Neurosciences - Neurosurgery

Neurosurgeons at DMC Harper University Hospital take an interdisciplinary approach to brain tumor therapy by collaborating with other departments and programs, including radiation oncology and medical neurooncology.

During surgery, Harper neurosurgeons use advanced brain-mapping techniques to identify and avoid injury to sites of language, motor, and sensory function. These techniques permit the neurosurgeon to resect the tumor to the maximum extent possible while minimizing injury to the surrounding brain tissue.

Harper also offers the most advanced surgical navigation systems, which permit the greatest precision in tumor resection. Harper was the first hospital in Michigan to offer Intraoperative MRI (iMRI), an advanced imaging technology that provides “near-real-time” MRI views during surgery. Expert use of this powerful technology results in greater precision, better surgical outcomes and faster recovery.

Innovative Treatment Options

From awake craniotomies to minimally invasive tumor surgery and non-invasive Gamma Knife® radiosurgery, many innovative treatment options are available.

• Gamma Knife ® radiosurgery is a revolutionary, non-invasive technology that uses precisely targeted beams of radiation — instead of scalpel incisions — for brain surgery. This innovative and effective procedure dissolves tumors, vascular malformations and other brain disorders with little or no damage to the surrounding tissue.
• Neurosurgeons at Harper University Hospital are pioneering minimally invasive neurosurgical procedures — accessing the brain through tiny burr holes or via the nose and sinus cavity. One procedure pioneered in Michigan at Harper University Hospital — Endoscopic Transnasal Transsphenoidal Hypophysectomy — is fast becoming the preferred choice for the treatment of pituitary tumors. Using a small endoscope, surgeons approach the pituitary gland through the patient's nose and sinus cavity. Since no incisions are necessary, the patient experiences virtually no pain and often returns home after only two days in the hospital.

Harper neurosurgeons can implant a "chemotherapy wafer" inside a resection cavity after removing a brain tumor — delivering a targeted dose of chemotherapy directly to affected tissue over time.

Harper University Hospital is a national leader in cerebrovascular surgery — the surgical treatment of diseases of blood vessels that supply the brain with nutrients and oxygen. Using advanced, microsurgical techniques and sophisticated equipment, vascular neurosurgeons at Harper are among the nation’s best in treating the following conditions:

• Aneurysms
• Arteriovenous malformations (AVMs)
• Stroke

When appropriate, endovascular neurosurgery techniques are used to treat a growing number of problems. These procedures involve the treatment of diseases of the blood vessels from within — requiring no incisions on the head or neck. Endovascular neurosurgery is the preferred treatment for patients who cannot undergo open surgical procedures because of age or other medical conditions.

Specialists at Harper University Hospital take a multidisciplinary approach to the treatment of patients with aneurysms. As a tertiary referral center — and one of the nation's top endovascular neurosurgery programs — Harper patients are treated by subspecialists in neurointerventional radiology and endovascular neurosurgery. This level of specialized expertise simply isn't available at most hospitals.

In preparation for complex aneurysm therapy, Harper subspecialists use state-of-the-art 3D angiography equipment to capture 3D images of the aneurysm. This technology is not available at most hospitals and helps Harper specialists choose the most appropriate treatment.

Advanced treatment options may include:

• Coil Embolization — During this procedure, a neurosurgeon or neurointerventional radiologist inserts a catheter into a blood vessel (usually in the groin) and uses advanced imaging techniques to guide the catheter through the body to the site of the cerebral aneurysm. One or more platinum coils are then inserted through the catheter and anchored inside the aneurysm. The body responds by forming blood clots around the coils, which helps block the flow of blood into the aneurysm and keeps it from rupturing or leaking. When appropriate, an inflatable balloon or stent may be used during this procedure.
• Clip Ligation — During this procedure, a metal clip is placed at the base of the aneurysm to control the bleeding and to decrease the risk of more bleeding. This procedure is usually performed as an open surgical procedure.
• Onyx® Liquid Embolization — This procedure is very similar to embolization. However, instead of placing coils in the aneurysm, a liquid glue called Onyx® is used. This special glue is carefully injected directly into the aneurysm through a micro-catheter while the bottom or base of the aneurysm is temporarily sealed with a separate balloon-tipped catheter.

