Cutting Edge Neurosurgery at The Medical City

By Dr. Jerold Justo, | September 18, 2020

The Department of Neurosurgery at the Medical City under the Institute of Neurological Sciences headed by Director Dr. Louie Racelis, is home to cutting edge neurosurgical procedures made possible by its diverse team of experts in the field and the latest available technologies. The combination of these two core components aids the practice of good neurosurgery at our institution. The neurosurgical team headed by Dr. Michael Sabalza was able to perform state-of-the-art procedures with the help of Dr. Guillermo Liabres, visiting Cerebrovascular consultant, alongside Neurosurgery residents Dr. Marinelle Castro, Dr. Jerold Justo, Dr. Avegail Uy and Dr, Alma Corazon De la Cruz on patients with complicated cerebrovascular lesions.

An STA-MCA (Superficial Temporal Artery - Middle Cerebral Artery) bypass procedure was performed for a previous stroke patient - A 55 year old male patient at risk of developing secondary strokes because of a block in the carotid arteries which are a major blood supply in the brain. The bypass procedure was done by connecting an artery outside the skull and into an artery inside the brain to supplement the blood flow that is already lacking that puts the patient at risk for strokes in the future.

The procedure starts with dissection of the arteries and this is made possible with the use of the Zeiss Kinevo 900 that provided great magnification and optics necessary in connecting very small blood vessels in the brain. This sophisticated microscope is a new acquisition of TMC that is the latest and newest technology in the world.

With proper skill, technique and technological guidance, we are able to sufficiently trace the blood flow coming from the superficial arteries going into the brain. A unique filter in the microscope using a dye called indocyanine green allows us to see the final product of this connection to confirm its success. Intraoperatively, we were also guided by a Doppler ultrasound which enables us to hear the strength of every pulsation of the vessels.

View of the blood vessels during infusion of indocyanine green which enables us to see blood flow and the newly reconstructed pathway going to the brain.

After the surgery, the patient did very well and was transferred to the Intensive Care Unit for further monitoring. The patient did very well post-operatively. Before his discharge, we were able to also get a CT Perfusion Exam which is an imaging in the brain confirming the patency of the new blood supply.

Before and after CT-Perfusion Exams showing blood flow on previous stroke

The Medical City alongside its Institute of the Neurological Sciences has shown that it will continue to strive to deliver the best in the field - guided by compassion and empathy to its patients and coupled with the best minds, skill, and technology to perform world-class surgeries.