Neurosurgeons save lives, but the procedures are highly challenging. New technologies offer a remedy.
Six percent of the world population have aneurysms in the heads
In 1991 the US neurosurgeon Robert F. Spetzler and his team ventured to perform an unprecedented procedure: 35-year-old Pam Reynolds had been diagnosed with an aneurysm – and the doctors initially gave her little hope of survival.
But they ultimately found a solution by using a technique that was unique anywhere in the world at the time: the doctors cooled the patient’s body temperature to 15 degrees Celsius and then stopped her heartbeat and breathing, hence draining the blood from her brain. Since then, Spetzler has conducted almost 6500 aneurysm surgeries during his work at the Barrow Neurological Institute, Phoenix, USA until his retirement this year. He is regarded a proven expert in this field and has been saving lives for more than 30 years – thanks to his outstanding skills and strategic industry partnerships. The weakness of the artery walls leading to the condition is congenital. However, it is still unclear what exactly causes the vessel to bulge. Therefore, it is also difficult to predict when and why a rupture occurs.
Risk factors: high blood pressure, the pill and alcohol
In some people the artery bursts during sporting or other activities, but sometimes it happens when the person is resting. Risk factors include high blood pressure, the pill and alcohol abuse, but scientists are still unclear about what the actual trigger is and why women are more frequently affected than men. Estimates show that a good six percent of the world population have aneurysms in the heads. According to the experts, five to ten out of every 100,000 people are affected by the condition.* They often remain undiscovered, but that does not make them any less dangerous.
Only 50 percent of patients survive a brain hemorrhage
Only 50 percent of patients survive a brain hemorrhage. It is important to identify the bleeding at an early stage: many people feel a sudden, almost unbearable pain while others have symptoms like vomiting, sensory disorders or epileptic seizures. The diagnosis can be made using computer tomography.
In some cases surgery is the only remedy. After the skull has been opened, the aneurysm is isolated from the artery by using Titanium clips that resemble clothes-pegs. Alternatively a neuroradiologist slides a catheter into the bloodstream and lodges a small metal coil in the bulge of the artery. The result: the blood flows more slowly, reducing the probability of subsequent rupture. Both of these methods, clipping and coiling, save patients’ lives. Depending on the shape, size and location of the aneurysm, often only one of these methods is feasible. A typical neurosurgical intervention lasts a minimum of 3 – 4 hours. During this time, a visualization system is moved several times to visualize the desired anatomical region. Once it is moved to a different position, it is very difficult to find exactly the same previous position again.
The procedure also demands the utmost from the neurosurgeon. Open skull surgery often takes several hours and is very challenging – the doctor must concentrate fully on the procedure, and even the slightest distraction can lead to complications, of which there are many in the operating room. Once the surgical instruments have been put down, it is very difficult to find exactly the same location again. For these situations, ZEISS together with surgeons developed KINEVO® 900, the Robotic Visualization System, that moves virtually uninterrupted and finds exactly the same previous position again. Neurosurgeons want to focus on surgery and have comprehensive information exactly when they need it.
For further support, ZEISS has developed the QEVO® Micro-Inspection Tool that can be integrated into the robotic system. This enables surgeons to discover unexplored areas during the surgical intervention without bringing in another device. They can look around corners and gain deeper insights into the structures of the brain.
“I was fortunate enough to have the ability to use the QEVO addition to the microscope which I find really provides that final solution of being able to see around corners. It visualizes the area that we are interested in that we can’t see through the microscope. Because QEVO can be seen as it’s inserted under the operative field while still having the microscope view it adds a degree of safety that we have not had.”
Working through oculars at extreme angles can sometimes be very cumbersome and cause pain if there is not the option to work heads-up and ocular-free. An uncomfortable posture leads more quickly to fatigue and hence to a loss in concentration. In challenging brain surgery this is dangerous in view of the unpredictability of the procedure. Just as dangerous as aneurysms themselves. However, the technological advances can help neurosurgeons like Robert Spetzler to save even more lives in the future.