Skull-base surgery is the operative treatment of lesions found at the complex base of the skull. This area is rich in vital, delicate neural and vascular structures, such as the cranial nerves and cerebral arteries. Procedures in this area carry a higher than average risk — especially if performed by an inexperienced surgeon.

But Harper University Hospital and Wayne State University neurosurgeons are at the forefront of technology which offers a safe and successful means of removing formerly inoperable brain tumors using skull-base techniques. Prior to skull-base surgical applications, many tumors were considered inaccessible, and therefore inoperable. Our neurosurgical group provides the most comprehensive team of skull-base surgery specialists in Michigan. Highly trained surgeons at Harper use specialized techniques and equipment to make each surgery as safe and effective as possible.

Harper neurosurgeons treat patients with a variety of lesions close to the base of the skull. Both benign and malignant tumors are approached via complex paths through the nose, ear, face, orbit of the eye, or mouth by carefully removing the bone around these structures. This access allows our team to reach difficult areas of the cranium without injuring the brain, its nerves, or its blood supply.

Many of the computer-assisted neurosurgery techniques now used around the world were developed by neurosurgeons at Harper University Hospital. Computer-assisted navigational techniques enable physicians to perform neurosurgical procedures with incredible accuracy — leading to better outcomes for patients. Computer-assisted techniques are used to treat patients with many neurological disorders, including tumors, chronic pain, epilepsy and movement disorders.

Interactive Image-guided Neurosurgery

Interactive image-guided neurosurgery is the process whereby normal images such as x-rays, computed tomographic scans, and magnetic resonance imaging of the brain and spine can be coupled with directional devices to allow the surgeon to find a precise spot in the brain or spine, and utilize the most efficient route to that spot.

A variety of techniques are available at Harper University Hospital, including:

• Frameless stereotactic surgery – The patient no longer needs to wear a metal device around the head during surgery. With frameless stereotactic surgery, the surgeon identifies fine points on the patient’s skull, scalp, or spine. The computer compares these points with the brain and spine radiology images to produce a precise map of the intended surgical targets.
• Intraoperative Magnetic Resonance Imaging (iMRI) – This advanced technology provides “near-real-time” images of the brain or spine during surgery — including changes to the brain and spine that result from the surgeon’s intervention. This allows the neurosurgeon to be more precise and make smaller incisions, but continue to deliver the most effective care at the site of the surgery.
• Intraoperative angiographic localization – The role of interactive image-guided neurosurgery is expanding with the use of intraoperative angiographic localization in three dimensions, which allows for more precise and complete angiographic care.
• Gamma Knife® Radiosurgery – Gamma Knife® radiosurgery is a revolutionary non-invasive technology that uses precisely targeted beams of radiation for brain surgery. The innovative and effective procedure dissolves lesions, malformations and other brain disorders with little or no damage to the surrounding tissue. The procedure is often used to treat patients with deep brain tumors, malformations and other disorders that would be otherwise inaccessible.

An endoscope is a tiny fiber optic device with powerful lenses, a light source and a digital video camera. Neurosurgeons at Harper often use endoscopes to perform minimally invasive exams and surgical procedures. Since no incisions are needed, patients experience virtually no pain and often return home after a short hospital stay.

Endoscopes are often used during cranial, spinal, and peripheral nerve surgery. The endoscope can be used alone or in conjunction with more traditional techniques. During more traditional open procedures, Harper neurosurgeons use endoscopes to examine confined areas. This improves outcomes and limits complications.

Other neurosurgical uses of endoscopes include:

• Pituitary tumor surgery – Harper neurosurgeons use an endoscopic approach to remove pituitary tumors. The traditional approach to this surgery requires extensive dissection and disruption of the nasal tissues. But when using an endoscope, no dissection is needed in the front portion of the nasal cavities. Only minimal reconstruction of the nasal tissue is needed after the tumor is removed.
• Spine surgery – Harper neurosurgeons use endoscopes to remove herniated discs and perform minimally invasive spinal surgery. Through the endoscopic approach, incisions are much smaller and patients experience less pain. The result: Decreased length of hospital stay and increased patient satisfaction.

