Brain surgery via the wrist

Monday, 29 July, 2019

Brain surgery via the wrist

Research from Thomas Jefferson University demonstrates that transradial surgery, done via the wrist, is safe and effective for a broad range of neuroendovascular procedures, and could give patients faster recovery with less procedural risk than traditional methods. The results were published in the journal Stroke.

For years cardiologists have threaded hair-like surgical instruments through arteries in the wrist, as an access point to perform procedures on the heart. For procedures in the brain, however, neurosurgeons more commonly thread instruments through arteries at the groin — a transfemoral approach.

“Despite improved safety shown in large cardiology trials, transradial brain surgeries via the wrist are much less common,” said neurosurgeon Dr Pascal Jabbour, senior author of the study. “Neurosurgeons tend to prefer the transfemoral approach on which many of us were trained. But our research demonstrates that all kinds of neurological procedures can be done effectively and even more safely via the wrist.”

Dr Jabbour and his team retrospectively examined the medical records of 223 patients treated at Jefferson via the transradial route. The procedures included diagnostic angiograms, mechanical thrombectomies, AVM/AVF embolisations, coiling, stent-assisted-coiling, WEB device placement and flow-diversion treatments of cerebral aneurysms, and carotid stent placement. A subset of 66 patients who had undergone both transfemoral (groin) and transradial (wrist) surgeries were selected to complete a satisfaction survey to assess their preference. The majority of patients, 94%, said they preferred surgery via the wrist.

One of the most compelling reasons to change practice, said Dr Jabbour, is that it eliminates the risk of rare but potentially dangerous complications of post-surgical bleeds in the groin and retroperitoneal area, which can be difficult to detect. In addition, it is easier to ensure a blood vessel in the wrist has clotted, and so patients can go home shortly after surgery, rather than lying horizontally for 4–6 hours after transfemoral surgery.

“Laying flat after certain kinds of brain surgery should be avoided in cases with high intracranial pressure, and yet it’s the best way to prevent groin and internal bleeds,” said Dr Jabbour. “For these cases surgery via the wrist is by far the safest option.”

Image credit: © Nivens

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