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January 29, 2015

Search For Less Invasive Brain Surgery Leads To The Eye

By LAURAN NEERGAARD

AP Medical Writer

Washington (AP) Doctor after doctor said removing the tumor causing Pamela Shavaun Scott’s unrelenting headaches would require cutting open the top of her skull and pushing aside her brain. Then one offered a startling shortcut—operating through her eyelid.

The idea: Make a small incision right in the crease and sneak past the eyeball into the hard-to-reach center of the head.

``The nice thing about it is, we have to saw off much less of your head,’’ is how Dr. S. Tonya Stefko of the University of Pittsburgh Medical Center explains it.

Less invasive brain surgery is not common but surgeons are working out different ways to get to tumors, aneurysms and other problems without as much trauma in hopes that patients recover faster. But Scott’s experience shows how difficult it can be for patients to learn about alternative options like the eyelid approach, performed by a small number of highly specialized surgical teams, or even to know what to ask.

Scott knew that major medical centers often offer second-opinion consultations for long-distance patients, and started hunting—aided when her husband used a 3D printer to create a life-size model of her skull with her tumor, a meningioma growing behind her left eye, for surgeons to examine.

``The sad thing is that people don’t know there are other options than what their small-town doctor is telling them,’’ said Scott, 56, who traveled from her home in Morro Bay, California, to Pittsburgh for the surgery. ``I feel like a walking miracle.’’

Brain surgery for this tumor can be through the eye

Reaching that spot above and behind the eyes, the underside of the brain, is a challenge. Traditional surgery means a large opening in the skull to give doctors plenty of room to maneuver. But they must move painstakingly past sections of healthy brain, and Scott was warned that because her tumor was in such a tough location, vision or even cognitive damage was a risk of that top-down surgery.

Sometimes, surgeons can snake their tools through the nasal passages instead, a straighter shot through a natural opening.
Now the eye is offering some paths into this difficult region, too.

Think of the eye socket like an ice cream cone, with the tip pointing back toward the brain’s center, said Dr. Paul Gardner, director of UPMC’s Center for Skull Base Surgery. Entering through the eyelid crease, surgeons can follow that cone to just the right spot to access the brain—removing a bit of bone about the size of two postage stamps from the inside.

Entering the socket at a different angle, doctors also can make a cut in the crow’s feet at the corner of the eye. Or they can hide an incision in the eyebrow, making a small hole in the skull just above the eye.

Dr. Robert Harbaugh, president of the American Association of Neurological Surgeons, cautioned that transorbital approaches haven’t been formally studied to compare ultimate outcomes, including safety, to traditional open surgery.

``This is worth exploring,’’ he said. But, ``because it’s new doesn’t mean it’s necessarily better.’’

The surgery is only for carefully selected patients, stressed Dr Alfredo Quinones-Hinojosa, a John Hopkins University neurosurgeon who co-authored one of the first medical journal reports on the eyelid method a few years ago.

Tumors can’t be too big. No important nerves can be in the way; he also turns away people with large sinuses, to be sure there’s room to get by. He calls infection the main risk.

And it can only be done by a specialized team with experience in both the eye and the brain, added Gardner, who will present some of Pittsburgh’s cases at a medical meeting next month. Stefko, UPMC’s director of orbital and oculoplastic surgery, has the job of protecting the eyeball, making the corridor for the neurosurgeons to work.

Those kinds of multidisciplinary teams are rare, limiting wider adoption of these techniques, said Quinones-Hinojosa.

``You really have to learn how to be co-captains. Medicine and surgery hasn’t been, traditionally, like that,’’ he said.

For California’s Scott, it took a few hours longer to remove her meningioma—a benign tumor that started in the brain’s protective covering and grew into the bone and near her optic nerve—through the small opening. But she awoke with essentially a black eye, and was back at work in her psychotherapy practice in two weeks, wearing sunglasses.

In Indianapolis, dentist Deborah Boyer underwent a similar months-long search to treat a meningioma growing around critical nerves and blood vessels, threatening her vision and motor function. She wanted both a brain and an eye specialist. So she read medical journals online and hunted designated ``centers of excellence.’’

Pittsburgh’s Gardner initially planned to cut through the side of her skull, a smaller operation than other doctors offered, but later decided the corner of her eye offered a good path. Boyer said it took twice as long as regular surgery, but she was discharged in four days pain-free.

``People need help to try to get connected more quickly, and to know what those options are,’’ she said.

