CYBER-SURGERY

Of the many things that can go awry with the brain, one of the most dangerous is a cerebral aneurysm, when a weakness in the arteries in the brain results in the formation of a bulge or bubble in the arterial wall. The immediate symptom is likely to be headaches or worse. And if the bulge should rupture, the result is severe hemorrhage and often death. Diagnosis of the condition is made by CT scan, MRI and cerebral angiography and requires immediate evaluation and treatment. But surgery for a cerebral aneurysm is delicate and risky.

Over the past decade, UCLA neuroradiologists, led by Fernando Vinuela, have pioneered an extraordinary new technique for treating cerebral aneurysms. Meanwhile, researchers in the UCLA Department of Radiological Sciences and Computer Sciences Department, led by Daniel J. Valentino and Walter Karplus, have developed a technique to create three-dimensional, computer-generated virtual images of the vascular structure of the brain. Being able to view the position and type of the aneurysm with which he is dealing allows Vinuela to plan treatment in a virtual paradigm. This technology promises to be the way of the future in clinical medicine.

The conventional treatment for cerebral aneurysms, until 10 years ago, was surgical clipping. "Literally, it's surgery where you cut through the brain, go to the aneurysm and place a clip to cut off the blood flow," explains Valentino. "The problem is there is a great deal of morbidity. It is a long and expensive procedure with a very long recovery time. It can be on the order of several months to more than a year and there's also a very good chance you could lose some function permanently."

The prospects for treatment began to change in September 1986, when Vinuela arrived at UCLA to develop the department of interventional neuroradiology in association with the department of neurosurgery. Two years later, Vinuela recruited Guido Guglielmi from the University of Rome and assigned him to research and develop a new technique of intervascular occlusion of aneurysms. The result is known as the GDC detachable microcoil system. "It is now the gold standard for treating aneurysms," says Vinuela. "It has been used in more than 20,000 patients."  The coil itself is a soft platinum wire that is maneuvered to the site of the aneurysm in a catheter. As Vinuela describes it, the catheter is inserted into the major blood vessel in the thigh and then navigated up through the aorta, the arteries in the neck and into the cortical and deep arteries of the brain to the point of the aneurysm. The coil is inserted into the aneurysm, packing the aneurysm and causing blood to coagulate around the wire and block off the aneurysm from inside the vessel. A small electric current is then passed through the coil to break it off, and the catheter is removed. "You're essentially cured of the aneurysm without surgery," says Valentino. "It's really amazing: This procedure can be done in a couple of hours, whereas neurosurgery can take up to 10 hours. And with this technique, you go home the next day, and typically you don't lose any brain function."