Harper University Hospital is known as one of the best endovascular neurosurgery programs in the nation. Endovascular neurosurgery (or neuroendovascular surgery) is the term used to describe repair procedures from within the blood vessels. Although it is a type of surgery, it is minimally invasive with most interventions occurring through an incision no larger than the tip of a pen. A small catheter is passed through the blood vessel using high-tech imaging equipment to reach the site of disease. Endovascular neurosurgery is the preferred treatment for patients who cannot undergo open surgical procedures because of age or other medical conditions.

A number of highly specialized neurosurgery procedures can be performed via an endovascular approach.

Intracranial Stenting

This procedure is used to treat intracranial stenosis, a severe narrowing of an artery within the skull. This narrowing of the blood vessel limits blood supply to the brain, putting patients with the condition at serious risk of stroke. With the patient awake, Harper neuroendovascular surgeons painlessly place a small stent within the diseased blood vessel to return it to its normal size. A stent is a small, metal mesh tube used to support the walls of an artery. Patients usually experience immediate relief from symptoms and, in some cases, are able to leave the hospital the next day.

Carotid Stenting

When severe narrowing of the carotid artery — carotid stenosis — puts patients at risk of stroke, the neuroendovascular surgeons at Harper perform the latest carotid stenting procedures. With the patient awake and mildly sedated, surgeons painlessly place a stent within the diseased segment of the carotid artery to return it to its normal size. A stent is a small, metal mesh tube used to support the walls of an artery. Patients usually experience immediate relief from symptoms and, in some cases, are able to leave the hospital the next day.

Stroke Thrombolysis

When a patient suffers a stroke due to a blood clot in the brain, stroke thrombolysis is the preferred treatment. Using small wires and catheters thousandths of an inch in thickness, Harper’s neuroendovascular surgeons deliver clot dissolving medication directly to the blood clot. The result: normal blood flow returns. Stroke thrombolysis is performed for patients with acute thromboembolic stroke within 6 hours of occurrence.

Embolization

Harper University Hospital is a premier center for the neuroendovascular treatment of arteriovenous malformations (AVMs). When a vascular malformation “steals” blood from its normal circulatory course, embolization — the intentional closing of a blood vessel — is often the best treatment to normalize blood flow. By placing a small microcatheter into one of the blood vessels leading to the AVM, Harper neuroendovascular surgeons are able to painlessly fill the abnormal blood vessel with rapidly hardening glue. Sometimes other embolic devices are used, such as a detachable balloon or coil. This eliminates the malformation and normalizes blood flow.

Intracranial Angioplasty

When blood thinners and other non-surgical treatments for low blood flow in the brain are ineffective, Harper neuroendovascular surgeons can expertly perform angioplasty procedures to improve blood flow and prevent a stroke. Using microwires and microcatheters, Harper neurosurgeons place a small angioplasty balloon in the targeted segment of artery. The balloon gently expands the diseased, narrowed artery, allowing more blood flow. Patients often experience immediate improvement in symptoms.

Aneurysm Therapy

An aneurysm is a balloon-like swelling in the wall of an artery that can steal blood away from the brain. Harper’s neuroendovascular surgeons are experts in treating cerebral aneurysms by rebuilding the artery from the inside. Using a small metal stent, Harper surgeons create a new wall between the artery and the aneurysm. A stent is a small, metal mesh tube used to support the walls of an artery. In some cases, small platinum coils are placed into the aneurysm, causing it to close and normalizing blood flow to the brain.

