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Minimally Invasive Brain Surgery Undergoes Major Expansion at University of Pittsburgh Medical Center

PITTSBURGH, April 25, 2000 — Through the newly formed Center for Neurointerventional and Neuroendovascular Therapy (CNNET) at University of Pittsburgh Medical Center, physicians at UPMC Presbyterian are now using minimally invasive surgery techniques for many types of brain and spinal cord surgery.

Patients benefit because they spend less time in the hospital, face fewer complications, have less pain, can be treated without being put to sleep under general anesthesia, and have a quicker recovery period, often returning to work the day after treatment.

In minimally invasive, or endovascular surgery, neurosurgeons and neuroradiologists thread small flexible tubes, called micro-catheters, through an artery or vein in the groin and then into the blood vessels of the brain and spinal cord to treat potentially life-threatening diseases. The procedures are completed without making an incision and opening the skull, neck or back and without causing the pain associated with traditional surgical procedures.

A collaboration of the departments of neurosurgery and radiology, the CNNET takes advantage of new and developing research and state-of-the-art instrumentation, which allow physicians access to the brain and spinal cord while reducing the risk of possible complications such as surgical infections.

These treatments are especially useful for the elderly and medically unstable patients who can less easily tolerate a traditional surgical procedure. They also are useful in younger patients whose problems can more easily be treated with the new technologies.

"Through CNNET, we hope to make patients more aware of their options should they be facing brain or spine surgery," said Michael Horowitz, M.D., associate professor of neurosurgery and radiology, and co-director of the CNNET with Charles Jungreis, M.D., professor of neuroradiology and neurosurgery at the University of Pittsburgh School of Medicine.

Although these new techniques cannot be used for all brain surgery, many types of surgeries that are now done by opening the skull can be performed or assisted using these new approaches.

"Some of these techniques have been used in the past, but newly developed materials, techniques and instrumentation make this type of surgery a more realistic option for many," Dr. Jungries said.

Endovascular surgery can be performed for strokes, brain aneurysms, traumatic vascular injuries, tumors, arterial venous malformations (AVMs), blocked carotid and intra-cranial arteries and even serious, life-threatening nosebleeds.

A cerebral aneurysm is a ballooning or bulging of an artery in the brain. If it ruptures, it has a 60 to 70 percent chance of killing or permanently incapacitating a person. Sometimes, because of its location in the brain or because of a patient's other medical problems, an aneurysm can be difficult to treat using traditional neurosurgical techniques. When aneurysms are treated with endovascular techniques before they rupture, many patients can leave the hospital the next day and return to work immediately. Patients can even be treated while awake.

An arterial venous malformation (AVM) is a tangle of blood vessels in the brain that can cause intracranial bleeding. A catheter can be used to block the blood vessels of the AVM with liquid adhesive or small particles, thus reducing or eliminating the AVM's blood supply. Such reductions make surgical removal of the AVM quicker and safer.

Narrowed, diseased carotid (neck) arteries can lead to stroke by reducing the blood supply to the brain. A balloon can be used to open these vessels similar to the way cardiologists open heart vessels. A stent can then be placed in the artery to keep it from reclosing.

Strokes can be caused by blood clots in the vessels. These clots can be dissolved using micro-catheters and new drugs. If the blocked vessel is opened quickly, patients can return to normal function.

"Such treatment may be especially useful in patients with poor cardiac function and in those who have had previous carotid surgery yet have had the vessel narrow once again," Dr. Horowitz said.

"Some nosebleeds are serious and require surgery," said Dr. Jungreis. "To stop the bleeding a catheter can be placed into the facial arteries feeding the nosebleed and tiny particles of polyvinyl alcohol can be injected to block the vessels and stop the bleeding. The same can be done for blood vessels that are bleeding uncontrollably following a car accident, a gunshot wound or a knife wound."

Many brain, neck, spinal cord and spinal tumors have significant blood supply that can lead to uncontrolled bleeding during conventional open surgery. By blocking the blood vessels that supply the tumor prior to surgery, tumor removal becomes quicker, easier, and safer.

"Such treatment may reduce the chance of a patient requiring blood transfusions during and after surgery," Dr. Horowitz said.

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