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MIS Approach has Proven Success

After seven years in development, a minimally invasive option for neurosurgeons was released to the market two years ago to atraumatically access blood clots and tumors from the brain without compromising the structures of the brain.

It’s called BrainPath, and it was developed by NICO Corporation in Indianapolis.

Since it was released, many peer reviewed abstracts and clinical papers have been conducted to prove its effectiveness, including the most recent one presented in February at the International Stroke Conference. Eleven neurosurgeons from eleven institutions across the country wanted to not only see if intervention of intracerebral hemorrhaging was possible with this tool, but if it would lead to statistically significant functional recovery. Neurological therapies for subcortical lesions are typically limited to the cerebral cortex and adjacent subcortical brain regions due to concerns of procedure-related injury, the study stated in its introduction. It found an 89 percent average clot removal rate in 35 cases, in which 100 percent of patients reported no new deficits. Most importantly the multi-center pilot study showed that functional recovery was not only possible but it was shown to be statistically significant.

These 11 neurosurgeons are only a few of the more than 200 trained to use this tool, including Dr. Gustavo Pradilla, an assistant professor of neurosurgery at Emory University School of Medicine, and chief of neurosurgery service at Marcus Stroke and Neuroscience Center at Grady Health System. While it took several years to develop the tool that helps surgeons weave through the brain’s natural folds to access deeper regions of the brain, he said it’s a valuable surgical tool and one that is allowing neurosurgeons to do more and give more patients a surgical option to their disease.

When he first heard about the BrainPath, he recalled he wasn’t certain it would be effective. “I was concerned about working through a narrow channel at considerable depth from the surface and about achieving sufficient visualization at the same time,” he admitted. “My other concern was being able to use two-handed dissection techniques and my ability to achieve proper hemostasis.”

It surpassed his expectations though, Pradilla said. He received the required training before using BrainPath independently on patients, which includes a certified course with a lab component, along with being accompanied for at least two surgeries. “The technical learning curve was very easy to overcome, and the impact on our patients has been substantial,” he reported. “BrainPath is allowing us to operate on these lesions safely and efficiently with much less access-associated morbidity, which was likely responsible for the failure of previous surgical trials.”

While the technical ability of the tool offers a less invasive solution, Pradilla added that imaging technologies available are just as valuable. “The higher resolution imaging and the ability to see tissue differentiation are apparent when observing the surgical videos of procedures done using BrainPath,” he said. “When coupled with a transulcal access principle and a fiber-sparing tractography-based surgical plan, most surgeons recognize the potential superiority of this approach.”

He’s comparing this to the traditional approach of cutting through white matter, which can permanently damage critical structures, said Jim Pearson, president and CEO of NICO. “Surgeons using BrainPath enter the brain uniquely through the sulci, the natural folds of the brain, to displace the critical structures in the white matter to reach the abnormality – reducing the potential for tissue damage,” he explained.

Pearson added this can reduce risk to patients, and neurosurgeons have documented that it has made inoperable cases operable because, “Suddenly, that hard-to-reach tumor or blood clot is in reach.”

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  • 12263 Bridgewater Road, Indianapolis, IN 46256, United States
  • NICO Corporation

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