When Don Bogart was diagnosed with Parkinson’s disease six years ago, the medications his neurologist prescribed did a good job of controlling his symptoms. But over time, the meds became less effective, and Bogart was left searching for solutions.
Bogart, a 59-year-old pharmacist, says that at the beginning, one dose would give him more than five hours of relief from the symptoms of his disease, which include rigidity in his arms and legs, painful muscle spasms, and jerky, involuntary movements. But that symptom-free period gradually diminished until he got just three and a half hours per dose.
“The end of the dosing period was like falling off a cliff,” Bogart says. “Within about five or 10 minutes, I would go from functioning adequately to having difficulty moving.” Mornings were especially rough; Bogart couldn’t start his day until the medicine kicked in. “I would have to take the medication and then wait an hour and a half until I could do anything.”
With his disease worsening, Bogart made the careful decision to pursue a procedure known as deep brain stimulation (DBS). In DBS, a surgeon makes two nickel-to-quarter-size holes in the patient’s skull to insert one or two electrodes, which fire regularly to correct the abnormal electrical rhythms that Parkinson’s triggers. “Through the use of electricity, we’re able to regulate that bad electrical rhythm to a more normal electrical rhythm,” explains Dr. Brian Kopell, a neurosurgeon at Froedtert & The Medical College of Wisconsin who specializes in DBS and operated on Bogart. “It’s the same way we put pacemakers into the heart to regulate the heartbeat.”
DBS involves several steps, including two separate surgeries, weeks apart, to install the electrodes. But with both operations, Bogart went home in two days. The procedure was considered a success; Bogart has reduced his medications by one-third, and that roller coaster between doses has evened out. Just a few months after he completed the process, Bogart was well enough to travel with his grandchildren to Disney World, and he currently holds two part-time pharmacist positions.
“You wake up every day and you know you have Parkinson’s disease. You don’t ever get rid of that,” he says. “But you’re able to deal with it much better when you can function better.”
Not Simple Surgery
DBS is just one of many kinds of minimally invasive neurosurgeries performed in the Milwaukee area. It might seem paradoxical to use the words “minimally invasive” and “neurosurgery” in the same breath, but neurosurgeons explain that “minimally invasive” refers to the route they take into the body. “It’s notminimal surgery,” stresses Dr. Max C. Lee, a neurosurgeon at the Milwaukee Neurological Institute and Columbia St. Mary’s Hospital.
The goal is to get the good results of traditional “open” surgeries, but to use techniques that cause less damage to the body. This is useful in any surgery; patients experience less scarring and usually recover faster. But minimally invasive strategies may be especially important in operations involving the brain and spine.
“You don’t want to cause a lot of brain destruction on your way in to take care of a tumor or an aneurysm,” Lee says. “The less trauma that you cause to a normal, functioning brain, the better.”
Minimizing such trauma is also important in spinal surgeries, one of Lee’s specialties. He frequently performs discectomies, in which he removes bone or discs from the spine to relieve pressure on the spinal cord or nerves.
“In a large, open type of procedure, you’re moving the muscle and ligaments and tendons, which can cause trauma and weakness in that area,” Lee explains. “The spine is a structural entity that has to support your body, arms and head,” so it’s important to preserve its integrity, he adds.
In a traditional, open spinal surgery, the surgeon makes a long incision in the back and strips muscles away from the spine. In contrast, Lee makes a 1-centimeter incision in the back and inserts a series of tubes known as dilators, which allows him to tunnel through back muscles to access the spine. He then uses a small, flexible endoscope to remove the problematic disc or bone. Patients usually go home the same day.
Still, spinal surgeries are somewhat controversial. Studies on the procedure are mixed; some researchers believe the open surgery produces better outcomes than the minimally invasive discectomy. But Lee says other studies find that “minimally invasive spine surgery for this purpose has less morbidity, patients go home quicker, they have a quicker recovery, they’re taking less postoperative narcotics, and they have less blood loss per surgery.” He believes that when performed by an experienced surgeon, the minimally invasive option is better.
Better Tools
Advances in imaging technology have made even major brain surgeries less invasive because surgeons now have a clearer picture of the terrain inside a patient’s head. Kopell, who performed Bogart’s surgery, credits faster computers for giving surgeons the ability to see where they are during brain surgeries.
Kopell’s patients often wear a device known as a stereotactic head frame during surgery. Attached to the skull, this lightweight frame holds sensors that collect information about the size and shape of the head and help orient the surgeon. Those coordinates are combined with MRIs and CT scans taken before surgery, creating a computer-generated 3-D map of the brain that allows surgeons to navigate precisely.
“This is particularly important,” Kopell says, “because unlike other areas of the body, the brain and the spinal cord don’t really heal themselves, under normal conditions, if they’re damaged.”
