The Advanced Path

New technology at St. Joseph’s/Candler allows access to deeper parts of the brain without disrupting healthy tissue

The truly devastating effect of unmanaged high blood pressure is often clearest when someone has suffered from a stroke. High blood pressure damages arteries to the point that they can be narrowed or blocked by a clot, which causes an ischemic stroke, or burst and bleed into the brain, which is known as a hemorrhagic stroke. 

In the past, if a stroke occurred too deep within the brain, there was nothing neurosurgeons could do. The risk of damage to dense and delicate brain tissue was too great. 

“These patients would linger in the Intensive Care Unit for weeks, and rehabilitation would take months,” explains board certified neurosurgeon Jay U. Howington, MD, of Neurosurgical & Spine Institute. 

But a new system of technologies allows neurosurgeons to reach those deeper levels of the brain, without damaging tissue on its way there, to remove deep-seated brain tumors and evacuate blood clots caused by stroke. Developed by NICO Corporation, it is known as the BrainPath system. 

“If you do a scan of the patient’s brain the day after the procedure, you can’t even see the path that the instrument took to get there,” Dr. Howington says. “But the clot or the tumor will be gone.”

How It Works

When Dr. Howington learned about the capabilities of the BrainPath system, he knew it was a game-changer in neurosurgery. St. Joseph’s/Candler procured the technology to bring previously inoperable brain tumors and intracerebral hemorrhages within reach. 

“To treat certain areas of the brain, you need to be able to advance through the brain without violating its tracts, or neural pathways,” Dr. Howington explains. “Advanced imaging shows us the different paths of the tracts in each patient, and I use BrainPath instruments to go around those tracts on my way to the clot or tumor.”

The cone-shaped introducer of the BrainPath allows for a non-traumatic entry into the sulci, the lower grooves on the surface of the brain, by gently dispersing brain fiber tracts rather than pushing or cutting through them. Dr. Howington uses 3D imaging technology to locate the clot or tumor and to guide the instrument through the optimal route. After removing the introducer, a sheath remains in the corridor, allowing him to insert another tool, called the NICO Myriad, to safely access the targeted tissue. If it’s a clot, it will be suctioned and chewed up. If it’s a tumor, it will be captured intact and biologically preserved using NICO’s Automated Preservation System, which keeps the tissue fresh by mimicking the brain’s microenvironment. 

“With this tool, I can collect a pristine tumor specimen that can be sent to pathology,” Dr. Howington says.

A stroke can’t be undone, of course, but Dr. Howington says being able to reach previously inaccessible clots can make the road to recovery much smoother for patients in the Neuro Intensive Care Unit at St. Joseph’s Hospital.

“We have taken the burden out of the brain,” he explains. “So patients are getting out of intensive care faster, they are getting to rehab faster, and their outcomes are better.”

The way the BrainPath achieves this without causing a deficit to the brain is nothing short of elegant in Dr. Howington’s estimation.

“It is so gratifying to look at a CT-scan post-op and think, ‘Wow, was there even a hemorrhage and was I even there?’” he says.

Navigating Your Own Way

As grateful as Dr. Howington is for this advanced neurosurgical tool, his wish for this kind of intervention remains the same as it has throughout his career.

“I hope we never have to use it on you,” he says. 

Though a person cannot prevent a brain tumor through lifestyle changes, they do have control over their risk for stroke and intracerebral hemorrhages. 

“Many of the patients I treat suffered a stroke due to uncontrolled, untreated high blood pressure,” Dr. Howington says. “But there are some very simple things you can do to get your blood pressure and other risk factors under control.”

Modifiable risk factors for stroke include:

A healthy diet. This includes lean proteins, lots of fruits and vegetables and healthy fats. It also means avoiding or at least limiting foods high in saturated fat, salt and sugar. 

Exercise. The American Heart Association recommends at least 150 minutes of physical activity a week, but the biggest takeaway is simply to move more and sit less. Physical inactivity can lead to high blood pressure, high cholesterol and other chronic health issues.

Weight management. Adults with a Body Mass Index (BMI) greater than 30 have been shown to be at a higher risk of suffering a stroke. Not surprisingly, the two factors above—a healthy diet and exercise—can help you lower your BMI to a healthy range.

Taking your medications and seeing your doctor. Always take your medication as prescribed, especially if you are on blood pressure or cholesterol medication. See your doctor annually. Routine visits with your doctor will help monitor potential risk factors including blood pressure, cholesterol and weight. 

“You can’t control things like your age, race or family history,” Dr. Howington says. “But so many of these other risk factors are within your control. If you take care of yourself, the less risk you have. If you live smart, the chance that you’ll have to come see me is low.”