September/October 2002 – Volume 1, Issue 5
Interventional Neuroradiology at Georgetown
Georgetown University Hospital has become one of the nation's leaders in interventional
neuroradiology, treating an ever-expanding number of patients with neurological
disorders using the most advanced minimally invasive techniques. Georgetown
is the only hospital in the country now performing robotically assisted procedures
to treat spine pain, and it is the only hospital in the region studying the
use of a liquid plastic to seal aneurysms and arteriovenous malformations (AVMs).
"The future looks even brighter," says Vance Watson, MD, the program's
director. "This is a huge field, and we have the opportunity to develop
new procedures and refine existing ones that will allow us to treat even more
complex neurological cases with just one small incision in the groin."
The Interventional Neuroradiology Department offers nonsurgical alternatives
to patients with:
- aneurysms
- arteriovenous malformations
- stroke
- spine pain
- certain types of brain tumors
Aneurysm Embolization with Coils
According to Dr. Watson, one of the most significant advances in the field of
interventional neuroradiology has been aneurysm embolization using GDC coils,
which offers an 85% cure rate in favorably shaped aneurysms. "Before, patients
had to undergo a craniotomy and spend weeks, sometimes months, in recovery,"
said Dr. Watson, who has had more than 10 years of experience with the coiling
procedure, training under the inventor of the coil, Guido Gugliemi, MD. "Now
the embolization is performed with just a tiny nick in the groin. Most patients
are eating dinner that night and are back home in one to two days."
During the procedure, the physician inserts a microcatheter into the aneurysm,
filling it with a series of platinum coils no wider than a human hair. This
closes off the aneurysm and reduces the risk of a rupture or rebleeding. In
the near future, the use of cerebral stents may enhance this aneurysm embolization
process.
Georgetown is the only center in the region now studying a new liquid plastic agent called Onyx, which is used for embolizing AVMs and certain types of aneurysms. This liquid polymer may eliminate the problems inherent in the adhesive substances that are currently used, which can stick to the catheter. Like the GDC coils, Onyx fills the aneurysm or AVM to seal it off and reduce the risk of bleeding or rupture.
Spine Pain Treatments for Complex Cases and Robotics
Georgetown offers experience in a number of advanced, minimally invasive approaches to reducing patients' spine pain, often treating patients who have been told there are no options available to them. Georgetown physicians have performed more than 300 vertebroplasties to treat painful compression fractures, many of them considered high-risk. In addition, the hospital is now offering robotically assisted needle placement for nerve blocks and other procedures. These approaches have been made more effective in the past few years with advances in imaging technology, particularly in three-dimensional and MRI images.
"For example, many of our vertebroplasties have been for cancer patients with severely de-stroyed bone," said Dr. Watson. "They are often told elsewhere that they are not candidates for vertebroplasty, but we have found that with the imaging technology available here, we have had significant success treating cancer patients with no complications."
The robot now being studied was developed at Georgetown in conjunction with the engineering department at Johns Hopkins University. Normally, when physicians place a needle, they must use intermittent X-rays to check on the needle's location, adjust it and check again in order to avoid radiation exposure. When the robot places the nerve-block needles, however, the process can be directly and continuously monitored by X-ray, allowing for greater precision in placement.
Thrombolysis and Clot-Retrieval Device for Acute Stroke Patients
The risk of brain damage can be reduced if patients receive an injection of a thrombolytic agent to dissolve the blood clot within six hours of a stroke. However, because these agents can also increase the risk of hemorrhaging in the brain, other approaches are now being studied, including a clot-retrieval device that actually allows the physician to grab the clot and pull it out. Georgetown will begin participating in a study of this type of device this fall.
CyberKnife Treatment of Certain Tumors of the Brain, Neck and Spine
Dr. Watson is a member of the team that develops treatment plans for patients with certain hard-to-reach or previously inoperable tumors. The CyberKnife is an outpatient, noninvasive alternative to traditional open surgery with little to no recovery time and fewer risks and complications.
-D. Arbogast
For more information about the advanced techniques available through the Department of Interventional Neuroradiology at Georgetown, call Physician Access at(202) 342-3300 or (800) 442-4200.
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Sept/Oct 2002
