At The University of Toledo Medical Center, even brain surgery is minimally invasive.Dr. Azedine Medhkour, UT associate professor of neurosurgery, is treating the most complex and vulnerable part of the human body — the brain — with techniques that minimize collateral damage and improve the longevity of patients with brain aneurysms.
An aneurysm is weakening of a blood vessel in the brain that causes the vessel to develop a bulge or bubble, leading to intense headaches, dizziness and balance problems, and should it rupture, a high probability of death.
Two patients recently treated at UTMC highlight the spectrum of UT brain aneurysm care and the innovative steps Medhkour and his team are taking to improve the procedures.
Last summer, Nadine Van Scoy was rushed to the hospital with what turned out to be a bleeding aneurysm. Working together, Medhkour and Dr. Hassan Semaan, UT assistant professor of radiology, performed a procedure called embolization or coiling, where a catheter is inserted through a large vessel in the groin and directed through the circulatory system to the vessel with the aneurysm in the brain where it can be repaired.
“It is estimated that some two million people in the United States currently have an aneurysm or a bulging of a vessel in the brain,” Medhkour said. “The coiling procedure is the best option for older patients and ideally is used to prevent a rupture. Unfortunately, not every aneurysm manifests symptoms and it was lucky Van Scoy was able to get to UTMC quickly.”
Lucky because, according to Medhkour, UTMC is the only medical center in northwest Ohio to offer coiling and a procedure called retractorless surgical clipping. The surgery is performed with minimal or no brain retraction, which gently pulls tissue to access interior parts of the brain.
“A high school student recently came to see me due to intense headaches she was having,” Medhkour said. “During our search for the cause, it was discovered that she had a large aneurysm located at the base of the skull actually pushing on her left optic nerve.”
This posed a series of problems for Medhkour. Because the student was only 16, coiling was too risky. Because the aneurysm was at the base of the skull, he would need to navigate through brain tissue without damaging it to access the aneurysm.
“To minimize the potential for damage, we didn’t use any retraction,” Medhkour said. Instead, long, thin surgical tools were inserted between lobes of the brain. The aneurysm was clipped to eliminate its blood supply.
“This was a very complex procedure. Retractorless surgical clipping is only being done in a handful of medical centers around the world,” he said. “The end result was a successfully treated aneurysm with no damage to her eyesight and a CT scan that showed no signs of brain injury due to the surgery. Three months later, she was back to school and in excellent condition.
“Each patient’s treatment will be a little different, but at UTMC, we are at the leading edge of innovative new techniques that improve your health and speed your recovery,” Medhkour said.
In a letter Van Scoy wrote to UT President Lloyd Jacobs thanking UTMC and Medhkour for her care, she closed by noting that two area physicians not affiliated with UTMC that she saw recently were “very surprised that [coiling] was being done in our area. I am happy not only that you’re offering the highly complex procedure, but doing it so very well.”