Revolutionary Techniques in Neurosurgery: A Q&A with Ravish Patwardhan, MD

What are the benefits of the Visualase laser probe technique, and do you believe it will become the standard for brain tumor eradication?

The best way to understand the Visualase laser system is to understand what it simplifies. Say a patient comes in with a brain tumor that is less than 2cm in diameter. While he or she is awake, a small area of the scalp is locally anesthetized, and a stab incision is made, with a small hole drilled in the precise trajectory to enter the middle of the tumor and run its length. The operating room portion ends here. The patient is transferred to the MRI suite, where the precise position is verified on MRI scan. Subsequently, the tumor is ablated in the MRI scanner, leaving a black hole where the tumor used to be. The probe is removed in the MRI scanner, and a previously placed stitch is tied, all while the patient is awake and responding, to ensure that no new problem has occurred. The entire procedure takes about an hour (5 minutes in the operating room and 45 minutes in the MRI suite).

The length of time of the procedure, avoidance of general anesthesia, shortened length of stay in the hospital (patients may go home the same day versus three days or more, following a typical craniotomy for tumor resection), reduced blood loss (a few drops), smaller incision size (stab incision), and subsequently less pain all result in a quicker recovery. Because this technology is so new, we’re learning more about it with each case. We learn about which tumors in which locations may or may not be amenable to treatment with laser ablation. Presently, though, laser ablation’s advantages appear to be its ability to treat deep brain tumors—which would destroy the brain if approached openly surgically—and to produce relatively instant results.

This is opposed to waiting several weeks to see an MRI change for techniques like Gamma Knife.

Concussions have been a hot topic, especially in the world of sports. Do you believe the public needs to be made more aware of the severity of concussions, and do you foresee any new developments in how they are treated?

The answer is “Yes” to both questions. The public needs to know that once a person has suffered a concussion, he or she does not need to continue playing that day. Also, wearing the right protection in the first place is paramount. Our frustration as neurosurgeons is that we can’t do much after a patient sustains a brain injury. We also need better tools that will allow us to detect an underlying brain problem. There is just no way to tell whether somebody who suffered a concussion has a more severe brain injury, such as a contusion or bruising of the brain, just by looking at them. A more detailed test, like a CT scan to detect new bleeds, or an MRI scan to look at more subtle shear injury, is not so far-fetched. We need to be proactive; it’s a lot better than being reactive.

What’s in store for the Comprehensive Neurosurgery Network in 2010 and beyond?

With all sincerity, gratitude for the patients who trusted in us, whose bravery helped them overcome adversity and unpleasant odds. I feel that although we tried to succeed every time, we failed when a patient with a terminal brain tumor died, or when a traumatic brain injury’s severity caused too much brain swelling for anything to be done to help.

Small but important steps in the right direction—treating a brain tumor in a new way, trying cooling patients down early after a brain injury to avoid problems later, or coming up with new devices to do something safer—are my goals for our practice. I admire my colleagues and other professionals who make life easier for our patients by innovation, because they get it done; ultimately, no matter how sophisticated the technology gets, we are helping people like you and me, our families and friends. And who wouldn’t want that goal to succeed?

Ravish Patwardhan, MD, is the founder and director of the Comprehensive Neurosurgery Network (www.brainandspinecare.com), which “specializes in minimally invasive techniques for treating brain and spine problems.” Patwardhan has more than 12 years of experience in the neurosurgery industry and has published several peerreviewed studies on brain trauma, tumors, epilepsy, and spinal procedures. He is also a frequent speaker on the latest treatments and advances in brain and spinal surgeries.