How surgeons are navigating deep inside the brain

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Minimally invasive procedures are common when it comes to the heart and other organs, but the brain has lagged behind. Now, taking advantage of the organ’s natural anatomy, surgeons tunnel through to reach tumors deep in the brain.

“We just assumed that it was exhaustion.”

For weeks, 44-year-old Jill Vannatta pushed through the unusual fatigue she felt. But there were other signs that troubled the active mother of three and her husband, Jeremy.

“We noticed a little bit of short term memory loss, but it was mostly things like user name and passwords. And there were some diffuse headaches," said Jeremy Vannatta, Jill's husband.

A competitive jumper, Jill was at a horse show when she realized something was terribly wrong.

“When I got there I was fatigued, had a bit of an odd mentality. I was laughing about things that weren’t very funny. My trainer would say left and I would go right," Jill said.

“I talked to Jill on Friday morning, and she clearly wasn’t herself. She sounded drunk at 11 o’clock in the morning. She was giggly and not really coherent, and as I talked to her that morning I said ‘I need someone to get you to the hospital,’” Jeremy said.

An MRI scan revealed the reason for Jill’s strange behavior.

“It’s all the way in the thalamus, which is the very deep center part of the brain, so it’s all the way in the very middle,” said Dr. Julian Bailes, a neurosurgeon at NorthShore Neurological Institute.

The complex organ is configured with natural folds -- tissue tightly pressed together. But in between the folds there are crevices -- natural separations surgeons can gently push aside to open up a pathway to deeper parts of the brain.

“And so rather than going through the surface and the cortex of the brain, we like to now go through the valleys, the folds, and go inside there and not have to damage or involve the functioning cortex on the surface,” Bailes said.

Through a half-dollar-sized incision in the skull, this tool and its bullet-shaped tip helps Bailes to separate the folds as he works his way toward a tumor. There’s no cutting, just pushing.

“You’re inserting this very small port that’s 13 mm and that for the most part spreads the fibers as it goes in, and we think it’s a real advancement over the regular way or old fashioned way,” Bailes said.

Once at the tumor site, the tunneling tip is removed but the chamber stays as a passageway for instruments to remove the mass.

“This keeps the other part of the brain separated, the fiber tracks open, and it allows us to go right down to our target,” Bailes said.

This is video of Jill’s surgery. The normal white matter of her brain is gently pushed aside as Bailes uses the special tool to tunnel about 8 centimeters through Jill’s brain to the tumor site.

“For deep tumors, tumors deep in the brain and the cavities deep in the brain, we can get there, remove more and do it more precise than ever. For the patient it adds up to a more precise, a more effective and hopefully better outcomes in the long term,” Bailes said.

It’s been a year since Jill’s surgery, and her tumor hasn’t grown back. Slowly, she and her family are returning to their typical routine.

“I feel so fortunate, really blessed that we had both the surgeon and this technique available to us when we needed it,” Jill said.

Bailes has been using the NICO Brainpath technology for about a year and a half with very promising results.

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