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Saint John's Neurosurgeons, NICO Corporation, Karl Storz and Stryker Medical Device Companies Team Up to Save Belgian Boy from Brain Tumor

In late February 2010, Amin Kassam, MD, Medical Director of the Neuroscience Institute at Saint John's in Santa Monica, CA, and Head and Neck Surgeon Ricardo Carrau, MD, flew from Los Angeles to Belgium. They were determined to help Tristan, a young boy suffering from a chordoma, a rare, malignant brain tumor. Although chordomas are slow-growing, they can cause pain, paralysis, problems with vision and swallowing, and death. In 2006, NFL Running Back Craig William "Ironhead" Heyward died of a recurrent chordoma.

Tristan was already having difficulty with his balance, and movement of his tongue was being affected by the growing tumor. His best chance at survival was immediate surgery. But due to the large size and position of the tumor - 4 cm, located near the junction of the neck and spine - his doctors in the city of Leuven were concerned about the risks of performing traditional "open" surgery. They realized the safest option would be to access the tumor through the nose, a less invasive strategy called the endonasal approach. But they were not highly experienced with the approach and did not have access to the equipment needed to perform this advanced technique. They contacted Dr. Kassam, one of the world's foremost neurosurgeons with experience in the endonasal procedure, and asked for his assistance.

Dr. Kassam organized a trip to Leuven, enlisting aid from additional surgical specialists and device manufacturers. He and Dr. Carrau (who has since joined the Neuroscience Institute) teamed up with a team of skilled surgeons in Leuven headed by Prof. Dr. Bart Depreitere.

Many tumors are rubbery or fibrous and hard to dissect out. They often adhere to critical structures like nerves and blood vessels. Neurosurgeons typically need many different specialized tools to remove tumor tissue, including devices that cut, scrape, pick, grasp, and suction. Traditional tumor removal instruments also create heat that can damage delicate tissues nearby. Dr. Kassam knew he needed access to the new FDA-cleared NICO Myriad instrument, an automated, non-heat producing tumor-removal tool which recently became available for commercial use. The Myriad device was launched in the United States about a year ago, and Dr. Kassam happened to be one of a select group of neurosurgeons already trained to use the new instrument.

The Myriad device combines multiple surgical functions in one tool. It acts like a "magic eraser," providing controlled and precise tissue shaving on or near critical structures, and serves as a rapid cutting instrument for larger tumors. The Myriad is the first non-heat generating device of its kind that also vacuums tissue as it cuts and saves it to a collection chamber for laboratory evaluation. Its small diameter-like a long, thin straw—allows surgeons to operate through narrow surgical corridors, minimizing the opening that needs to be created in the skull and reducing the risk of injuries and damage to healthy neurovascular structures.

The device's bendable cutting tip allows surgeons to access hard-to-reach tumor sites and provides a high degree of surgical precision while significantly reducing operating room time. Fewer hours in surgery helps avoid surgeon fatigue and also minimizes the number of hours a patient needs to be anaesthetized, reducing overall risk, recovery time, and procedure costs.

NICO Corporation of Indianapolis, IN, developed the Myriad. The company not only provided the instrument to Dr. Kassam, it sent a technical specialist to Belgium to support the surgical team. Other manufacturers who supplied critical equipment included Karl Storz and Stryker. Karl Storz provided the key visualization tools and cameras as well as additional instrumentation needed to dissect out the tumor. Stryker provided a system of drills and navigation.

The procedure, performed through the child's nostril, took a team of surgeons 13 hours. "This surgery would have taken much longer and been far more difficult without the Myriad device, and impossible without the collaboration of all of our corporate partners," Dr. Kassam said. "Tristan's brain tumor was unusually hard and rubbery, like the sole of a tennis shoe. We had to access deep areas of the brain that are full of critical structures and arteries, and shave off the tumor very carefully. Without surgery, the tumor would have grown into his brainstem and spinal cord, which would have devastated this child."

Tristan is doing well, and his tongue is functioning more normally. An additional surgery was performed by Dr. Depreitere's team to stabilize his neck region.

Minimally invasive tumor techniques such as the endonasal approach, which Dr. Kassam and colleague Daniel Kelly, MD, Director of the Brain Tumor Center at Saint John's, helped pioneer, can potentially reduce patient trauma, shorten hospital stays, speed recovery, and minimize the risk of complications.

Jim Pearson, President and CEO of NICO Corporation, said NICO was privileged to have the opportunity to help a child in need. "The new Myriad instrument is making complicated procedures easier and adding to the success of brain tumor removal surgeries," he said. "As more neurosurgeons begin to use the Myriad, we believe they will also find it an essential tool that provides superior results and improves patient care.

"We're honored to work with such distinguished pioneers as Dr. Kassam," he continued. "Everybody came together to commit their time, skills, expertise, and equipment to save this child. Reducing the trauma of complex procedures is something that benefits everyone, and we're glad to help bring the benefits of neurosurgery to more people in need."

About Saint John's

Since its founding in 1942 by the Sisters of Charity of Leavenworth, Saint John's Health Center has been providing the patients and families of Santa Monica, West Los Angeles and ocean communities with breakthrough medicine and inspired healing. Saint John's provides a spectrum of treatment and diagnostic services with distinguished areas of excellence in oncology, spine, neurosurgery, orthopedics, women's health, cardiac and specialized programs such as the internationally acclaimed John Wayne Cancer Institute. For more information, visit www.newstjohns.org.

About NICO Corporation

Formed in October 2007 and based in Indianapolis, NICO Corporation is dedicated to developing technology for the field of minimally invasive neurosurgery, including skull base and spinal surgery. Their technology and products are designed and developed to positively impact patients' lives, their families, the care giver, and the health system provider. For more information, visit www.niconeuro.com.

Saint John's Health Center
Greg Harrison, (310) 829-8010
gregory.harrison@stjohns.org