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Surprising brain-saver

A glue becomes a cutting-edge treatment for a rare blood vessel malformation

Would you believe a key new advance in brain surgery is a four-letter word you can already spell? It’s true—it’s glue. A Westchester Medical Center neurosurgeon is helping to pioneer the use of embolic materials or “glue” in treating aneurysms and arterial venous malformation, or AVM.

“An AVM is a tangle of blood vessels in the brain,” explains neurosurgeon Michael F. Stiefel, M.D., Ph.D., Director of Cerebrovascular and Endovascular Neurosurgery. It occurs in just 1 out of 100,000 people, and most affected people don’t know it until they have symptoms, such as severe headaches or seizures. Symptoms can be even worse if the AV M bleeds— blood can leak into the brain, causing stroke or perhaps even death. Dr. Stiefel is the only lower Hudson Valley neurosurgeon to offer this new treatment for AV Ms and aneurysms.

He has used it, for example, with a patient we’ll call Martha, who prefers not to be identified. She was referred to Dr. Stiefel suffering from intense headaches. He took three images, using a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan and an angiogram to confirm an AV M on the left side of her cerebellum, a region of the brain that’s vital for motor control and coordination. Some AVMs can be safely left alone, but Dr. Stiefel determined that Martha’s posed a danger of bleeding. He needed to reduce the blood supply to it and then remove it surgically.

In the past, blood flow was blocked using either small platinum coils or a very fast-drying glue called N-butyl cyanoacrylate, or NBCA. But coils can leave voids, which in turn can become filled with blood and eventually burst. Since 2007, however, a new copolymer has been available that has been found to be more effective.

“It turns out that this new embolisate or ‘glue’ does a better job than the previous materials we had—and a much better job than the wire coils,” Dr. Stiefel says.

For Martha, Dr. Stiefel went with the new polymer. “Its adhesive properties allow us to go deep into the smaller blood vessels, and this suited her case better,” he says. Martha was taken to a special operating room dedicated to endovascular neurosurgery and put under general anesthesia. Dr. Stiefel threaded a wire just eight one-thousandths (0.008”) of an inch thick from her groin to the AV M and injected the adhesive. After the procedure, patients spend 24 to 48 hours in a neurovascular intensive care unit to monitor brain function. “They then go right back to their normal activities,” Dr. Stiefel says.

Most patients, like Martha, require several sessions before the AV M shrinks to a size Dr. Stiefel is comfortable removing through open surgery. By November, Martha had had two of her four scheduled sessions. Dr. Stiefel plans to remove the AVM in January, a process that will require a few days in the hospital. “Then, she’ll be cured, with no restrictions,” he says. “She’ll never have to come back for this.”

To learn more about neurosurgery at Westchester Medical Center, please call 877-WMC-DOCS or visit www.WorldClassMedicine.com

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