Tools of the Trade: Neurosurgery

In Kevin’s case, the tumors in his brain had formed in the ventricles, the chambers in the center of the brain that produce cerebrospinal fluid. One of the tumors was blocking the outlet of the ventricles, so the continuously produced fluid was backing up, causing the chambers upstream to enlarge. That, in turn, was putting pressure on his brain, causing the headaches and eye problems.

To address that problem, neurosurgeon David Hersh, MD, had to insert a tube through a small hole in the skull and draw out the excess fluid to release pressure on the brain. Then he used a clear cylindrical retractor to gently create a path to the tumor deep within the brain. This allowed him to use long, delicate microinstruments to remove the tumor.

The first tool that Dr. Hersh used was microbipolar forceps, which precisely and accurately apply heat to coagulate blood vessels that feed the tumor. Next, he used microscissors, with the pivot very near the tip and blades that are slightly larger than a grain of rice, to cut the coagulated vessels. Once this was complete, he was able to use a microdissector to “disconnect” the tumor from the surrounding healthy tissue. Finally, once the tumor was free, he used special tumor microforceps to pull the tumor out. These have tiny toothed discs on the tips to help grip the tumor.

The second brain tumor and the others in his body can be controlled with a medication that inhibits their growth.

This procedure demonstrates why it’s so important to have the right tools for the job. The finer and more precise the tool, the less likely any collateral damage. Tools with specialized tips give surgeons the ability to deal with a wide range of situations. And tools of varying lengths mean they can reach the right spot with maximum control.

Happily, Kevin’s surgery was entirely successful, and the medication is keeping his other tumors from growing, so he is getting back to being his old self. Football will have to wait a few months, but once the healing is complete, Kevin will be on the field again.