The functional neurosurgery program at Harper University Hospital and Wayne State University focuses on the management of movement disorders and other chronic neurological diseases including:

• Parkinson’s disease
• Dystonia
• Tremors
• Spasticity
• Tourette syndrome
• Depression
• Obsessive compulsive disorders

Advanced Therapies

Using advanced, image-guided surgical procedures and innovative technology, the functional neurosurgery experts at Harper are often able to provide effective symptom relief to patients when medication and other treatments fail. The primary techniques are:

Deep Brain Stimulation

Neurosurgeons at Harper University Hospital use deep brain stimulation for the treatment of Parkinson’s disease, dystonia and tremors as well as Tourette syndrome, obsessive compulsive disorders and chronic depression. Often called a “pacemaker for the brain,” the technique utilizes an implantable electro-stimulator device connected to a tiny electrode placed in a precise area of the brain. The device provides electrical impulses to a targeted motor center of the brain — correcting the manifestations of disease. A minimally invasive procedure, deep brain stimulation is completely reversible and programmable. The result after surgery is often quite dramatic with almost immediate and nearly complete stoppage of the tremor and restoration of patient mobility and quality of life.

Intrathecal Drug Delivery

Intrathecal Baclofen Therapy uses a programmable pump placed just under the skin of the abdomen connected to a small, flexible catheter that delivers an intrathecal baclofen injection directly into the area where fluid flows around the spinal cord — the intrathecal space. This therapy may relieve spasticity with only small amounts of medication. The drug is delivered where it is needed and does not circulate throughout the body in the blood. This may help minimize potential side effects.

Harper University Hospital was the first to bring this revolutionary, non-invasive brain surgery technology to Michigan. Today, the neurosurgeons and support staff at Harper are the most experienced in its use.

Gamma Knife® radiosurgery is a revolutionary, non-invasive technology that uses precisely targeted beams of radiation — instead of scalpel incisions — for brain surgery.

The innovative and effective procedure dissolves lesions, malformations and other brain disorders with little or no damage to the surrounding tissue. The procedure is often used to treat patients with deep brain tumors, malformations and other disorders that would be otherwise inaccessible.

By eliminating the need for cutting, surgical risks are reduced. As a result, Gamma Knife® radiosurgery patients experience less pain and enjoy accelerated recovery times. Most patients are back on their feet in hours and out of the hospital within a day. This highly efficient technology offers another important benefit: reduced costs for the patient and insurance provider.

When is Gamma Knife ® Used?

Harper University Hospital’s Neurosurgery Department uses Gamma Knife® radiosurgery to treat the following conditions:

• Arteriovenous malformations (AVMs)
• Benign brain tumors, such as:
• Acoustic neuromas
• Craniopharyngiomas
• Meningiomas
• Pituitary adenomas
• Malignant brain tumors
• Metastatic brain tumors
• Trigeminal neuralgia (intractable facial pain)

Other disorders that are inaccessible through conventional neurosurgery

Gamma Knife® radiosurgery is particularly useful for patients whose advanced age or medical condition place them at a high risk for conventional neurosurgery. Other patients that may benefit from the Gamma Knife® include patients with disseminated carcinoma and patients with movement disorders, such as Parkinson’s disease.

How it Works

Using input from arteriograms, computerized tomography (CT), Magnetic Resonance Imaging (MRI) and other sources, the Gamma Knife’s sophisticated computer software targets abnormal brain tissue with sub-millimetric accuracy.

The physician then uses the Gamma Knife® to direct beams of gamma radiation from 201 different sources of cobalt 60 material to the exact site of the lesion or other disorder. Each low-dose gamma radiation beam passes harmlessly through the surrounding tissue. However, when all 201 beams converge with pinpoint accuracy, the targeted abnormality is destroyed.

What are the Benefits?

Patients who undergo Gamma Knife® radiosurgery:

• Experience little or no pain
• Maintain their normal appearance — their heads are not shaved prior to surgery and there is no scarring
• Resume their normal lifestyle quickly, usually within 24 hours
• Enjoy reduced costs due to dramatically shortened hospital stays

Physicians who refer patients to Harper for Gamma Knife® radiosurgery:

• Achieve improved patient outcomes
• Reduce complications from general anesthesia and traditional surgery
• Are able to treat brain tumors, AVMs and other deep-seated disorders that were previously surgically inaccessible

Harper University Hospital was the first in Michigan to offer this innovative technology, which provides physicians with "near-real-time" MRI views during surgery. The use of this technology promises increased accuracy, better surgical outcomes and faster recoveries.

