Tucker Marr’s life changed forever last October. He was on his way to a wedding reception when he fell down a steep metal staircase and hit the right side of his head so hard that he went into a coma.
He had fractured his skull and a large blood clot formed on the left side of his head. Surgeons had to remove a large piece of skull to relieve pressure on his brain and remove the clot.
“It was crazy to me to have a piece of my skull removed,” said Marr, 27, an analyst at Deloitte. “I almost felt like I had lost a part of me.”
But what seemed even crazier to him was that instead of being left without a piece of skull or reinstalling the bone, a procedure that has a high infection rate, he got a prosthetic skull made with a 3D printer. But it is not the typical prosthesis used in these cases. Covered by your skin, it has an acrylic window that would allow doctors to observe your brain with ultrasound.
Some medical centers offer these types of windows to patients who have had a piece of their skull removed to treat conditions such as a brain injury, tumor, brain hemorrhage, or hydrocephalus. Supporters say that if a patient with that window has a headache or seizures or needs a scan to see if a tumor is growing, a doctor can slide an ultrasound probe over the patient’s head and look at the brain in the office. This can avoid expensive and time-consuming computed tomography (CT) or magnetic resonance imaging (MRI). Instead of waiting for a radiologist to read the scan, the patient and doctor can immediately know the state of the brain.
Mark Luciano, a professor of neurosurgery at Johns Hopkins University in Maryland, is using ultrasound to monitor patients with hydrocephalus, who have drains in the brain to remove excess cerebrospinal fluid. Patients need regular CT scans to see if the fluid is draining properly.
Luciano recently published a study of 37 patients who had windows placed in their skulls, compared to 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. Now, she said, the challenge is to improve ultrasound images and quantify what they show, as well as monitor their safety for several years.
But not everyone is convinced. 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.
That clinical trial “has not been done yet,” he said.
Others, such as Joseph Watson, director of the brain tumor program at Georgetown University in Washington, called the technique “frivolous.” “You are passing through a small port. “It doesn’t give you enough of a picture of the entire brain.”
But Netanel Ben-Shalom, Marr’s doctor and assistant professor of neurosurgery at Lenox Hill Hospital in New York, disagrees. “As long as the window is located above the tumor, the cavity is clearly demonstrated,” he said.
Ben-Shalom was convinced from the moment he tried to install a window a few years ago. He was a resident at Johns Hopkins and his patient had a brain tumor.
“It was amazing,” Ben-Shalom said. He could see the whole 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 makes the windows, and has been implementing its clear polymethylmethacrylate windows ever since.
During a recent ultrasound, Marr’s brain looked perfect, Ben-Shalom said. The midline that separates the two hemispheres—and which had been shifted to one side after Marr’s injury—was exactly where he should be.
By: Gina Kolata
BBC-NEWS-SRC: http://www.nytsyn.com/subscribed/stories/6907144, IMPORTING DATE: 2023-09-25 18:40:06
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