Neurological Surgery

This week I had the opportunity to observe several more procedures in the interventional neuroradiology department. I gained a better appreciation of the broad range of treatments endovascular approaches combined with imaging technology have made possible. Last week, I discussed the detection and treatment of aneurysms, which are the main cases dealt with in this department. However, I was also able to observe treatment of a scalp AVM (arteriovenous malformation) patient where a glue-type substance was injected to block the channels connecting the arteries to the veins, a stroke patient who was treated with thrombolytic agents injected endovascularly, and a brain tumor patient whose arteries leading to the tumor were embolized to block blood flow to the tumor. These suggest the treatment of many other brain disorders through endovascular means - a much less invasive means than craniotomies – however the technology just needs to be developed.

I also observed a myelogram (a procedure in which a contrast dye was injected into the subarachnoid space next to the spine and x-ray images were taken to visualize the bones and space between bones in the spine) on a patient whose intervertebral disk had slipped and was compressing the spinal cord, causing weakness in his legs and one of his arms. The method of spreading the dye consisted of basically tilting the patient and allowing gravity to spread the dye, and seemed especially crude.

What struck me most during this past week is how much room there is for improvements in biomedical technology - every doctor seems to have ideas of things that could really dramatically improve treatment if developed. In the interventional neuroradiology department, there are still issues with catheters being able to navigate through some of the tortuous channels in the brain, technology for treatment of aneurysms, and so forth. I spent some portion of this past week investigating improvements in technology for treating cerebrovascular disorders and parameters that would govern improvements. Some ideas that are being worked out for aneurysm treatment in particular include hydrogel coils that expand upon being inserted in the blood such that they expand to fill an aneurysm and polymer materials that harden to fill an aneurysm.