And that’s why radiosurgery may be one of the most important advances in neurosurgery. In these procedures, surgeons don’t cut into the skull at all, but instead use tools such as the Gamma Knife or CyberKnife to irradiate tumors and other problems in the brain and spine.
Both “knives” are actually devices that deliver hundreds of beams of radiation to very specific areas in the brain. “We now have computers fast enough that we can deliver radiation within 1 millimeter accuracy,” explains Dr. Arvind Ahuja, a neurosurgeon who uses this technology at Aurora St. Luke’s Medical Center. That means he can target a brain tumor or a blood vessel abnormality (known as an arteriovenous malformation) with less risk of damaging surrounding white matter in the process. Patients are sedated but conscious during these procedures, and they go home the very same day.
Ahuja’s specialties include endovascular surgeries, or noninvasive methods to treat blood vessel problems in the brain, such as aneurysms, life-threatening balloon-like bulges in the blood vessels. The surgeon enters the brain not through the head, but through the groin. The procedure involves inserting a tiny catheter into the femoral artery and threading it all the way up through the heart and through the carotid artery into the brain.
The catheter is used to deliver miniscule coils made of platinum into the bulging vessel. Once the aneurysm is filled with coils, blood begins to flow around the aneurysm, eliminating the risk of rupture. The procedure can be performed in 30 minutes to an hour, Ahuja says, and patients go home the same day.
Difficult Decisions
Lee laments that the term “minimally invasive” has grown into a buzzword that’s thought to be synonymous with “easy.” As a result, he says, many people with mild to moderate back pain come to him hoping for surgery, when their symptoms would be better served with nonsurgical options, such as physical therapy, pain medications and, in some cases, chiropractic manipulation or acupuncture therapy.
He believes a good surgeon is one who will carefully weigh your case and keep you out of the operating room, if possible. Unnecessary surgeries, minimally invasive or not, can lead to serious complications.
“It’s still surgery, and there are still risks,” Kopell says.
Bogart was very deliberate in researching the DBS procedure. He attended several seminars on it and discussed it thoroughly with his doctor before choosing to pursue it. “It’s a major decision to have someone poke something into your brain,” he says. “You want to be sure that it’s something that you really want.”
Ahuja adds that a neurosurgeon may recommend that you go with an open surgery instead of a minimally invasive version. For example, Ahuja still treats some aneurysms – such as those that involve bleeding – with open surgery.
“Everybody wants minimally invasive, thinking that’s better, but you just need to focus on finding the better fit for you,” he says. “But if the minimally invasive technology treats your disease the best, then there’s no better solution.”
Health Tips by Julie Sensat Waldren
Low-back Pain? Say “Om” Twice-weekly Iyengar yoga classes helped alleviate symptoms of chronic low-back pain, including functional disability, pain and depression, reports a study in Spine.The research was funded by the National Center for Complementary and Alternative Medicine. About 90 people participated in the 24-week trial, with half assigned to a control group of standard medical care. Iyengar yoga uses props, such as blocks, belts and ropes, to help with different poses.
Put Down the Neti Pot
Daily use of a neti pot to treat sinus infections may actually hurt more than it helps. Neti pots, which irrigate the nasal passages with saline solution to clear congestion, are an alternative to nasal sprays. In a study reported at the annual meeting of the American College of Allergy, Asthma and Immunology, people who used a neti pot for one year and then stopped had 62 percent fewer cases of sinusitis during the year they didn’t use it. Daily use of the neti pot may interfere with the protective function of nasal mucus.
Coffee and Cancer Prevention? Good news for men who love their morning cups of joe: Harvard scientists report that drinking coffee may cut the risk of advanced prostate cancer. In a study of nearly 50,000 men, those who drank the most coffee (six or more cups a day) had a 60 percent lower risk of aggressive prostate cancer than non-coffee drinkers. Results were reported at the Frontiers in Cancer Prevention Research Conference. Decaf drinkers also had a reduced cancer risk, so the magic is not in the caffeine, but more likely in coffee’s antioxidants and minerals.
The Health Risks of Loneliness Social isolation leads to breast cancer in rats, reports Proceedings of the National Academy of Sciences. In the study, rats that lived alone were three times more likely to develop breast tumors than rats that lived in a social group. The lonely rats were also more stressed, anxious, fearful and vigilant, and their tumors more deadly. Other studies have suggested social isolation has a negative effect on human health.
Benefits of Breastfeeding Breastfeeding may reduce a woman’s risk of metabolic syndrome, a group of risk factors that can lead to heart disease, stroke and Type 2 diabetes. A study in Diabetesfound that the positive effects of breastfeeding were even greater among women with gestational diabetes, a condition of high blood sugar during pregnancy. Researchers studied 704 women over 20 years. It’s not yet clear why breastfeeding has this positive effect.