Intraoperative Magnetic Resonance Imaging (iMRI) is a breakthrough for physicians and their patients — enabling neurosurgeons to work in the most delicate areas of the brain with increased accuracy. The result: Better surgical outcomes and reduced recovery times.

When is iMRI Used?

Neurosurgeons at Harper use iMRI technology to treat:

• Tumors (benign and malignant; primary and metastatic — both in the brain itself and on the skull base)
• Congenital disorders
• Epilepsy
• Infections such as abscesses
• Movement disorders like Parkinson’s and Huntington’s diseases
• Vascular malformations

What are the Benefits?

Harper University Hospital’s iMRI system provides “near-real-time” images which allow the surgeon to understand changes in the shape of the tumor and surrounding brain and differentiate between normal and abnormal brain tissues during the surgery. This innovation promises:

• Improved tumor recognition
• Enhanced detection of brain shift
• Increased degree of resection
• Increased safety
• Shorter hospital stays
• Improved recovery and quality of life

The neurosurgeons at Harper University Hospital and Wayne State University aren’t satisfied with the way things are. They’re constantly looking for better ways to treat patients with complex neurological disorders. Through research and clinical trials, Harper neurosurgeons are helping to develop new neurosurgical procedures.

Brain Tumor and Epilepsy Research

Neurosurgeons at Harper University Hospital and Wayne State University are investigating the molecular mechanisms involved in tumor growth and epileptogenesis. They are also working on novel approaches to treat malignant gliomas, such as the use of gene therapy and immunotherapy after surgery.

Obesity Treatments

Neurosurgeons at Harper University Hospital and Wayne State University are studying deep brain stimulation of the areas of the brain responsible for hunger and satiation. This innovative treatment may someday be an effective treatment for obesity.

Spinal Cord Injuries

Harper neurosurgeons are collaborating with teams of medical and basic scientists to study stem cell transplantation as a possible treatment for spinal cord injuries.

Stroke Management

Researchers are investigating motor cortex stimulation as a way to manage the effects of a stroke. Motor cortex stimulation involves implantation of an array of electrodes over the motor cortex region of the brain.

Cervical Disc Replacement

Neurosurgeons at Harper University Hospital are investigating this ground-breaking surgical procedure for treatment of cervical disc disease. Harper is one of the few centers around the country involved in this clinical trial.

Neurosurgeons at Harper University Hospital and Wayne State University are internationally known for advanced management of complex pain syndromes, including the facial pain associated with trigeminal neuralgia.

Face Pain

Harper University Hospital is considered a Face Pain Center of Excellence by Janetta Clinics, Inc. – creator of the Microvascular Decompression (MVD) procedure, a leading treatment for face pain. All five of the approved treatments for face pain are offered at Harper University Hospital.

• Gamma Knife® Radiosurgery – For patients who are not candidates for surgery, Gamma Knife® radiosurgery can be performed to reduce pain transmission on the trigeminal nerve.
• Microvascular Decompression – Most cases of trigeminal neuralgia are caused by a blood vessel pressing on the trigeminal nerve. In a microvascular decompression (MVD) procedure, the nerve and blood vessel are separated and a soft fabric barrier is placed between them to stop the pressure. When performed by a specialized neurosurgeon, the procedure effectively stops the pain without nerve scarring and associated numbness.
• Balloon Compression – Balloon compression of the trigeminal nerve can effectively treat the pains of trigeminal neuralgia by reducing pain transmission along the nerve.
• Glycerol Injection – Using advanced imaging technologies, a neurosurgeon inserts a needle and guides it to the trigeminal nerve. A small amount of sterile glycerol is injected into the area surrounding the nerve. In a few hours, the glycerol damages the nerve and blocks pain signals.
• Radiofrequency Thermal Rhizotomy – The neurosurgeon inserts a needle and guides it to the trigeminal nerve. Once in place, an electrode is inserted through the needle and an electrical current is passed through the electrode — heating the tip of the electrode to a temperature which damages the nerve fibers and blocks pain.

