Are We There Yet?

Most of this week was spent trying to define the parameters of my project. I am very lucky to be shadowing Dr. Riina as he is a very busy surgeon. However, that also means that there is less time for defining project parameters and such. However, at this stage my project proposal looks as such.

Before any procedure or operation, most patients desire to know their chances of a successful outcome. In many situations, patients will not move forward with the proposed procedure if their chances are not favorable. Obviously, no doctor keeps track of every single case so it is very hard to calculate any success rate associated with any given procedure. Even more confounding are the different variables associated with each case. Ultimately, a physician’s attempt to give accurate prognostic information is a calculated guess. One can be certain that by no means does a physician intentionally mislead a patient as they are not computers and certainly not omnipotent. What if it was possible to devise a scale with predictive values based on a physician’s body of work? This prognostic indicator would be semi-quantitative and give a more accurate assessment of the patient’s chance of having a successful procedure. It is proposed that the scale would consider and account for the multiple variables effecting patient’s with an aneurysm such as location, size, age of patient. The value generated would then correlate to percentage ranges to be determined. For this type of study, a sample of historical data would be taken from multiple cases. After analysis, this information would be used to incorporate the multiple variables existing in aneurysm cases to be used as tool to give patients a truer assessment of their relative chances of a successful procedure.

This week was slow. Dr. Riina was in the hospital for two days so on the off days, I observed Dr. Pierre Gobin, a neurology interventional radiologist. He performs many of the same procedures as Dr. Riina. I saw an interesting case where this child had a retinoblastoma. To treat this, Dr. Gobin embolized the tumor by stopping its supply of blood with polyvinyl alcohol particles. At this stage, it is a possibility that the tumor will be carefully excised by surgeons at Memorial Sloan Kettering Cancer Center.

I also had a chance to get back to the OR. I saw another aneurysm clipping. This was much like others I have described but they never get old. A couple of the really cool things about this particular procedure were the location of the aneurysm and the clipping of the lower vessel that fed into the aneurysm. The aneurysm was located near the optic nerve. Because of the complexity of the area, a temporary clip was placed on the external carotid artery to stop blood flow to the aneurysm. At this point, Dr. Riina proceeded to clip the aneurysm. For this case, two clips measuring more than 10 mm each were used. One was initially in place but was not sufficient to stop blood flow to the aneurysm. This was because of the location and neck size of the aneurysm. After both clips were in place, Dr. Riina used infrared imaging and a Doppler instrument to check the blood flow integrity and assure that the abnormal vessel was properly repaired.

Well, the last week of this immersion is approaching quickly. I am looking forward to making more progress on my project. I will be collecting the much needed patient data to get the study underway. After receiving the patient data, the meat of the project will begin as I need to investigate if a correlation exists between a successful procedure and any variable or variables associated with each patient’s particular procedure. If all works well, a recipe may exist for each patient to have a successful procedure. Maybe as important, this study could offer semi-quantitative prognostic information for Dr. Riina’s patients in the future.