A unique device developed to make brain surgery easier and less traumatic has been successfully used on a patient who was pregnant and suffering from a potentially life-threatening brain cyst. The device, called a "Brain Port," was pioneered by renowned neurosurgeon Amin Kassam, MD, Medical Director of the Neuroscience Institute at Saint John's Health Center.
“We were so lucky to find Drs. Kassam and Kelly”
The Brain Port uses a small needle and dilator to gently part the delicate fibers within the brain, opening up a safe working corridor between the organ's natural folds. A thin telescope called an endoscope can be inserted through the Brain Port, providing a magnified flashlight view that surgeons can watch on a high-definition screen. At the same time, tiny instruments can be passed down the Brain Port to perform delicate procedures, such as cutting out and remove a tumor, cyst or other tissue.
Importantly, once the Brain Port is removed, the fibers that make up the brain have the potential to return to their natural state. This can reduce the risk of permanent tissue damage from the surgery itself, which may occur with some traditional procedures that require removing brain tissue to create access.
The patient, 29-year old California resident Irene Henein, came to the Neuroscience Institute diagnosed with a colloid cyst, a rare and potentially dangerous growth that occurs in only three people per million. Although colloid cysts are not cancerous, if they block the flow of cerebrospinal fluid they can cause memory loss, severe headaches, loss of consciousness, seizures, coma and even death.
Henein, a native Canadian and registered nurse, was first diagnosed with a colloid cyst in 2003, when she started suffering terrible headaches and sudden muscle weakness. She underwent a traditional craniotomy in Halifax, Nova Scotia, during which surgeons sawed through and temporarily removed part of her skull. But the cyst was judged to be too close to critical memory structures, so part of it was left behind.
Henein married and moved to Sacramento, CA with her husband. When her headaches returned in 2008, an MRI revealed that the cyst was growing back. But her doctor at that time simply recommended a "watch and wait" approach. Then, in late 2009—now living in Orange County and pregnant with her second child—Henein's headaches began getting worse. Another doctor strongly advised surgery.
While Irene and her husband were worried about her health, she was even more concerned that undergoing another radical procedure might harm their unborn baby—and that the slow, fatiguing process of recovery would make it impossible to care for her other child, now a toddler. They decided to get a second opinion.
Through a friend, the couple was introduced to the surgeons at the Neuroscience Institute, Dr. Kassam and his associate Dr. Daniel F. Kelly, Medical Director of the Brain Tumor Institute at Saint John's Health Center. They explained that their experience with minimally invasive techniques and advanced equipment like the Brain Port would make the procedure far less risky and traumatic.
On December 21, 2009, the team operated on Henein when she was 15 weeks pregnant. The surgeons required only a small opening in the skull, through which the Brain Port was gently introduced. The procedure took several hours. This time, it was a complete success: the entire cyst was removed via the Brain Port.
"Anything that improves brain surgery is a huge step forward for patients," Dr. Kassam explained. "The Brain Port can minimize tissue damage on the way in to the surgical area. This allows us to better preserve brain function, which can lead to better outcomes. We still have some of the concerns regarding brain surgery such as infection, but now we have the potential to access and remove tumors in deep locations with the least amount of disruption.
"Besides colloid cysts, this device has a lot of applications for primary brain tumors and metastatic tumors," Dr. Kassam continued. "In fact, we are using it for both."
Meanwhile, Henein is thrilled with the results, and is excited about having her baby in June. "I feel good, I'm back on track, and even the occasional headache isn't nearly as bad," she said.
"Even though the cyst was in a difficult location, they still got it all out," Henein asserted. "My recovery time was much faster than my first surgery, I had no facial swelling, I didn't need to have a brain shunt, and overall, it was much easier on me.
"We were so lucky to find Drs. Kassam and Kelly," Henein concluded. "I don't know what the outcome would have been otherwise. There's no way I can express my thanks for what they did. And if there's even a chance that I might need to have this surgery again, I know who I'm going to."
SOURCE Saint John's Health Center
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