences. Members of the surgical team narrate these cases which feature a mix of story art, immersive surgical footage from GoPro cameras, medical illustration, animation, and patient scans.
: Illustration showing the ‘thunderclap headache’ which patients describe as ‘like being hit across the back of the head with a baseball bat’. This occurs an aneurysm bursts and causes a sub-arachnoid haemorrhage (a type of bleed). The character demonstrates some of the risk factors for this, including smoking, sex, and ethnicity. Illustrated by Dr Ciléin Kearns (Artibiotics).
Illustration showing how brain aneurysms can be ‘clipped’ to prevent bursting, or stop bleeding. Neurosurgeons must place these tiny clips precisely on the neck of an aneurysm to isolate it from the circulation, preventing the catastrophe of a strok,e or death in the event of rupture. Illustrated by Dr Ciléin Kearns (Artibiotics).
Medical illustration plays a key role in breaking down anatomy and surgery to guide our audience through the content. For the non-expert,including junior doctors, it can be easy to get lost in the detail of a surgical view. This can be obscured by hands, tools, anatomical structures like blood vessels, and limited by the space available and incision size. We overcome this by using illustration and animation that hides irrelevant detail and accentuates important aspects to present concepts clearly and beautifully wherever possible. Art can also aid in explaining concepts that are not readily visualised, such as the physics that allow a CT scanner to produce a three-dimensional image.
Patients are people; presenting surgery in the context of their stories is important for our films. Dr. Kearns draws from experience in narrative art design for video games to craft a meaningful, emotional impact. This is as important as the scientific information being communicated, and we believe it makes our content more relevant, enjoyable, and memorable.
We also design illustrated blog posts and YouTube video logs to supplement this content. The latter aim to show the human side of working in a busy, high-stakes environment. We want to build a genuine connection with our audience to improve perceptions of neurosurgery and neurosurgeons.
The true power of Brainbook is in connecting the public and professionals from all over the world. Everyone is welcome to participate in the discussion we stimulate on Twitter, Instagram, and Facebook. Our public audience ranges from the science-interested public wanting to know more about our field, as well as patients and their families wondering about an upcoming or past surgery.
We started by creating surgical videos that we uploaded on YouTube with patient permission, and organising active discussions on Twitter. This piqued a lot of interest and a small amount of corporate funding for an illustrated blog post on bleeding within the skull, which is associated with aneurysms. A collaboration with a company called Fundamental VR meant that we could combine art and film into a 360 virtual reality video that let viewers step into the operating theatre. This was featured in Wired magazine and showed us how much people wanted to learn about neurosurgery and the operating theatre.
This led to a science dissemination project with the NIHR Global Health Research Group on Neurotrauma who funded medical illustration and videography for a series of videos. These explored how surgeons reach and stop bleeds within the skull, and relieve brain swelling by removing bone. This was a resounding success with over 100,000 social media impressions over 72 hours and stimulated engaged public-with-professional dialogue across online platforms. The results of this case and benefits of the Brainbook platform are currently being published in the European Journal of Neurosurgery, Acta Neurochirurgica. We want to lead the medical profession by example, demonstrating the benefits of public engagement via high-impact, open-access, peer-reviewed publication (ie by ‘speaking their language’).
This whole project was initially funded by a donation from Barts Charity two years ago. This bought GoPros, a microphone, and let us develop an online home for our content at www.realbrainbook.co.uk. Since this humble start, Brainbook has thrived despite lacking a consistent stream of funding. We have been surviving on passion, donations, and occasional limited funding for science dissemination.
To sustain ongoing content development our next project will be funded via Kickstarter. Artibiotics and Brainbook are collaborating to create an illustrated short film exploring a patient’s journey through repair of a broken neck; a potentially life-threatening, and often life-changing injury (Figure 9). Should we succeed, we will aim for a larger Kickstarter for content featuring multiple artists including Luis Domitrovic (www.ladvic.com), and Merlin Strangeway (www.drawntomedicine.com). We hope to establish a Patreon channel to establish roots for a consistent income stream that supports regular content for public engagement and science dissemination.
With each project Brainbook evolves towards our ultimate goal: to become the go-to team for designing unique, trusted, content that builds bridges between the public and professional world of surgery. Feel free to check us out and spread the word!