With the rise in stroke cases come advances in neurosurgery
MakatiMed specialists present cutting-edge procedures, but emphasize need for prevention: ‘Avoid us’
As incidences of fatality from stroke in the country continue to rise, Makati Medical Center (MakatiMed) strives to bring in the latest advances in neurosurgery to help save and improve the quality of lives of patients. In fact, the hospital was awarded the diamond status by the World Stroke Organization this year, the first and only private hospital in the country to receive the distinction.
“The prevalence of stroke in the country is the leading cause of death from 2009 to 2019, and is in the Top 5 leading causes of disability,” said Dr. Saturnino Javier, MakatiMed medical director, adding that deaths from stroke average at 63,804 per year for the last decade, with the number going up to 68,000 in 2021. And this number is likely even underreported due to the restrictive movement during the pandemic.
According to him, heart disease is still the no. 1 cause of death in the country, while brain disease comes in second. (Cancer comes in third.) That is because these two are intertwined, with many of the things that cause cardiovascular diseases also causing cerebrovascular diseases, he explained.
Dr. Guillermo Liabres, a cerebrovascular neurosurgeon, agreed: “What we can do for the heart, we can do for the brain.”
The word “bypass” in medical parlance is usually heard in relation to reconstituting blood flow to the heart. This can also be done to the brain.
“We are glorified tuberos, plumbers of the brain,” Liabres joked. If there’s a part that’s not getting enough blood supply, they fix that by using a donor vessel from another part of the body to redirect blood flow around blockages in the brain.
Liabres also gave the reminder that stroke is not an elderly disease. “Stroke happens even in 4-year-olds.”
This renders untreatable conditions—like aneurysms— treatable, he said. And so far, they have had a 100-percent patency rate for cerebral bypass surgeries.
Stroke awareness
The key, he said, is patient identification. Not all stroke patients require a bypass or can benefit from one, so it is important to be able to pin down those who need and can go through the procedure.
“Time is brain. The more time we lose, the more brain we lose,” Liabres said. So stroke awareness is also important. Chances are very slim that patients who have suffered a stroke in the past can still be helped by a bypass procedure, and with stroke, patients should be treated within the three- to four-hour period. Lay forums should be held to improve and strengthen stroke awareness.
Some neurological conditions need to be treated with open brain surgery. MakatiMed offers awake craniotomy for patients with tumors located in the brain’s speech and motor function centers as a safer, more effective and
more economical option.
As with any surgery, there are risks, but because the team is able to check on the patient’s functions right as they are working on scraping off every bit of the tumor from the brain, doing awake craniotomy removes much of the guesswork and surprise postoperation complications from the procedure. Being unable to test the patient right away might lead to deficit (loss of neurological function) or incomplete removal of the tumor that would lead to a regrowth later.
The procedure likewise does away with the need for anesthesia and recovery in the intensive care unit. They won’t even have to shave the head.
During awake craniotomy, because the brain does not have pain sensors, only the scalp is anesthesized. This means the patient can remain conscious throughout the procedure. Of course, the patient needs to be relaxed; they cannot be jittery or panicky or tense; otherwise it just won’t happen. Obese patients might also have a hard time being on their side for long periods, as the entire procedure may take up to four hours.
This approach, MakatiMed neurosurgery head Dr. Michael Sabalza said, can be an enjoyable experience, but it is not for
the faint of heart.
“I haven’t had a patient who did not like the procedure,” he said. But there was one patient who almost had to be made unconscious due to panic. After calming down, they were able to push through with it.
Through MakatiMed’s affiliations, they are also able to operate on less fortunate patients, like the one featured on news television who was playing the flute during the operation. Another patient sang karaoke during the procedure to check her speech functions.
No-incision surgical procedure
For small tumors, there is a procedure that can be done that will not require opening up the patient, Sabalza said. The stereotactic radiosurgery (SRS) is not actually a surgical procedure in that no incision will be made. However, it is referred to as such because the result resembled having done surgery. This is recommended for patients with small inoperable tumors deep in the thalamus.
Imagine sunbathing, he explained. The sun will burn a large area slowly, but using a magnifying glass to focus that beam will burn a small target area quicker and at a much higher intensity.
For SRS, the same dose of radiation is used as regular radiation therapy, but instead of doing it multiple times for six weeks, it can be done in just one sitting. “This is an outpatient procedure; no wound, no downtime,” Sabalza said.
But, of course, the doctors emphasize the need for prevention. “MakatiMed is also spending a significant time on wellness and prevention, but we have available treatments if that happens,” Javier said.
“Avoid us,” the doctors said.