Windows installed in skulls help doctors study damaged brains | ET REALITY


Tucker Marr’s life changed forever last October.

He was on his way to a wedding reception when he fell down a steep flight of metal stairs and hit the right side of his head so hard that he fell into a coma.

He had fractured his skull and a large blood clot had formed on the left side of his head. Surgeons had to remove a large chunk of skull to relieve pressure on his brain and remove the clot.

“It was crazy to me to have a piece of my skull taken out,” Marr said. “I almost felt like I had lost a part of me.”

But what seemed even crazier to him was the way that piece was restored.

Marr, a 27-year-old Deloitte analyst, became part of a new development in neurosurgery. Instead of being left without a piece of skull or salvaging old bone, a procedure that is expensive and has a high infection rate, he got a prosthetic skull made with a 3D printer. But it is not the typical prosthesis that is used in these cases. His prosthesis, which is covered by his skin, has an embedded acrylic window that would allow doctors to observe his brain using ultrasound.

Some medical centers offer these types of acrylic windows to patients who had to remove a piece of their skull to treat conditions such as a brain injury, tumor, brain hemorrhage, or hydrocephalus.

“It’s great,” said Dr. Michael Lev, director of emergency radiology at Massachusetts General Hospital. But “it’s still early,” he added.

Proponents of the technique say that if a patient with such a window has a headache or seizures or needs a scan to see if a tumor is growing, a doctor can slide an ultrasound probe into the patient’s head and look at the brain in the consulting room. . That way, the patient can avoid expensive, time-consuming, and burdensome CT scans or MRIs. Instead of waiting for a radiologist to read the scan, the patient and doctor can immediately know what the patient’s brain is like.

Dr. Mark Luciano, a professor of neurosurgery at Johns Hopkins, is using ultrasound to monitor patients with hydrocephalus, who have shunts in the brain to drain excess cerebrospinal fluid. Patients need regular CT scans to see if the fluid is draining properly.

In an attempt to evaluate the windows, Dr. Luciano recently published a study of 37 patients who had windows placed in their skulls, compared with a larger group of similar patients from the year before the method was developed.

Over a period of one year, he saw no risk of infection. The challenge now, she said, is to improve ultrasound images and quantify what they show, as well as monitor their safety for several years.

But not everyone is convinced.

Dr. Ian McCutcheon, a professor of neurosurgery at the University of Texas MD Anderson Cancer Center, said the window “is an intriguing idea.” But, he said, before using it to evaluate patients with brain tumors he would need evidence from a rigorous clinical trial that ultrasound is as accurate as an MRI in detecting changes, such as a growing tumor.

That trial, he said, “has not yet taken place.”

Others, such as Dr. Joseph Watson, director of Georgetown University’s brain tumor program, called the technique “frivolous.”

“You’re passing through a small port,” he said. “It doesn’t provide enough of a picture of the entire brain” that he gets with a CT scan or MRI.

But Marr’s doctor, Netanel Ben-Shalom, an assistant professor of neurosurgery at Lenox Hill Hospital in New York, disagrees. In his experience, he said, “as long as the window is located above the tumor, the cavity is clearly demonstrated.”

Dr. Ben-Shalom was convinced from the moment he attempted to implant a window a few years ago. He was a resident at Johns Hopkins and his patient had a brain tumor.

“It was amazing,” Dr. Ben-Shalom said. He could see the entire brain, he said, and all the structures in it.

He moved to Lenox Hill in January 2022, became a consultant for Longeviti, the company that manufactures the windows, and has been implementing and using their clear polymethyl methacrylate windows ever since.

One afternoon earlier this year, Marr sat in a wooden chair in a small office in Lenox Hill, smiling as Dr. Ben-Shalom slid an ultrasound probe over the window of his skull. A group of medical students watched.

For Mr Marr, life was difficult after the piece of skull was removed to treat his swollen brain. His head was deformed, with a large dent. He became fatigued and dizzy because his brain was not sufficiently protected from atmospheric pressure.

During the scan, Mr. Marr’s brain seemed perfect, Dr. Ben-Shalom said. The midline separating the two hemispheres (and which had been shifted to one side after Mr. Marr’s injury) was exactly where he should be. His brain structures appeared normal, Dr. Ben-Shalom said. The ultrasound even showed the heartbeat of his brain.

Marr is young and healthy but, Dr. Ben-Shalom said, anyone who has had brain surgery needs monitoring. If Mr. Marr comes in one day with nausea and vomiting or a bad headache, or if he had a seizure, his doctors would have to examine his brain. The acrylic window makes it easy, Dr. Ben-Shalom said.

At the University of Southern California, Dr. Charles Liu and his colleagues are embracing the idea of ​​ultrasound. one more step. in a investigation projectis studying the use of ultrasound as a simpler, cheaper way to perform the type of studies now done with fMRI, a method that uses MRI scanners to examine brain activity.

For the study, he needed a patient who required a skull restoration for medical reasons and to volunteer to have one with a specially designed window. If the idea was successful, he and the team thought they could one day use the method on intact skulls.

The hope is to detect small signs of changes in blood flow in different parts of the brain as patients perform different activities. That, Dr. Liu said, “could provide unprecedented insights into brain functions.”

He found one such patient: Jared Hager, 39, who suffered a traumatic brain injury when he crashed his skateboard. He had gone two and a half years without a large chunk of skull.

Dr. Liu met Mr. Hager when he was admitted to Rancho Los Amigos National Rehabilitation Center in Downey, California, part of the Los Angeles County public safety net health system.

When Dr. Liu met Mr. Hager, he had no health insurance and was homeless: he and his brother lived in a van. And Mr. Hager was missing a large chunk of his skull. He was scheduled to have his skull restored, but Dr. Liu offered him a choice: a standard prosthesis or one with a specially designed window optimized for brain studies.

Prior to their surgery, the Rancho Los Amigos Foundation provided free lodging in a facility next to the hospital for patients and their families. But Dr. Liu was worried about what would happen after Mr. Hager was discharged.

“When you do this type of surgery, it’s a big operation,” he said. “My God, what if we operate on this guy and he ends up in a van in downtown Los Angeles?”

Through the Rancho Los Amigos Foundation, Dr. Liu found Mr. Hager an apartment in Long Beach.

Mr. Hager has become a regular presence in Dr. Liu’s laboratory, working with his scientists to discover everything they can about his brain.

“I will never stop helping with anything Dr. Liu needs,” he said.

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