Welcome to our new video series called “Columbia Neurosurgery Medical Minute.” For our very first episode, Dr. Robert Solomon, Chair of the Department of Neurosurgery at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital shares his expertise on the assessment and treatment of brain aneurysms.
When it comes to brain aneurysms, there is no hotter topic right now than the big three treatment options: clipping, coiling and no treatment at all. Dr. Solomon is a world-renowned aneurysm expert, and has surgical expertise in traditional and minimally invasive treatments.
In the video above, Dr. Solomon explains the difference between these treatments and how neurosurgeons like himself go about choosing what is best for each patient.
A brain aneurysm is a ballooning, weakened blood vessel in the brain. The danger of an aneurysm is that the “balloon” might burst, bleeding into the brain. Such a bleed can quickly be fatal. Therefore, the goal of treatment is to prevent the aneurysm from bursting.
To clip a brain aneurysm, a neurosurgeon opens the skull, then places what amounts to a tiny metal clothespin over the “neck” of the balloon. The clip seals off the aneurysm so that it cannot rupture and bleed.
But he has created a department that also includes experts in a different approach, called coiling. In coiling, the surgeon does not open the patient’s scalp or skull. Instead, the surgeon passes tiny tubes called catheters through the patient’s blood vessels, all the way to the aneurysm. Then the surgeon uses tiny, specialized instruments to fill the ballooning area of the vessel with small metal coils (or other materials) to block it off.
This approach, using tiny instruments that pass through the blood vessels, is called an endovascular approach. The endovascular approach can also be used for an increasing number of other treatments, like stents that keep the metal coils in place or tubes that divert blood flow away from the aneurysm.
Researchers and experts like Dr. Solomon are intent on finding out which treatment option is best for which patients. There is no “one size fits all” solution: Each aneurysm is different, each patient is different and each approach has its own benefits and drawbacks. Each also carries its own risks.
This is important because, with today’s improved imaging techniques, more and more small aneurysms are being found in passing—aneurysms that, if left alone, are unlikely to ever cause a problem. If the risk of surgery outweighs the risk of the aneurysm itself, the patient and doctor may well decide that the best treatment is no treatment at all.
To make these critical decisions about treatment, doctors keep up with studies that examine treatment type vs. aneurysm size, aneurysm location, blood flow patterns and other factors. New information is being published regularly. In Dr. Solomon’s opinion, helping other doctors digest all this information is a vital part of his work helping patients.
Recently, Dr. Solomon presented a lecture on treating unruptured aneurysms at St. Barnabas Hospital in Livingston, New Jersey. Dr. Solomon’s lecture was part of a medical tradition called Grand Rounds.
These educational lectures are attended by leading doctors, fresh medical students and physicians everywhere in between. St. Barnabas uses its Grand Rounds to “highlight important updates and advances in the field of medicine. Renowned specialists at the forefront of these medical developments are specifically invited for this purpose.”
In his Grand Rounds lecture, Dr. Solomon presented the very latest data on unruptured brain aneurysms and clipping, coiling or no treatment at all. He also presented instructive case studies, anonymized true stories about patients, their treatments and their outcomes.
Stay tuned for more informational videos like this one in our ongoing series Columbia Neurosurgery Medical Minute.
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