If brain transplants like the one in Poor Things were possible, this is how they might work

By Dan Baumgardt, University of Bristol

The neurosurgeon Sergio Canavero announced in 2015 that he could soon be capable of performing the world’s first human head transplant procedure. This would mean that it would be possible to remove someone’s head, and graft it onto the neck and shoulders of another person. As of yet, this has only been performed on cadavers and not on living humans.

But suppose you want to keep the face that you’ve already got? Or have grown tired of the body you inhabit? Could it ever be possible to switch brains between bodies instead?

Emma Stone recently won her second Oscar for her performance in the brilliantly surreal comedy Poor Things. In the film, Stone’s character, Bella Baxter, receives a brain transplant from her surviving unborn child after killing herself. The surgery is performed by experimental scientist Dr Godwin Baxter (played by Willem Dafoe).

Anyone who’s watched the film will see Dr Baxter remove the brain from the back of the skull, shelling it as easily as a pea from a pod.

For reasons I’ll explain later, this scene isn’t anatomically correct, but it does beg the question – how feasible is it to perform a brain transplant? What are the practicalities in perhaps the most challenging operation ever conceived?

Challenge one: getting in, getting out

The living brain has the texture of soft-set blancmange, and is protected from harm by the skull. Despite being a tough nut to crack, the bone would probably prove the easiest structure to negotiate. Modern neurosurgical techniques make use of craniotomy saws to remove a patch of skull, and access the brain underneath.

It’s worth noting that not all neurosurgical operations reach the brain this way. The pea-sized pituitary gland sits upon the brain’s base, just behind one of the sinuses at the back of the nasal cavity. In this case, it makes sense to use the nose instead for pituitary surgery.

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