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February 21, 2012 > Eyelash-Sized Incision Used for Brain Surgery

Eyelash-Sized Incision Used for Brain Surgery

Interventional Neuroradiology Offers New Techniques for Cerebral Aneurysms and Stroke

A relatively new area of medicine is making it possible for neurosurgeons to perform brain surgery without cutting open the skull. Interventional neuroradiology (also known as endovascular neurosurgery) uses an eyelash-sized incision to introduce a small hollow tube called a microcatheter into the arterial system of the leg and guide it through the bloodstream all the way up to the brain.

"Advances in technology are dramatically changing the way we do medicine," said Dr. Jeffrey Thomas, a cerebrovascular neurosurgeon and the new medical director of Interventional Neuroradiology at Washington Hospital. He is one of only about 120 neurosurgeons in the United States with dual expertise in microscopic brain surgery and interventional neuroradiology. "Radiology and computer techniques are now being applied to surgical treatments. Advances in digital imaging have made endovascular neurosurgery possible. We can see the blood vessels with excellent resolution."

Thomas uses the new technique to treat cerebral aneurysms and ischemic stroke, two life-threatening conditions that affect the brain. A brain aneurysm is an abnormal bulge on the side of the artery wall. The artery carries oxygen-rich blood and pressure on the wall can cause the bulge to burst, allowing blood to flow out of the vessel into the brain.

"Usually patients don't know they have an aneurysm until it behaves badly," Thomas said. "All of a sudden it ruptures and it becomes a medical emergency. About 20 to 30 percent of people with a ruptured aneurysm don't make it to the hospital, and many are neurologically injured or die later because of severe brain injury. A rupture puts people in great danger and they need to get to a hospital for treatment immediately."

Common signs of a ruptured aneurysm include a sudden and extremely severe headache, blurred vision, stiff neck, confusion, drooping eyelid, seizure, and sensitivity to light.

Coiling Over Clipping

The traditional surgical treatment for a ruptured aneurysm is to close off the aneurysm using a tiny titanium clip, Thomas said. The surgeon removes part of the skull, locates the blood vessel that feeds the aneurysm, and places the clip on the neck of the aneurism.

With the newer technique, a tiny microcatheter is introduced into the leg and guided through a series of blood vessels into the chest, through the aorta, and into the head and brain, he explained. A soft platinum wire is pushed through the microcatheter and into the aneurysm. The wire coils up inside the aneurysm, stops the blood flow, and causes the blood to clot. With the help of advanced interventional neuroradiology equipment, including biplane cerebral angiography, Thomas performs the delicate surgical procedure while watching his movements on a high-resolution monitor.

"I used to use the coiling method only for patients who could not be clipped," Thomas said. "Because of the tremendous advances in endovascular technology, I've completely changed my bias. Now I only clip aneurysms that can't be coiled due to their shape."

Interventional neuroradiology was introduced in the 1980s to develop new ways to treat brain conditions when traditional methods are not possible, such as surgically inaccessible aneurysms, according to Thomas. These new techniques were considered largely experimental until the 1990s, when a detachable platinum coil was developed and key advancements were made in angiographic imaging, allowing surgeons to see clearly inside the blood vessels.

"The first human aneurysm was coiled in 1991," he added. "Since the mid-90s, the technology has improved steadily and pretty magnificently. There have been significant technological improvements in each new generation of medical devices and materials that have been developed in that time."

Stopping Stroke

Thomas also uses the procedure to treat ischemic stroke, which occurs when blood flow to the brain is cut off due to a blockage in the artery. Without enough oxygen-rich blood, brain cells die.

"Today stroke is the fourth-leading cause of death, and the leading cause of disability, affecting about 795,000 people in this country each year," he said. "The majority of strokes occur in people over age 65, so as our population ages, we will see more strokes, making better treatments even more critical."

Thomas is able to open up the blockage using the microcatheter. He inserts it into the leg and moves it through the bloodstream to the blockage. He said the procedure must be done soon after the onset of stroke symptoms, usually less than six hours. Common symptoms include the loss of speech and ability to move on one side of the body.

"As soon as the blood flows back into the brain, the stroke symptoms stop," Thomas said. "The results are very dramatic. It is possible to completely reverse the situation with this procedure. Until recently, this kind of emergency medical treatment of stroke was not possible and patients received only supportive care."

Thomas said he is excited about bringing this newer surgical technique to Washington Hospital and the surrounding community.

"Interventional neuroradiology holds a lot of promise for people with brain and spine disorders," he added.

Find a Physician

To find a physician specializing in interventional neuroradiology, visit www.whhs.com/services or visit www.mywtmf.com. For information about wellness programs and other services at Washington Hospital, visit www.whhs.com.

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