It’s hard to turn on the TV without finding a reality cooking show that pits talented chefs against one another. Half a dozen chefs start with the same ingredients and come up with dishes of varying quality. The judges shower one chef with praise but criticize another, dramatically dumping his dish in the garbage.
Since all the dishes start with the same ingredients, the difference between success and failure lies in the details. Too much salt. Just enough cumin. Preheating the pan. Extra time in the oven. Tiny differences can turn a dish worthy of a five-star review into an embarrassment.
It might seem strange to compare neurosurgery to the “MasterChef” kitchen. But patients can experience vastly different results, even when their surgeon starts with the finest ingredients, such as a steady hand and a keen sense of brain anatomy. Outcomes are often determined by the smallest details.
Much like Julia Child’s knowledge and technique help set the standard for beef bourguignon, neurosurgeons with the most experience set the standard for the safest and most effective approach to neurosurgical procedures. They have familiarized themselves with the medical evidence and perfected the smallest details. They offer the best shot at a five-star result.
Philip M. Meyers, M.D., of Columbia University Medical Center/NewYork-Presbyterian Hospital is one of those involved with setting the standard of care. In a recent issue of the Journal of NeuroInterventional Surgery, Dr. Meyers contributed to Guidelines and parameters: percutaneous sclerotherapy for the treatment of head and neck venous and lymphatic malformations.
About one in a hundred individuals is born with a malformation of the venous and lymphatic systems that return blood to the heart, or carry immune cells to the site of an infection. These malformations are often found in the head and neck. Depending on the location and size of the affected vessel, it can cause a variety of problems including difficulties with speech, swallowing, hearing and vision. These lesions may also create cosmetic concerns for some patients.
Usually, these malformations are connected to normal structures in the body, making surgical removal undesirable because of the extent of tissue injury that may result. For this reason, a procedure called percutaneous sclerotherapy has become important. Sclerotherapy means “scar” treatment. The goal is to cause the malformation to become scarred and shrink away. In this treatment, a medication that induces scar formation is injected into the malformation.
This is done using image-guidance, avoiding the need for conventional surgery, if possible. Sclerotherapy initially causes blood to clot within venous malformations or lymphatic fluid to coagulate within lymphatic malformations. The body then heals the tissue like a bruise or other injury.
Various other methods have been used in an attempt to treat these disabling lesions such as laser therapy, radiation, even chemotherapeutic drugs used to treat malignancies. As medical knowledge about the genetic causes for the malformations and the biochemical pathways causing growth and symptoms of the malformations advances, so do the techniques available for treatment.
In the development of the consensus statement, Dr. Meyers and his 24 co-authors from the Society of Neurointerventional Surgery Standards and Guidelines used the best evidence-based methodology to examine existing research into the treatment of these vascular malformations. They noted that much of the information on treatment is based on case reports and small series of patients, so the final recommendations come from expert consensus.
The statement includes all aspects of diagnosis and treatment of these vascular lesions, including imaging choices and necessary laboratory studies, treatment selection, treatment methods, complications and post-treatment care. It will serve as a recipe of sorts for physicians treating vascular malformations around the world.
With this information at their fingertips, physicians will be more likely to get all the details just right for the best possible outcomes—earning rave reviews from their patients.
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