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Technology make minimally invasive brain surgery possible
The Times
Published Thursday, October 25, 2007
by Mary Jimenez

Minimally invasive brain surgery sounds like a misnomer.
David Stevens thanks God it's not.

"I feel real lucky, if you can call it that," said the 50-year-old Forest Hill resident, whose partially ruptured brain aneurysm last year was treated without open surgery. "It might have been an intervention from a higher power."

Call it a coincidence in word choice, but there was an intervention for Stevens, a neuroradiology intervention.

"We treat everything through the blood vessel," said Dr. Mike Williams, a specialist in interventional neuroradiology at LSU Health Sciences Center in Shreveport . "We're accessing the artery in the leg, and we run a catheter up in the artery as it goes to the brain."

LSUHSC-Shreveport's neurosurgery department recently opened a neuro-interventional suite, bringing endovascular brain therapy to this region.

The $2 million project allows the team to perform minimally invasive repairs of brain aneurysms, occlusion of vascular tumors in the brain and the opening of blocked arteries in the brain.

Real-time X-ray fluoroscopy (technology to monitor movement inside the body) and angiography (injection of contrast to obtain pictures of blood vessel anatomy), ultrasound, computed tomography and magnetic resonance imaging allow specialists to visualize their operative procedure without cutting into the body.

Williams, a graduate of LSU Medical School in Shreveport , received his training in neuroradiology at the University of Tennessee-Memphis.

"Especially when you get into aneurysms that are a real high risk to treat surgically, this offers a safer treatment with better outcomes," the Ruston native said. "At our institution, we treat about 80 brain aneurysms a year. Before I came, all those patients had surgery. The year after I came, we treated 75 with (endovascular therapy)."

Stevens is one of those patients.

In September 2006, the construction supervisor experienced "the worse headache ever.

"I worked through it for about a week before I went to see my doctor," Stevens said. "After a CT scan and seeing two specialists, they told me it was a ruptured aneurysm in the frontal lobe, like right in the middle of my head.

"Hearing that wasn't a good feeling."

Stevens was sent to Shreveport to see Williams, who gave him the choices.

"One choice was to cut a hole in my skull and pull apart the brain to reach the aneurysm," Stevens said.

Another was the nonsurgical technique coil embolization or "coiling." It involves the insertion of a micro-catheter (small plastic tube) into the femoral artery in the patient's leg. At the end of the catheter is a delivery wire with a tiny piece of pre-shaped platinum coil on the end.

The catheter is navigated through the vascular system into the head and the aneurysm. The coils are pushed into the aneurysm. Once in place, they are detached from the delivery wire with a small electrical current or heat.

"There are more than 100 different sizes of coils pre-shaped to match the size of the aneurysm," Williams said. "You pack the aneurysm until it occludes (fills)."

In a small-necked aneurysm, the coils initiate a clotting reaction that, if successful, eliminates the aneurysm. But with an aneurysm that has a wide neck, as was the case with Stevens, a third option is used.

"A stent was put in first to hold the coils in place, then they did the coiling," said Stevens, who was in the hospital only three days and recuperated a week before returning to work.

"They just gave me my one-year checkup, and Dr. Williams said everything looks good."

While endovascular therapy offers a shorter hospital stay and faster recovery, it isn't for everyone, Williams said. "The difficulty comes in the size of the aneurysm neck. The location and condition of the patient is also a factor."

The use of image-guided interventional procedures continues to grow Williams said. "Every time we turn around, there's something new and innovative."

For Stevens and many others, the science behind may seem confounding, but he's thankful just the same.

"When I found out about my aneurysm, I started going online to do research and found a chat room with others going through the same thing," Stevens said. "Some didn't make it, and others have a severe disability. Here, I am able to function and work. I'm very grateful."

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