Endovascular neurosurgery is minimally invasive alternative for some patients

San Antonio (June 28, 2007) – The University of Texas Health Science Center at San Antonio is utilizing today’s imaging breakthroughs to repair potentially fatal aneurysms and other vascular disorders of the brain, spine and spinal cord, and head and neck.

Patricia M. Fernandez, M.D., associate professor in the departments of neurosurgery and radiology at the Health Science Center, is fellowship trained in “endovascular neurosurgery,” a new discipline that blends the latest radiological advances and neurosurgical understandings to produce safe and effective alternatives to traditional neurosurgery.

Dr. Fernandez and her colleagues perform the cutting-edge procedures at University Hospital, which is a teaching hospital of the Health Science Center. This group constitutes the only academic, university-based endovascular neurosurgery service in San Antonio.

Brain aneurysms are bulging areas of the wall of diseased blood vessels in the brain. These blood-filled protrusions are dangerous because rupture can be fatal. Traditional surgical management involves opening the skull and stopping blood flow into the aneurysm by closing communication to the artery with a clip.

During the last decade, endovascular treatment of brain aneurysms with tiny platinum coils has revolutionized treatment of both ruptured aneurysms and intact aneurysms.

A plastic catheter is inserted into the femoral artery in the leg and is threaded through the vasculature to the site of the brain aneurysm. Coils are deployed through the catheter into the aneurysm. The coils are flexible enough to assume the shape of the aneurysm and fill it. A clot forms around the coils, stopping blood flow to the aneurysm and preventing rupture.

The procedure is identical for a brain aneurysm that has ruptured.

According to a recent international study comparing the safety and efficacy of endovascular coil treatment versus surgical clipping for treatment of ruptured brain aneurysms, “The relative risk of death or significant disability at one year for patients treated with coils was 22.6 percent lower than in surgically treated patients, an absolute risk reduction of 6.9 percent.”

Ruptured brain aneurysms kill half of the patients who do not get immediate care, said Dr. Fernandez, who has 15 years of experience treating these patients. She said a sudden unexpected headache is very often a sign of aneurysm rupture and should be considered a medical emergency. “Get to a hospital,” she said.

Help for stroke victims

The endovascular neurosurgery service also treats patients who have had strokes. Stroke is the third-leading cause of death behind heart disease and cancer. It strikes 700,000 Americans each year, and the estimated cost of care for 2007 is expected to be $62.7 billion.

A research project conducted in Corpus Christi demonstrated an increased incidence of stroke among Mexican Americans.

Patients who suffer an ischemic stroke have narrowed blood vessels that become obstructed by a clot preventing normal blood flow to the brain. During the first three hours after onset, a clot-busting drug called TPA can be administered intravenously with good success. After the three-hour window, mechanical removal of the clot is recommended, which is what is offered by the Health Science Center team at University Hospital.

“The problem is, many people do not recognize that a stroke is occurring. It is critical to get treatment as soon as possible,” Dr. Fernandez said.

“With access to the latest technological development and relying on a multidisciplinary approach, our fellowship-trained specialists are among the best in Texas at treating debilitating neurovascular disorders and limiting its consequences,” she added.

Dr. Fernandez said a commitment to excellence in clinical practice and research makes the service a unique asset to the community. The faculty is involved in several research trials focusing on cerebrovascular diseases, including a randomized research study to examine patient outcomes when TPA treatment is combined with the endovascular technique.

“Dr. Fernandez brings a high degree of skill and superb training to the treatment of patients with these disorders,” said David F. Jimenez, M.D., F.A.C.S., professor and chairman of the Health Science Center department of neurosurgery.

“A distinct advantage of this program is that it brings together the skills of two disciplines, radiology and neurosurgery, thus providing the best care for patients,” said Gerald D. Dodd III, M.D., F.A.C.R., professor and chairman of the Health Science Center department of radiology.

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The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $536 million, the Health Science Center is the chief catalyst for the $14.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $35 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 22,000 graduates (physicians, dentists, nurses, scientists and allied health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, allied health, dentistry and many other fields. For more information, click on www.uthscsa.edu.

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