A new minimally invasive surgical procedure may benefit stroke patients who were previously deemed hopeless cases. UCLA neurosurgeons announced the results of their study on February 7 at the International Stroke Conference today in Honolulu, Hawaii. The study was led by Dr. Paul Vespa and Dr. Neil Martin, chairman of neurosurgery at the David Geffen School of Medicine at UCLA, in conjunction with Johns Hopkins University,
A few decades ago, minimally invasive surgery was mainly limited to gynecologic procedure where it evolved from merely taking a look inside the abdomen and performing limited surgery such as tubal ligations to complex procedures such as a hysterectomy. It then spread to many other medical specialties such as general surgery, orthopedic surgery and urologic surgery. Currently, neurosurgeons have embraced the surgical concept. The UCLA neurosurgeons conducted a potentially groundbreaking, multi-center, randomized, controlled phase II clinical trial. The study was conducted at a number of medical centers to determine whether minimally invasive endoscopic surgery appears to have safer and more effective outcomes compared to standard medical treatment for brain hemorrhage.
“These exciting results offer a glimmer of hope for a condition that most doctors have traditionally considered hopeless,” noted Dr. Vespa, professor of neurosurgery at the David Geffen School of Medicine at UCLA and director of the neurocritical care program at Ronald Reagan UCLA Medical Center. He added, “That is a big deal in medicine.”
Nearly 800,000 Americans suffer from strokes every year and the condition is the leading cause of death and long-term disability in America. Two types of strokes cause damage to the brain: ischemic and hemorrhagic. An ischemic stroke is caused by blockage of a blood vessel in the brain. A hemorrhagic stroke is caused by rupture of a blood vessel and bleeding into the brain. During a hemorrhagic stroke, bleeding becomes toxic and deadly in the brain. Brain hemorrhage that results in a stroke is a devastating, critical condition with a mortality rate of 75%. If the patient manages to survive, he or she could face a life of long-term severe disability.
In the past, brain surgery involved making a large incision to remove the blood; however, the procedure resulted in further trauma to the brain and often failed to improve the outcome of the patient’s quality of life. As a result, open surgery is uncommon for bleeding in the brain. The neurosurgeons set out to determine the safety and effectiveness of removing blood using a small incision smaller than the size of a dime. The endoscope, a tiny probe with a light and video camera on the tip, was used to navigate with GPS-like precision. The image-guided system displays CT scans of the brain on monitors that allow the surgeons to immediately pinpoint and remove the blood. Dr. Martin explained, “Endoscopic surgery has the key advantage to get the blood out all at once, immediately alleviate the pressure on the brain and set the stage for ultimate recovery.”
The procedure was performed at seven major medical centers with 24 enrolled patients; 18 of the patients underwent the endoscopic surgery while six received standard medical treatment. Six months postoperatively, the neurological outcomes for patients were better and mortality rates lower for the endoscopic surgery patients compared to the second group. The investigators noted that their study found that the procedure appears to be safe with no further bleeding or harm to the patient. On average, 71% of the blood was immediately removed. The neurosurgeons determined that the ICES study appears to be a safe and potentially helpful surgical procedure for brain hemorrhage and will continue to be investigated in a more definitive clinical trial in the near future.
The UCLA Department of Neurosurgery notes that it is committed to providing the most comprehensive patient care through innovative clinical programs in minimally invasive brain and spinal surgery; neuroendoscopy; neuro-oncology for adult and pediatric brain tumors; cerebrovascular surgery; stereotactic radiosurgery for brain and spinal disorders; surgery for movement disorders such as Parkinson’s disease; and epilepsy surgery. For 21 consecutive years, the department has been ranked among the top neurosurgery programs in the nation by U.S. News & World Report, including No. 1 in Los Angeles and No. 2 on the West Coast.