First brain surgery of its kind in Canada

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Trillium Health Partners’ Dr. Sumon Chakrabarti with Doris Gomez Rueda.
Trillium Health Partners’ Dr. Sumon Chakrabarti with Doris Gomez Rueda.

Current technological advances in brain microsurgery have resulted in patient outcomes that would have been impossible just a few short years ago. Patients are now recovering much faster, and have significantly higher success rates. Trillium Health Partners’ Mississauga Hospital has a busy regional neurosurgery program, with at least 500 people benefitting from therapeutic interventions on the brain and spinal cord last year. Most recently, during a one-of-a kind, minimally invasive procedure, Trillium Health Partners’ ventricular brain surgeon, Dr. Mihaly Kis, deftly removed a live parasitic cyst from a patient’s brain.

Ever since Doris Gomez Rueda moved to Toronto in 2009 from her native Colombia, things were not quite right. She began experiencing intense headaches, and took over-the-counter pain medication for relief. Doris’ health took a drastic turn for the worse on February 28th, 2015, when she went to bed with flu-like symptoms and was found unresponsive by her daughter early the next morning. After suffering several seizures, and receiving care at two Toronto hospitals, Doris was transferred to Trillium Health Partners’ Mississauga Hospital, which was equipped to manage complex neurological cases.

Trillium Health Partners’ Infectious Diseases and Tropical Medicine Specialist, Dr. Sumontra Chakrabarti, used several MRI images to confirm the presence of tapeworm cysts in Doris’ body. Tapeworm infections, or neurocysticercosis, are common in developing countries such as Colombia, where lower sanitation standards can often lead to people ingesting microscopic tapeworm eggs present in contaminated water. Tapeworm cyst infestations can take several years to mature in a person’s body. Growing cysts can put pressure on the brain, sometimes causing seizures. While tapeworm infections in the human bowel are quite common and treatable with anti-parasitic drugs, Mrs. Rueda’s case was unique: the infection spread beyond her body and even brain tissues, and the tapeworm larvae travelled all the way to the ventricular system within her brain. She required immediate surgery to save her life.

Ventricles are cavities within the brain where spinal fluid is made and circulates. Spinal fluid supports the brain and provides lubrication between surrounding bones, the brain and spinal cord. “I’ve seen tapeworm larvae in brain tissue many times before, though this is the first time I’ve seen it in the ventricle, outside of a textbook,” explains Dr. Sumontra Chakrabarti. “A blockage in these small tunnels of the brain is like a blockage in an artery. It can be fatal.”

Dr. Mihaly Kis performed Doris’ life-saving procedure, using microsurgery to get through to the infected ventricle, deep at the centre of the brain, without having to perform risky invasive brain surgery. Trillium Health Partners’ neurosurgery program specializes in safer, micro-neurosurgical procedures like this one, utilizing state-of-the-art technology. For Doris’ surgery, Dr. Kis used a special navigational device that matched the patient’s MRI imaging with her actual head position and anatomy, tracking the instrument in the surgeon’s hand.

“The conventional surgical approach would have been to cut through the patient’s brain in order to reach the ventricle at the centre of the head,” says Dr. Kis.  “Using the navigation tool instead, we were able to minimize our incision and work within 1mm accuracy. The entire surgery was done under a microscope connected to a navigational device, effectively providing a GPS roadmap during the surgery and allowing the roadmap to be projected, creating a holographic like view, much like fighter pilots use during air combat.”

Using a combination of delicate microsurgical instruments, Dr. Kis was able to remove two tapeworm cysts, gently extracting the entire cysts without rupturing them. Doris has recovered well from her surgery, and is taking strong antibiotics to remove the rest of the infection.

“Throughout this entire process, Trillium Health Partners staff have become like family to me and my son and daughter,” says Doris, most of whose family still lives in her native Colombia. “I am forever grateful for the kind of care I received here, which would not have been possible to get at home. The doctors and nurses are our angels in Canada.”

Trillium Health Partners is the only regional centre specializing in neurosurgery between Toronto and Hamilton, resourced with state-of-the art equipment and medical expertise to ensure patients in the region have faster access to life-saving treatments.