For years, removing a brain tumor most likely meant a craniotomy—and the long recovery time that goes along with having a piece of your skull temporarily plucked out. In the last year, though, neurosurgeon Aaron Cohen-Gadol and his IU Health Methodist Hospital team have become the first group in Indiana to adopt a more refined approach: dissecting and drawing out tumors through the nose.
It turns out the ancient Egyptians, who used hooked instruments to pull out brains through the schnoz pre-mummification, were on to something. Cohen-Gadol’s method, which he learned from surgeons in other states, is, of course, a lot more advanced—and more impressive, considering he’s working on people who are still alive. First, an endoscopic camera is inserted up the patient’s nose, and a small piece of bone separating the nasal passage and the brain is removed. This allows Cohen-Gadol to carefully extract a tumor through that same passage with fine surgical instruments in about four to five hours. While a regular craniotomy takes about that long, too, this procedure is much less invasive. And recuperating takes just a couple of weeks, compared to months for the traditional surgery.
IU’s Dr. Cohen-Gadol is a bit of an overachiever. He’s also on the frontier of using fluorescein dyes to identify tumors. When exposed to the dyes—which are injected intravenously—cancerous brain tumors give off a slightly different wavelength than healthy tissue, allowing them to “glow” when exposed to a special light.
Cohen-Gadol got the idea after seeing how successful the dyes were when used in eye surgery. Now he is one of just a few doctors in the country applying the same process to the brain, where tumors often branch and root, making them notoriously difficult to completely eliminate. “Using these contrast agents, we’ll be able to better differentiate the tumor from the normal brain,” says Cohen-Gadol, who has now performed 50 such surgeries. Plus, the glow allows him a better chance of locating and maximizing the portion of the tumor that can be removed.
Deep brain hemorrhages. Tricky tumors. For surgeons, treating either problem can mean cutting through tissue and creating even more damage—or they can be impossible to reach altogether. But Dr. Ronald Young of Goodman Campbell Brain and Spine at the St. Vincent Neuroscience Institute is the first surgeon in the U.S. to use a new minimally invasive device to try to avoid such harm.
The NICO BrainPath, developed right here in Indianapolis at NICO Neuro and Spine, is a long, specially curved tube that “agrees” with the brain’s grooves so that Young—after cutting a dime-sized hole in the skull—can delicately part brain fibers with the instrument rather than cut through them. The result? Fewer complications, less brain swelling, and faster recovery times.
“Before, where we told people, ‘Oh, there’s nothing we can do for [a deep brain hemorrhage]’ and just watch them, now we can actually do something,” says Young, who became interested in the device after he was introduced to a prototype a few years ago. He has now successfully performed the surgery on more than 20 patients.
A Dose of Your Own Medicine
Vaccines have won battles against myriad maladies—measles, smallpox, polio. But brain cancer? Dr. Stephanie Wagner, head of the state’s only neurooncology program, is testing a version she thinks could do just that. For the past year at IU Health Methodist Hospital, Wagner has administered the vaccine—developed by Maryland’s Northwest Biotherapeutics and made with the patient’s own white blood and tumor cells—in preliminary trials to those suffering from one of the most deadly types of brain tumors: glioblastoma multiformes.
The 10-dose vaccine is specially crafted to attack the patient’s cancerous brain tumor and, should it work, would have advantages over traditional cancer remedies like chemotherapy (which isn’t tailored to specific patients or tumors) and radiation (which focuses only on tumors)—though trial patients must still endure both before starting the vaccine. The concept has been successful with other cancers, including melanoma and prostate. A similar trial performed at UCLA in 2006 resulted in patients who are still alive today.
“What the vaccine is doing is activating your immune system to attack those cancer cells,” says Wagner. Her first trial will complete enrollment around April 2014, and while the average survival time is 14 months, preliminary data shows the trial extending that period to three years.
Illustration by Carl Wiens
This article appeared in the November 2013 issue.