09:11am Tuesday 02 June 2020

Brain Surgery on Monday, Home on Tuesday

MAYWOOD, Ill. — Loyola University Hospital is the first center in the Midwest to use new technology that makes minimally invasive surgery for life-threatening brain aneurysms safer and cheaper.

Dr. John Whapham used the technology to repair an unusually large aneurysm (bulging blood vessel) in patient Randy Riiff of New Lenox, Ill. Riiff went home the morning after his surgery, feeling tired, but experiencing no pain or discomfort.

The surgery took just 1½ hours. By comparison, minimally invasive surgery using standard technology would have taken about seven hours. And the longer the surgery, the greater the risk of anesthesia side effects and other surgical complications, Whapham said.

“The faster we can get in and out, the better it is for our patients,” Whapham said.

Whapham led an endovascular neurosurgical team that included radiographers Daniel Arnswald, BSRT(R), and Tomasz Szkliniarz, RT(R), and nurses Vanessa Brunson, RN, and Niakisha Jackson, RN.

About 6 million Americans — 1 in 50 people — have brain aneurysms that could rupture. Each year aneurysms burst in about 25,000 people and most die or suffer permanent disabilities, according to the Brain Aneurysm Foundation.

Traditional open-brain surgery to repair aneurysms is highly invasive. The surgeon opens the skull, gently retracts the brain and places a clip across the base of the aneurysm. Recovery can take months. Open surgery also can affect thinking skills by, for example, making it difficult or impossible to do complex tasks.

Whapham uses a less-invasive technique that’s becoming increasingly common in brain surgery. He inserts a catheter (thin tube) in an artery in the groin and guides it up through blood vessels into the brain. He passes tiny coils of platinum wire through the catheter and releases them into the bulging aneurysm. The bulge fills with coils, causing the blood to clot. This effectively seals off the aneurysm. “It’s like filling a bathtub with concrete,” Whapham said. The procedure is called a coil embolization.

Riiff’s aneurysm was unusually large. At its widest, the bulge was about 17 mm (about 0.7 inch) across. Typical aneurysms are 3-5 mm wide. Riiff’s aneurysm was discovered after he underwent a CT scan to investigate what was causing his severe headaches.

With standard technology, filling such a large aneurysm would require 40 or 50 coils and take 7 or 8 hours. Whapham used a new type of platinum coil, called Penumbra Coil 400®, which is four times longer than standard coils. Consequently, Whapham needed only 12 coils to fill the aneurysm.

Coils cost $1,000 to $2,000 apiece, so using fewer of them will sharply reduce the cost of the surgery, Whapham said.

Moreover, the new coils are four times softer than conventional coils. This will reduce the small risk that a surgeon could accidently puncture a blood vessel wall while deploying the coils, Whapham said.

“This new coil is a game changer,” Whapham said. “It’s the start of a revolution in the minimally invasive repair of aneurysms.”

Whapham is an assistant professor in the Departments of Neurological Surgery and Neurology at Loyola University Chicago Stritch School of Medicine.

“He did a wonderful job,” Riiff said.

Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 28 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 569-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola’s Gottlieb Memorial Hospital campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.

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