Rebranding Classical Aneurysm Surgery The Right Way

As a Waterloo Engineering student, I feel like I have a slightly higher than average knowledge on lasers, as well as their many potential applications. We’ve seen them used in the military, in cosmetic surgery, or as the cornerstone of a rebranding campaign. One of the latest applications that’s been attracting a lot of attention is for use on your brain – laser brains! Well, not quite, but it’s still exceptionally impressive. A surgeon at the Toronto Western Hospital is making a name for himself as the master of the laser surgery, in which he uses tiny fiber optic lasers to fix brain aneurysms that normally would not be repairable.

An aneurysm is the swelling of an artery due to the weakening of the vessel wall. The exact cause of an aneurysm is unknown, although factors such as genetics and nasty habits like smoking, high blood pressure and high cholesterol are known contributors to the formation of these swellings. There are a handful of places where these swellings can occur, including the intestine, legs, the spleen and the aorta. The most common, and unfortunately most hazardous, are when these swellings form in the brain. These often present with no symptoms, but can cause numbness, pain, blindness, dizziness, depending on where in the brain the aneurysm is located and the degree of the swelling. The most frightening problem occurs if and when the aneurysm ruptures, during which the patient often experiences an increased heart rate, decreased blood pressure and light-headedness. The risk of death after an aneurysm rupture is extremely high, particular in cases where it was previously undiagnosed.

In the cases where the swelling had been identified via a CT scan, surgical intervention was often required to repair the swelling. The most conventional methods used either a stent, a coil or a highly risky bypass procedure. A stent would be a small tube that was inserted into the vessel to essentially counteract the damage experienced by the vessel walls. However, this method could not be very commonly used. In some cases, a very thin platinum wire can be fed through the major vessels, starting in the leg, eventually up to the site of the aneurysm where the welling can be coiled shut. Bypass involves essentially stopping the blood flow to that particular vessel where the swelling occurs by using very small clips that close the blood vessel so an alternative pathway can be built for the blood to flow through. Not all cases are eligible for this treatment however, depending on the location of the aneurysm within the brain, and the procedure is very risky. There is a considerable risk associated with these clips slipping and rupturing the vessel wall in the process, which in some cases can cause the patient to bleed out. There are also a significant number of patients who are not eligible for any of these procedures due to their condition and nature of aneurysm, so they are left with no option but to sit, wait and hope for the best.

Enter Michael Tymianski. As the current acting head of Neurosurgery at Toronto Western and the head of a research lab at the Krembil Neurosience Centre, he’s seen his fair share of these tragic cases where little could be done to help. In 2008, he traveled to Holland to learn a new procedure that utilizes fibre optic lasers for a new procedure, best described as ‘rerouting a river without ever stopping the flow of water.’ The procedure utilizes some small vessels harvested typically from the leg that are first attached to the same vessel on each side of the swelling. A very tiny laser is then fed into each of these attached blood vessels and is used to cut a hole into the main artery. These vessels are quickly clipped shut after the laser is removed, and the two vessels on each side of the swelling are then attached. When the clips are removed, the blood flow within the artery can then be redirected to the newly formed bypass and away from the weakened artery, all without every having to stop blood flow in the artery. This greatly increases the number of potential candidates who could potentially benefit from this surgery, most of whom would previously have gone untreated at the rate of an estimated 100 people per year in Canada.

After returning from Holland, Tymianski was pumped with the knowledge that this very technically demanding yet promising surgery presented. The only problem? Them lasers don’t come cheap. The highly precise laser required for the procedure costs $300,000 which isn’t exactly within the McGuinty budget. Enter real estate mogul Ron Kimel, who donated the money required to purchase the laser. A small price to pay, Kimel explains, as he credits Tymianski with saving his personal assistant’s life after she was diagnosed with a severe brain tumor. “She had a brain tumor. It was pretty serious. He took it out. As a gift to Mike I put up the money to buy the laser. It is as simple as that. The fact is, he is a great guy and we are friends. He is brilliant and talented and he has this heart, and kindness,” Kimel explains.

Tymianski has performed the surgery over a dozen times since. Although they have not all been perfect endings, he has had an extremely high success rate and has saved lives already. The full medical and nursing staff at the Western, which is already considered one of the top neurological centres in North America, are very used to seeing the extreme when it comes to neurological patient care. As a result, the whole procedure from checking the patient in to sending them home has been made a huge success, and they’re already starting to mentor other medical centers on the same procedure in hopes that it will eventually be able to help more of those in need. It’s truly become a medical marvel that is something to make Toronto Western proud; now let’s just hope it doesn’t become subject to tragic rebranding.