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Introduction
Dr Hodes' background in internal medicine and research have led him to understand that surgical treatment should be used to repair disease, while minimally disturbing normal structures surrounding the abnormal area.
With this in mind, he uses minimally invasive surgical procedures such as embolization with glues, coils and/or stents for cerebral aneurysms and arteriovenous malformations; angioplasty for carotid, vertebral, or intracranial artery stenosis; endoscopic spine surgery for herniated disc removal; endoscopic spinal fusion; endoscopic transphenoidal pituitary surgery; endoscopic removal of intracerebral blood clots; endoscopic placement of ventricular shunts; minimally invasive aneurysm treatment and brain tumor removal; vertebroplasty and kyphoplasty for spinal compression fractures; and radiosurgery for brain tumors, arteriovenous malformations, cancer pain, and trigeminal neuralgia. Dr. Hodes was the first surgeon in Kentucky to perform many minimally invasive surgeries including endoscopic discectomy, coil embolization of aneurysms, successful cardiac standstill cerebral aneurysm clipping, and Kyphoplasty.
While the best approach to structural disease is with minimally invasive incisions and pathways, sometimes the only way to minimally damage the nervous system is to remove and then replace parts of the skull. This is done with skull base neurosurgical approaches.
Brain Tumors
Stroke
Spine
Spine Information
Surgery of the spine usually involves going through the skin, muscles and other normal tissues to free up nerves that are compressed and/or to take care of a damaged disc. Dr. Hodes believes that this should be done with as little damage to the normal anatomy as possible. Beginning in 1996, Dr. Hodes was the first surgeon in Kentucky to use endoscopic spinal retractors to perform minimally invasive spine surgery.
Minimally invasive spine surgery with endoscopic retractors uses dilators to gently spread the spine muscles. At the end of the surgery, the retractor is removed and the spinal muscles return to their normal configuration. Using dilation, instead of typical surgical cutting, substantially reduces blood loss and minimizes tissue damage, resulting much more rapid healing and less pain for most people.
Minimally invasive spine surgery allows the patient to concentrate on healing from their disease process and less from the surgical procedure. These procedures reduce disability time and speed return to work. In Dr. Hodes' experience, minimally invasive spine surgery is one of the most important advances in treatment of spinal disease of the past 50 years.
For an in-depth description of the spine from Dr. Hodes, click here.
Websites
Aneurysm
Aneurysm Information
An aneurysm is an abnormal ballooning (swelling) of an artery due to weakness in the wall of the artery. Aneurysms in the brain are a potentially dangerous condition. They can rupture or leak (bleed) resulting in death or stroke in a third of people immediately; and in a third of those who survive and make it to the hospital. Brain aneurysms can compress brain tissue or cranial nerves leading to the eyes, ears, tongue, nose etc, causing progressive neurological deficits such as weakness, blindness, double vision, hearing loss, headache, swallowing problems, etc.
Brain aneurysms are usually discovered in patients between the ages of 40-60 years old. Risk factors include cigarette smoking, high blood pressure and having a close relative who had an aneurysm. More women develop aneurysms than men (3 women: 2 men), and 20% of patients have two or more aneurysms.
Aneurysms are classified by their shape, size, and location:
By shape:
The "berry" shape is the most common type. It is a small, saccular-shaped aneurysm that resembles a berry. The "fusiform" shape is elongated and spindle shaped. It looks like an inner tube or long balloon that developed a sausage-shaped bubble. The dissecting aneurysm is the result of the artery wall splitting open through a small tear causing the artery to swell up.
By Size:
Small <10mm
Large 10-25mm (a dime is 18mm)
Giant >25mm
By Location:
About 85% of brain aneurysms are discovered in the anterior (front) arteries of the brain and are associated with the carotid arteries and their branches.
The remainder, 15%, are found in the posterior (back) arteries of the brain and involve the vertebral arteries and their branches.
Risk of Bleeding:
The risk of an aneurysm bleeding is estimated at 1% to 2% per year and varies with aneurysm size, location, type, and history of previous aneurysm rupture. Family history of aneurysmal rupture may increase the risk of an asymptomatic (asymptomatic is when an aneurysm is present, but you're not having any symptoms from it) aneurysm bleed. This risk is cumulative and so the risk of hemorrhage for an asymptomatic 7 mm posterior communicating artery aneurysm over 10 years is approximately 10-20%.
If a brain aneurysm ruptures, the blood usually bathes the surface of the brain (subarachnoid space) and enters the fluid filled spaces in the brain (ventricles), or less commonly penetrates directly into the brain tissue. Patients who bleed often complain of a severe headache and describe it as "the worst headache of my life!"
A subarachnoid bleed is considered a medical emergency with severe risks to the patient. Up to 30% of those patients will die before getting to the hospital. Another 30% are at risk for stroke since the bleeding from the aneurysm will irritate the major blood vessels of the brain and cause severe narrowing. This is a condition called vasospasm.
How do I know if I have an aneurysm?
The majority of patients with brain aneurysms have no symptoms or complaints unless the aneurysm ruptures. In 40% of cases, there are warning signs that an aneurysm is present such as pain above and behind the eye, nerve paralysis, localized headache, neck pain, nausea and vomiting. An increasing number of aneurysms are found prior to rupturing because CT (computed tomography) and MRI (magnetic resonance imaging) are now used commonly to check patients with these complaints. Although CT and MR can show many aneurysms, most patients with aneurysms need a cerebral angiogram, a "brain cath" in order to diagnosis and determine the best course of treatment.