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Published October 09, 2013, 09:51 PM

Endoscopic brain surgery removes cyst that could have killed Oxbow woman

FARGO – Michelle Breen suspected her migraine headaches were triggered by caffeine, alcohol, wheat or refined sugar.

By: Patrick Springer, INFORUM

FARGO – Michelle Breen suspected her migraine headaches were triggered by caffeine, alcohol, wheat or refined sugar.

But the headaches continued, and became more severe, after she eliminated those from her diet.

The symptoms worsened, including periodic muscle weakness and balance problems. Her symptoms were transitory. But they continued to progress.

To find out what was wrong, her primary care doctor ordered a diagnostic scan, which revealed a cyst in the center of her brain. The growth prevented fluid from draining, causing hydrocephaly, a buildup of pressure that caused her symptoms.

The 50-year-old Oxbow woman learned brain surgery was required.

“That’s kind of scary hearing that you have to have brain surgery,” she said.

Breen, a former nurse, didn’t want to travel to the Twin Cities or Rochester, Minn., for brain surgery.

It turned out she didn’t have to leave the area for a minimally invasive surgical procedure that deflated the cyst and restored drainage, alleviating the pressure.

The procedure involved making two small incisions above her hairline so the surgeon could insert instruments manipulated by an endoscope.

Dr. Adam Jackson, a Sanford Health neurosurgeon with a fellowship in endoscopic neurosurgery, removed the cyst, which measured about 2 inches in diameter.

“It’s kind of smack in the middle of her head,” Jackson said. The cyst, he added, was “reasonably sized and it was in a bad spot.”

Without surgery, it ultimately would have been fatal, Jackson said.

The endoscopic technique allowed Jackson to enter the “safer” part of Breen’s brain, the frontal lobe. Conventional methods would have required a larger incision, and removal of a portion of her skull, to enter from the top of the brain.

The result: an operation at Sanford Medical Center that took about 2½ hours instead of the five or six hours conventional surgery would have required.

That translated into a shorter hospital stay – three days instead of five or six, and a shorter recuperation, allowing Breen to return home in three days and be back to work in 10.

“That’s pretty short, I think, for brain surgery,” Breen said.

As for the July 12 operation: “It didn’t take very long. I was awake right after.”

She had a 4-inch strip of hair shaved from her scalp, but easily covered it by parting her hair until it grew back. A titanium plug was inserted into one of the surgical openings.

Conventional brain surgery would have meant an incision about 4 inches long on top of her head, Jackson said.

After the surgery, Breen’s migraine headaches went away, along with her periodic muscle weakness and difficulty balancing.

“Everything was gone,” she said. “It’s been pretty miraculous, I think.”

Endoscopic brain surgery is effective in removing certain cysts, as Breen’s case illustrates, as well as certain tumors, Jackson said.

Aneurisms require a different specialty, endovascular neurosurgery, a position Sanford is recruiting, Jackson said.

Over time, as new techniques come along, more and more surgery of all kinds is moving toward minimally invasive procedures, a well-established trend that continues.

Essentia Health in Fargo also offers minimally invasive neurosurgery with an interventional neurologist and an endovascular neurosurgeon.

Readers can reach Forum reporter

Patrick Springer at (701) 241-5522

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