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Woman is second in N. America to undergo rare brain surgery By Melody Brumble Shreveport Times November 7, 2008

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Karen Mowad felt the pressure of a drill bite through her skull as a Shreveport doctor prepared to vaporize a tumor on the front of her brain.

“If you’ve ever seen a saw go through a deer bone, that’s pretty much what it looks like,” Mowad recalled.

Dr. Ravish Patwardhan guided a laser probe into Mowad’s skull through the hole, used magnetic resonance imaging to double check the tumor’s location, then zapped the cancer. Mowad was wide awake for the hourlong procedure, which involved two newly developed pieces of medical equipment. She went home the next day.

She took time off work because Patwardhan warned her there could be short-term side effects from the surgery. She’s noticed a tendency to put objects in odd places and forget words, but otherwise she feels fine.

“I look at words and don’t know what they mean,” she said. “I put things away and don’t know where I put them. I found my ketchup in the bathroom and didn’t know why I put it there.”

Mowad was the second person in North America to undergo the surgery, which combines the probe and a patented targeting system one of Patwardhan’s companies developed. The doctor performed the first surgery Oct. 13.

The targeting system, called fastNAV, consists of a handheld pointer that looks like a video game pistol. Touching the pointer to a person’s skull allows Patwardhan to find the corresponding spot on the person’s MRI scan and drill a precise path to a spot in the person’s brain.

“It’s like a global positioning system for the brain,” Patwardhan said. Such pinpoint targeting shortens surgery time and allows a surgeon to drill a single hole in a person’s head instead of cutting multiple holes over the course of several hours.

Fewer incisions mean less blood loss, less invasion of the brain and a shorter recovery time, Patwardhan said.

Patwardhan decided to use the fastNAV equipment for brain tumor surgery after representatives of Visualase approached him. Visualase, based in Houston, created the laser probe that Patwardhan used to burn away Mowad’s tumor.

Willis-Knighton Pierremont, where Patwardhan has his practice, is one of three places approved for a clinical trial of the Visualase equipment. The others are M.D. Anderson Cancer Center in Houston and a hospital in New Jersey.

“We beat M.D. Anderson by two weeks,” Patwardhan said. “We didn’t intend to. It just worked out that way.”

In May, Patwardhan cut out a tumor on the back of Mowad’s brain. When Mowad’s oncologist found the most recent tumor, Mowad chose the laser surgery after weighing the pros and cons of an experimental treatment.

She joked with Patwardhan about getting a better drill bit during the laser surgery. She watched the targeting and MRI scans on a monitor. At one point, she shushed everyone so she could hear what the doctor was saying.

“They put a small incision right over where they thought the tumor was,” Mowad said. “They checked, and Dr. Patwardhan was dead center on it. He was so proud.”

From start to finish, the operation lasted about an hour. Shortly after returning to her hospital room, Mowad talked about the experience and showed off the incision on her forehead. She compared it to the three-inch scar from the traditional surgery Patwardhan performed in May.

“I can cover the incision with my thumb,” Mowad said.

Her biggest concern a week after the surgery was getting her home in Many ready for the holidays.

“I’m cleaning out my clutter corners,” Mowad said. “This is my year to hold Thanksgiving and Christmas at my house. On Thanksgiving Day, I’ll have about 20 people over. At Christmas, I usually have 20 to 45 people, that’s all day.”

She’ll return to Shreveport for follow-up MRI scans in November.

“Hopefully, there’s nothing else that’s popped up there,” Mowad said. “I’ve been fighting cancer for seven years. The first place it came up was in my lungs and larynx.”

Mowad couldn’t tolerate radiation and chemotherapy. That made her a candidate for the laser surgery.

Patwardhan said he recommends the laser surgery only in specific cases, including those in which radiation and chemotherapy aren’t effective. Tumors must be 3 centimeters or smaller, and patients must be able to move around on their own and perform everyday activities.

A French hospital has performed 16 laser brain tumor removals without significant side effects in patients, but Patwardhan said doctors still are studying the long-term effects of such procedures.
“It’s not a cure-all,” he said.

However, he believes laser brain tumor removal, in conjunction with the fastNAV targeting system, offers a valuable option for surgeons and their patients. He plans to try the fastNAV system for other neurosurgery procedures and make the equipment commercially available.

His company built the system using pieces from other medical equipment already approved by the U.S. Food and Drug Administration. The FDA regulates medication and medical devices.

“There’s modifications to the existing technology we want to do so we can make it better,” Patwardhan said.

Mowad said she would have the laser surgery again if the cancer returns. She made the initial decision based on Patwardhan’s description of the procedure, taking into account his warning that “things can go wrong quick” when doctors are working inside a person’s brain.

“If someone is thinking about this, what I would say is, do your homework,” Mowad said. “Check into what they’re going to do. Talk to anybody that’s had it done. Weigh your facts.”

 

 
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