Other Pain Syndromes

Harper neurosurgeons treat other pain syndromes with a wide variety of procedures, including:

• Neurostimulation – This advanced treatment option involves implantation of electrodes on the spine or motor cortex region of the brain. Stimulating these areas with electrical impulses can inhibit pain. The technique is used in the treatment of chronic back pain, post angina pain, phantom limb pain, chronic pain from vascular disease, face pain and other pain syndromes.
• Kyphoplasty/Vertebroplasty – Kyphoplasty is a minimally invasive procedure for the treatment of spine osteoporotic fracture pain. It can be performed in an outpatient setting in less than an hour. Using x-ray guidance, the surgeon inserts a small needle into the fractured bone and inflates a balloon to restore the spinal vertebral height and reduce the fracture. The surgeon then injects a fast-drying surgical cement to secure the bone fragments. Patients often experience almost immediate pain relief.

Neurosurgeons at Harper University Hospital and Wayne State University specialize in the management of chronic back disorders, including degenerative disc disease and traumatic conditions and tumors of the spine.

Using innovative new procedures, Harper neurosurgeons can often repair back disorders and stabilize the spine while preserving the patient’s range of motion and functional status. Today, many spinal surgery procedures at Harper University Hospital are performed using advanced, minimally invasive approaches — leading to faster recoveries, shorter hospital stays and reduced postoperative pain.

Some of the nation’s most innovative spinal surgery procedures are available at Harper, including:

Minimally Invasive Spinal Fusion

Harper neurosurgeons perform delicate spinal fusion procedures using minimally invasive techniques. Spinal fusion unites two bony segments of the spine, whether a fracture or a vertebral joint. During the procedure, rods and screws act as an internal cast to stabilize the vertebra until fusion occurs.

Dynamic Stabilization of the Spine

During this advanced surgical procedure, a device with internal spacers is attached to either side of the affected vertebra. The device stabilizes the joints, helping to keep the vertebrae in a more natural position while leaving the spine itself intact. Made of flexible materials, the device permits a controlled range of motion. This device is currently FDA approved for spinal lumbar fusion. Dynamic stabilization may be appropriate for patients with spinal stenosis, spondylolisthesis, or painful disc degeneration. The procedure may give some patients a surgical option that allows them to maintain some flexibility and function, while reducing pain.

Disc Arthroplasty

In this technique, the painful and degenerative disc is completely replaced by an artificial disc. In a selected group of patients with a single level disc disease, artificial disc replacement provides the best treatment of back pain while maintaining the normal biomechanics of the spine.

Scoliosis and Kyphosis Correction

Complex deformities of the spine are corrected using innovative minimal access technologies to avoid large, painful incisions. In the XLIF approach, a tube is inserted in the retroperitoneal space on the psoas muscle, and multiple discectomies and fusions can be performed under optical magnification and precise nerve function monitoring. This achieves amazing correction of complex and difficult spinal deformities with minimal blood loss and postoperative pain. Often the patient can be discharged from the hospital in one to two days instead of staying for five to eight days with the usual long-back incisions. If a second stage is needed from the back, the screws can be introduced through minor stab incisions that minimize tissue injury and allow for speedier recovery.

Complex Spinal Surgery

Harper Hospital is a tertiary referral center for especially complex spinal conditions. Harper neurosurgeons have the most experience across Michigan in the management of spinal tumors. These include tumors inside the dura and spinal cord like ependymomas, meningiomas, and schwannomas, and also benign and malignant tumors of the bone of the spine. They use the most advanced surgical techniques, including laser and ultrasonic aspirator techniques, to remove tumors safely. After tumor removal, the spine often needs complex reconstructive procedures to replace the bone destroyed by the tumor. The neuro-spine surgeons also manage the difficult cases of post laminectomy/fusion syndromes and failed back surgery. The Neuro-Spine Center enjoys excellent outcomes and a strong referral base.