A better avenue for neurosurgery to improve outcomes

July 18, 2019

PHILADELPHIA -- For years cardiologists have threaded hair-like surgical instruments through arteries in the wrist, as an access point to perform procedures on the heart. For procedures in the brain, however, neurosurgeons more commonly thread instruments through arteries at the groin - a transfemoral approach. In the largest cohort study to date, new research from Jefferson (Philadelphia University + Thomas Jefferson University) demonstrates that transradial surgery, done via the wrist, is safe and effective for a broad range of neuroendovascular procedures, and gives patients faster recovery with less procedural risk.

"Despite improved safety shown in large cardiology trials, transradial brain surgeries via the wrist are much less common," says senior author of the study and neurosurgeon Pascal Jabbour, MD, Professor of Neurological Surgery and the Chief of the Division of Neurovascular and Endovascular Neurosurgery, and researcher at the Vickie & Jack Farber Institute for Neuroscience -- Jefferson Health. "Neurosurgeons tend to prefer the transfemoral approach on which many of us were trained. But our research demonstrates that all kinds of neurological procedures can be done effectively and even more safely via the wrist."

The results were published in the journal Stroke on July 17.

Dr. Jabbour and his team, including first author Omaditya Khanna, MD, retrospectively examined the medical records of 223 patients treated at Jefferson via the transradial route. The procedures included diagnostic angiograms, mechanical thrombectomies, AVM/AVF embolizations, coiling, stent-assisted-coiling, WEB device placement and flow-diversion treatments of cerebral aneurysms, and carotid stent placement.

A subset of 66 patients who had undergone both transfemoral (groin) and a transradial (wrist) surgeries were selected to complete a satisfaction survey to assess their preference. The majority of patients, 94 percent, said they preferred surgery via the wrist.

In addition, it is easier to ensure a blood vessel in the wrist has clotted, and so patients can go home shortly after surgery, rather than laying horizontally for 4-6 hours after transfemoral surgery. "Laying flat after certain kinds of brain surgery should be avoided in cases with high intracranial pressure, and yet it's the best way to prevent groin and internal bleeds," says Dr. Jabbour. "For these cases surgery via the wrist is by far the safest option."

One of the most compelling reasons to change practice, says Dr. Jabbour, is that it eliminates the risk of rare but potentially dangerous complications of post-surgical bleeds in the groin and retroperitoneal area, which can be difficult to detect. A pioneer in the field, Dr. Jabbour was one of the first neurosurgeons to perform brain surgery via the wrist and has continued to teach others this technique.
-end-
Article Reference: Omaditya Khanna, Ahmad Sweid, Nikolaos Mouchtouris, Kavya Shivashankar, Vivan Xu, Lohit Velagapudi, Geoffrey P. Stricsek, Abdelaziz Amllay, Pavlos Texakalidis, M. Reid Gooch, Stavropoula Tjoumakaris, Robert H. Rosenwasser, Pascal M Jabbour, "Radial artery catheterization for neuroendovascular procedures: clinical outcomes and patient satisfaction measures," Stroke, DOI: 10.1161/STROKEAHA.119.025811, 2019.

Media Contact: Edyta Zielinska, 215-955-7359, edyta.zielinska@jefferson.edu

Thomas Jefferson University

Related Brain Articles from Brightsurf:

Glioblastoma nanomedicine crosses into brain in mice, eradicates recurring brain cancer
A new synthetic protein nanoparticle capable of slipping past the nearly impermeable blood-brain barrier in mice could deliver cancer-killing drugs directly to malignant brain tumors, new research from the University of Michigan shows.

Children with asymptomatic brain bleeds as newborns show normal brain development at age 2
A study by UNC researchers finds that neurodevelopmental scores and gray matter volumes at age two years did not differ between children who had MRI-confirmed asymptomatic subdural hemorrhages when they were neonates, compared to children with no history of subdural hemorrhage.

New model of human brain 'conversations' could inform research on brain disease, cognition
A team of Indiana University neuroscientists has built a new model of human brain networks that sheds light on how the brain functions.

Human brain size gene triggers bigger brain in monkeys
Dresden and Japanese researchers show that a human-specific gene causes a larger neocortex in the common marmoset, a non-human primate.

Unique insight into development of the human brain: Model of the early embryonic brain
Stem cell researchers from the University of Copenhagen have designed a model of an early embryonic brain.

An optical brain-to-brain interface supports information exchange for locomotion control
Chinese researchers established an optical BtBI that supports rapid information transmission for precise locomotion control, thus providing a proof-of-principle demonstration of fast BtBI for real-time behavioral control.

Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.

Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.

Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.

Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.

Read More: Brain News and Brain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.