New brain surgery technique

UNDATED Surgeons are now able to remove brain tumors, without cutting through the brain.

One wrong move during brain surgery can change a patient's personality forever, or wipe away years of memory. But this technique, performed at only two hospitals in the country, helped a busy mother recover with her memory intact.

Irene Henein had a brain tumor removed. Before that, she would get crippling headaches, which made it impossible to keep up as a mom. "Everything would go black on me."

Scans revealed a tumor buried deep in her brain. Surgeons cut open her skull, but they couldn't reach the mass without jeopardizing her memory. "They basically did the full opening from one side to the other," explained Henein.

She lived with the tumor until she got pregnant again. Doctors said this time, the mass had to go.

Henein feared the worst. "Am I going to wake up the same person? Am I still going to remember everyone that is around me?"

Doctors Amin Kassam and Daniel Kelly created the brain port procedure. Instead of cutting the tissue, they work through a small tube. It forms a path leading to the buried tumor. The port allows the doctor to come in along brain fibers, part them and position the port close to the target in the deep structures. 

Surgeons pull the tumor out through the tube. The brain then acts like a sponge.

Doctor Kassam explained the procedure further. "When the tube is removed, the surrounding brain is protected and has an opportunity then to come back to its natural position."

Compared to a Craniotomy, the brain port procedure cuts recovery from a month and a half to two weeks. It lowers the risk of disrupting vital brain structures, and it allows surgeons to reach deeper into the brain.

Henein feels lucky to have come out of the experience with her memory in tact. "I'm just very blessed and lucky that they were able to do this, and I'm still who I am."

Her tumor is now gone, but not her memory. Now Henein is getting ready for the new addition, a baby girl. "She's our fighter. She's our blessing."

The surgery is done at two medical centers: one in Santa Monica, California and one in Pittsburgh.

BACKGROUND: A colloid cyst is a slow-growing tumor typically found near the center of the brain. If large enough, it obstructs cerebrospinal fluid movement, resulting in a build-up of fluid in the ventricles of the brain and elevated brain pressure. Most patients suffer from headaches and sometimes blurry vision. In the most serious cases, prompt surgical treatment is required to reduce the chance of sudden death.

BRAIN PORT: The brain port was designed to work within the brain substance itself or within the fluid system in the brain. The procedure uses a small needle and a dilator to part the fibers within the brain, creating access to the structures located below the surface. Using the dilator, a small, clear plastic tube is placed within the substance of the brain, and an endoscope is placed inside this tube. This creates an up-close and magnified view that is projected on a plasma screen.

This precise surgical pathway is used to remove the tumor. Surgeons use specialized instruments and work completely inside this small tube. Once surgeons remove the tumor, they rely on the concept that the brain behaves like a sponge. The brain port gives surgeons the ability to reduce brain tissue damage by working through delicate brain fibers using the protective port. Once the port is removed, the fibers have the potential of returning to their natural state with less disruption than with traditional surgery.
 
"The concept behind the brain port was to find a way of essentially parting the brain and separating the fibers, working along them rather than through them," said Amin Kassam, M.D., Director of the Neuroscience Institute at St. John's Health Center in Santa Monica, California.

The port allows doctors to access cysts or tumors below the surface of the brain with less tissue disruption, preserves critical fibers of the brain and allows surgeons to operate closely to critical brain structures including the sections responsible for judgment and memory.

Dr. Kassam pioneered the brain port procedure and was the first in the world to perform it. He has done more than 100 cases using the brain port. St. John's Health Center and the University of Pittsburgh Medical Center are the only two centers in the country performing the surgery.

FOR MORE INFORMATION, PLEASE CONTACT:
Maribel Leyva
St. John's Health Center Neuroscience Institute
Santa Monica, CA
(310) 582-7450
neuroscience@newstjohns.org