Endoscopy Techniques Revolutionizing Neurosurgery

November 19, 2004
Section: Lifestyle/Health & Science
Edition: All
Page: E01

Endoscopy techniques revolutionizing neurosurgery

PATRICIA NORRISSTAFFThe Republican (Springfield, MA)

he 70-year-old patient was not himself for more than a year, according to family. But as his memory slipped steadily and he suffered a fall, breaking his hip, the situation could not solely be dismissed as diagnosis: old age.

While his symptoms did begin to mirror the memory hallmarks of Alzheimer's disease and dementia, two HolyokeMedicalCenter neurosurgeons, Dr. Christopher Comey and Dr. Kamal Kalia, had another answer - hydrocephalus, or water build-up on the brain.

"People told me I was having trouble but I am still not sure the reason why I fell," said the man, who did not want his identity disclosed for this article.

The patient's problem was eventually uncovered by a CT scan. Spinal fluid was getting clogged in his brain. The condition developed because the man had a colloid cyst blocking the natural drainage from the left and right lateral ventricles of the brain. The fluid buildup adversely began to affect memory, balance and bladder control.

Comey and Kalia told the man and his family they had the answer to his problem. But the solution required new surgical technology for the area: an endoscope designed for the brain, a navigation system to pinpoint where surgery must occur and a programmable shunt that would help drain the fluid and be manipulated with magnets as needed after surgery.

In simpler terms, an opening would need to be made in the thin membrane at the midline of the brain. The hole would allow the fluid to pass evenly again and both sides of the brain would resume clear communication. The placement of a shunt stabilized pressure in the brain and ensured the process would continue throughout the rest of the patient's life.

"It wasn't the happiest day of my life. But these two guys seemed to know what they were doing. They said we've got it under control," the patient said.

Although Comey said other treatment options were available, they were ruled out because of patient age or higher chance of failure. For instance, operating on the brain to remove the cyst was not an option as it "was too much surgery for a man in his 70s."

"If the patient was younger we would have went in and taken the tumor out," he said.

Kalia said while this was their first endeavor into this type of surgery, he and Comey were well prepared, having completed their usual continuing education, in which some instruction required practice on cadaver heads to perfect skills.

"This is an evolution of what we do anyway," he said. "This is an example of instrument evolution."

As far as their patient is concerned, recovery over the past weeks has been tough but positive, he said.

"I have been in twice for a check and things are working perfectly," he said. "The hip is still bothering me but my head doesn't."

(COLOR) A look inside the operating room where new endoscopic and image-guided surgery technology is transforming the neurosurgery field.

(COLOR PHOTO 2) Neurosurgeon Dr. Kamal Kalia, right, performs endoscopic brain surgery, a far less invasive surgical procedure than typical brain surgery with significantly reduced recuperation time. Neurosurgeon Dr. Christopher Comey, left, assists in the procedure.

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