Experts Believe The Grave Of Cervantes Has Been Found

By JORGE SAINZ

Associated Press

MADRID (AP) Experts searching for the remains of Miguel de Cervantes said Monday that they found wooden fragments of a casket bearing the initials ``M.C.’’ with bones in and around them in a crypt underneath the chapel of a cloistered convent in Madrid.
Archeologists made the find over the weekend during excavations to solve the centuries-old mystery of where the famed Spanish writer was laid to rest. The initials on a plank of the coffin were formed with metal tacks imbedded into the wood.

The bones of at least 10 people were found inside the niche containing the broken wooden planks of the coffin, though some of the remains belonged to children, said forensic anthropologist Francisco Etxeberria, who participated in the autopsy that confirmed the suicide of former Chilean president Salvador Allende.

Etxeberria and others will now start examining the bones to try to determine whether Cervantes’ are among them. Cervantes was 69 when he died and investigators have solid clues to work with as they conduct their probe.

Archaeologists hold images of their find; note ‘M. C.’ in photo on right

The investigation will refer to the author’s portraits and his own stories, in which he relates that shortly before dying he only had six teeth.

But the most obvious marks will be the battle wounds that Cervantes sustained.

In 1571, the writer was wounded in the Battle of Lepanto, which pitted Ottoman Turkish forces against the Holy League, led by Spain. Aboard the ship La Marquesa, Cervantes was hit with three musket shots, two in the chest and one in his hand.

He spent several months in a hospital in Sicily, but managed to recover.

Cervantes is a towering figure in Spanish culture. His novel ``The Adventures of the Ingenious Nobleman Don Quixote of La Mancha’’ changed Spanish literature.

The ``Don Quixote’’ author was buried in 1616 at Convent of the Barefoot Trinitarians in Madrid’s historic Barrio de las Letras, or Literary Quarter. But the exact whereabouts of his grave within the convent chapel were unknown.

Three Billion Mile Journey: NASA Craft Is Approaching Pluto

By MARCIA DUNN

AP Aerospace Writer

Cape Canaveral, Florida (AP) NASA’s New Horizons spacecraft has traveled 3 billion miles (5 billion kilometers) and is nearing the end of its nine-year journey to Pluto. Sunday, it begins photographing the mysterious, unexplored, icy world once deemed a planet.

The first pictures will reveal little more than bright dots, New Horizons is still more than 100 million miles (160 million kilometers) from Pluto. But the images, taken against star fields, will help scientists gauge the remaining distance and keep the baby grand piano-sized robot on track for a July flyby.

It is humanity’s first trip to Pluto, and scientists are eager to start exploring.

``New Horizons has been a mission of delayed gratification in many respects, and it’s finally happening now,’’ said project scientist Hal Weaver of Johns Hopkins University’s Applied Physics Laboratory.

``It’s going to be a sprint for the next seven months, basically, to the finish line,’’ he said Friday. ``We can’t wait to turn Pluto into a real world, instead of just a little pixelated blob.’’

Launched from Cape Canaveral in January 2006 on a $700 million mission, New Horizons awoke from its last hibernation period early last month. Flight controllers have spent the past several weeks getting the spacecraft ready for the final but most important leg of its journey.

``We have been working on this project, some people, for over a quarter of their careers, to make this mission happen,’’ said project manager Glen Fountain of the Applied Physics Lab, ``and now we’re about to hit the mother lode.’’

The spacecraft’s long-range reconnaissance imager will take hundreds of pictures of Pluto over the coming months. It snapped pictures last summer, before going into hibernation, but these new ones should be considerably brighter. It will be a few days before the new images are beamed back to Earth; scientists expect to release them publicly in early February.

By May, New Horizons’ photos should equal and then surpass the ones taken by the Hubble Space Telescope, with pictures of the plutoid and its moons improving with each passing day.

The real payoff will come when New Horizons flies by Pluto on July 14 at a distance of 7,700 miles (12,400 kilometers) and speed of nearly 31,000 mph. (50,000 kph) It will whip past Charon, Pluto’s largest moon, from 18,000 miles (29,000 kilometers) out.

Scientists have no idea, really, what Pluto looks like way out in the Kuiper Belt beyond Neptune’s orbit, home to little icy objects galore.

Pluto is the biggest object in the Kuiper Belt. Together with mega-moon, Charon, roughly half Pluto’s size, the two orbs could fit inside the United States with room to spare. Five moons have been found so far around Pluto. More could be lurking out there, awaiting discovery by New Horizons.

The Applied Physics Lab designed and built New Horizons, and is now managing the mission for NASA.

Pluto was still officially a planet, No. 9 in the solar system lineup, when New Horizons departed Earth. It was the only planet in our solar system yet to be explored. But seven months later, the International Astronomical Union stripped Pluto of its planethood, classifying it instead as a dwarf planet. Later came the term, plutoid.

 

 

 

 

 

 

 

 

 

 

 

 

 


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