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Hopkins Medicine Magazine - Avoiding Open Brain Surgery

Hopkins Medicine magazine, Winter 2011

Avoiding Open Brain Surgery

Less invasive strategies expand options for aneurysms, brain tumors—even stroke.

By: Marjorie Centofanti
Date: February 18, 2011


The open craniotomy has been a boon for neurosurgery, saving lives and restoring neurological health to countless patients. But what if the operation is more dangerous than the problem it aims to fix? Take the example of an elderly man with an arteriovenous malformation who’s had multiple heart attacks and is on anticoagulants. This patient clearly isn’t a craniotomy candidate.

That’s where Alex Coon comes in. A specialist in endovascular neurosurgery, Coon is able to reach places in the brain and perform procedures that would be impossible using more traditional means.  By using X-ray contrast dye as a roadmap to guide catheters and tiny devices through the body’s network of blood vessels—a technique borrowed from interventional radiologists—he can treat aneurysms, arteriovenous malformations, strokes and even some brain tumors in many patients who aren’t able to undergo traditional open surgery.

One of the more common procedures Coon provides is “coiling” an aneurysm—threading a bundle of platinum wires into the aneurysm to block blood flow and prevent rupture. It’s an alternative to the traditional standby of clipping an aneurysm, which requires an open craniotomy. For patients who qualify for coiling and other endovascular surgeries, the benefits are a less invasive treatment, shorter recovery time and lower risk of complications.

“It’s not a good modality for all patients,” says Coon, “but someone trained in both traditional neurosurgery and endovascular techniques can understand which patients each type of treatment would be appropriate for and offer patients more options.”

Coon is also working to improve the technology. He and his colleagues are on the cusp of creating a new type of catheter that will allow even more types of patients to undergo endovascular treatments. Additionally, he’s studying the safety of new endovascular devices, the best way to use them, and innovative ways to get devices where they’re needed in the brain.

“Physicians have been putting stents in the heart for a long time now,”

Coon says, “so people ask, what’s the big deal with putting one in the brain? The difference between the heart and the brain is an extra foot and a half and about 20 more torturous curves in the arteries. We have zero margin of error.”

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