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Brain Surgery Better When Awake?

<P>Conscious Brain Angioplasty May Reduce Complications</P>

WebMD Health News

Feb. 14, 2003 -- Having brain surgery while awake may sound like something out of a Frankenstein movie, but a new study suggests that performing a risky procedure on a conscious patient may actually help prevent complications.

Researchers say performing an angioplasty on the brain without general anesthesia allows the patient to report any unusual symptoms, which let doctors immediately alter their technique and reduce the risks.

During an angioplasty, a tiny balloon is interested into a blocked blood vessel and inflated to clear up or burst the blockage. The procedure is commonly used to open blocked heart arteries, but its use in clearing blocked head and neck vessels is considerably riskier. Damaging the blood vessel wall during a brain angioplasty could cause a stroke from bleeding in the brain.

In a study presented today at the American Stroke Association's 28th International Stroke Conference in Phoenix, Ariz., researchers say they were able to perform angioplasties within the skull safely on 10 patients who were given local anesthesia and mild sedation rather than general anesthesia, which causes a complete loss of consciousness.

"Since the patient was awake, he could tell us about any unusual symptoms such as numbness or pain behind the eye that are signs of impending complications," says researcher Alex Abou-Chebl, MD, an interventional neurologist at the Cleveland Clinic, in a news release. "If the patient felt a sudden painful sensation behind the eye, for example, that told us that we're over-stretching the vessel with the balloon. So we would immediately deflate the balloon, minimizing the damage."

In some angioplasty cases, a miniature, cylindrical, mesh-like coil called a stent is left in the artery to keep it propped open, which researchers say further increases the likelihood of complications when dealing with head and neck arteries. The stents can cause debris within the blood vessel to break off, travel, and become lodged in another blood vessel. This blockage of blood flow to the brain could lead to a type of stroke known as an ischemic stroke or a temporary blockage known as a transient ischemic attack.

That's why researchers say it's particularly valuable to be able to monitor the patient's neurological status during surgery to reduce the risk of these complications.

During the study, there were three complications from the angioplasty or stenting. In two cases, there was minor bleeding in the brain, and in another the stent blocked a small artery at the base of the skull. But Abou-Chebl says that in every case, the constant neurological monitoring provided by this technique heralded the complication and helped guide immediate therapy.

Although these preliminary findings are promising, researchers say the technique isn't suitable for everyone. Patients who are not stable, have other complications, or who have already had a stroke would not be good candidates for this type of surgery.

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