Brain Surgery Doesn't Have To Be...Brain Surgery
Posted 9/8/2006
Watch COLUMBUS, Ohio – The addition of a highly specialized neurosurgeon at Ohio State University Medical Center gives patients a choice that is currently rare in this country: seeing a single physician who can perform a relatively new minimally invasive treatment to repair an aneurysm or a traditional open surgery, whichever best suits the individual.
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Louis Caragine Jr., M.D., Ph.D. |
Dr. Louis Caragine is one of an estimated 40 neurosurgeons nationwide trained to perform both the traditional brain surgery through an opening in the skull long associated with aneurysm repair as well as a growing number of blood vessel-based brain procedures that involve virtually no cutting at all.
Among the options offered by Caragine, director of endovascular neurosurgery at OSU Medical Center, is an increasingly popular coiling procedure to repair an aneurysm, which is a defect in an artery wall in the brain. Aneurysms resemble bubbles, and as they grow, they are at increased risk of bursting, causing damaging bleeding in the brain.
Many aneurysms can be repaired through the coiling technique and some, depending on their location, are much more safely treated endovascularly rather than through a surgery in which the brain must be retracted.
In a coiling procedure, the physician threads a flexible wire from an opening in the groin through the body’s blood vessels up to the site of the aneurysm in the brain and packs the opening in the artery wall with a mesh created by coils of the wire. Blood clots around the coils, and the filling causes blood to bypass the aneurysm. Some patients are still best treated by open surgery, which involves opening the skull and accessing the aneurysm directly and placing a clip on the weakened artery wall to repair the defect.
“The dual training I have allows me to wear two hats. I can see if the aneurysm is too deep and would require too invasive an operation and is better treated by coiling. Or, in someone very young, I might opt for open surgery and a clip so they never have to worry about the aneurysm again,” Caragine said. “This also gives patients a choice in their own care. If the aneurysm permits it, they can have an endovascular procedure rather than a traditional craniotomy.”
A new surgical suite under construction will make his dual training even more useful. OSU Medical Center is set to open a hybrid suite late this year that will support both open or endovascular brain surgeries. It will be the first suite of its type in the country and will eliminate the need to move a patient whose surgical needs evolve during a procedure. The suite will be equipped to allow Caragine to perform an intraoperative angiogram to check the success of every vascular procedure.
Patients who undergo a craniotomy are at higher risk for infection, bleeding and cognitive problems from the brain retraction. Patients undergoing the endovascular repair tend to have shorter hospital stays and lower complication rates overall, but they must be followed for a longer post-op period to make sure the disorder doesn’t recur. The rate of recurrence is very low when an aneurysm is clipped during open surgery.
Aneurysms affect between 1 and 10 percent of the U.S. population. Those most at risk for developing the defects include women, smokers and people with high blood pressure or connective tissue disorders. Symptoms include a change in headache trends or sudden, very severe headaches. About 30 percent of ruptured aneurysms result in death.
“Imaging makes it easier to catch them, so now we are seeing more patients before they rupture,” Caragine said.
He notes that some aneurysms with a wide base or “neck” would not respond as well to coiling alone but can be treated in conjunction with an endovascular stent. Stenting in the brain is emerging as a treatment option for stroke prevention. OSU Medical Center and Caragine expect to receive approval soon to implant intracranial stents for people whose narrowed arteries in the brain don’t respond well to medications. These stents, which are more flexible than stents used to open coronary arteries, can help prevent stroke in patients who otherwise are at high risk to have a stroke within a year. So far, such stents are federally approved only for humanitarian uses.
Caragine also is able to use endovascular techniques to treat other ailments affecting the brain, including arteriovenous malformations, which are congenital abnormalities causing vessels to cluster and communicate abnormally, and dural fistulas, vascular malformations on the protective layer of the brain, which often develop after trauma, infection or vessel blockages.
The availability of endovascular neurosurgery options marks an important trend for the care of patients with vascular brain abnormalities.
“Now that we have these minimally invasive options and lower complication rates, patients have more options than they’ve ever had before for problems in the brain,” Caragine said. “And we’re saving people now that before we could not save.”
# # #Note to editors and news directors: Dr. Louis Caragine of OSU Medical Center will participate in the “Brainstorm Walk” Saturday (9/9) stepping off at 9 a.m. from Dublin’s Coffman Park Pavilion, 5200 Emerald Parkway. The event is intended to raise awareness about the debilitating effects of brain aneurysms.
Click for more informationContact:
Emily Caldwell
Medical Center Communications
614.293.3737
emily.caldwell@9osumc.edu