Astonishing recovery after minimally invasive brain surgery
After being diagnosed with a brain tumour on his pituitary gland and being told surgery was too risky, John Fairchild was facing blindness and possible death. Minimally invasive brain surgery at The Ottawa Hospital restored his sight and his future.
Category: Neuro
After experiencing vision problems, severe headaches, and repeated transient ischemic attacks (TIA’s) –mini-strokes, John Fairchild was diagnosed with a tumour on his pituitary gland. With each TIA being potentially fatal or causing paralysis, and with surgery being high-risk, John began making detailed plans to help his wife carry on without him.
That was until September 2015, when minimally invasive brain surgery at The Ottawa Hospital saved his life.
In 2011, John had been told by a doctor in Edmonton that he had a tumour in his pituitary gland and the operation to remove it was too risky. The doctor advised him to wait several years until the procedure had been improved.
Five years later, John and his wife Suzanne had moved to Ottawa, and he was having regular TIA’s. During these mini strokes, his vision was reduced to seeing through a small hole, and his memory and speech were impaired. The 71-year-old was referred to see Neurosurgeon Dr. Fahad Alkherayf at The Ottawa Hospital. Dr. Alkherayf recommended John undergo the newly available minimally invasive brain surgery. With this technique, his tumour, which was benign, would be removed through his nostrils instead of the traditional more radical and risky surgery, which required opening up his skull.
The benefits of minimally invasive brain surgery
“It is a new field in neurosurgery,” said Dr. Alkherayf, who has advanced minimally invasive brain surgery techniques in recent years. “There are no incisions in the skull, no cut in the skin. Everything is done through the nose.”
This operation is safer with surgery time greatly reduced. It means patients not only spend less time in the operating room, but they go home sooner. They experience less complications and better recovery.
John Fairchild at home following his surgery
Vision and hope restored
“I believed there was some risk of being blind or dead after the operation, as it was so new,” said John. “I spent two months before the operation, training to carry on being blind. I taught my wife how to use the snow blower and handle the finances.
“When I opened my eyes in the recovery room, I could see a clock on the wall, and I could see the time! I wasn’t blind.”
— John Fairchild
The Ottawa Hospital is a North American leader in this procedure.
“We have been asked for consultations internationally,” said Dr. Fahad Alkherayf. “It’s a very exciting technique that has definitely improved patient care during these surgeries.”
A bright future
In the year since the operation, John has resumed his active life.
“Thanks to The Ottawa Hospital’s virtuoso surgery team, I am again now in vital good health – curling, skiing, golfing — with excellent vision and no headaches. I am extremely grateful for the extraordinary care I received in the hospital, and wonderful after-care.”
“I am so well now, you’d never know anything was ever wrong with me. I am very proud of the hospital and the medical team. You guys saved my life.”
— John Fairchild
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Innovation and Technology, Innovation and Technology
It was March 7, 2018. Leata hadn’t seen Joellie in five weeks. She had been at CHEO, in Ottawa, with their 3-year-old daughter who needed dental surgery.
When they got home from the airport, Joellie said he wasn’t feeling well and went to bed. He woke with a fever. Leata called her aunt who wondered if he might be having a stroke.
“I called the nursing station and they said to bring him in. Our truck wasn’t working, so we took the Ski-Doo. He [Joellie] drove it to the nursing station,” said Leata. The nurses could see something was wrong and started calling doctors in Iqaluit who arranged for medevac from their northwest Baffin Island community.
Joellie lost consciousness at the nursing station. He didn’t come to until he arrived at the Qikiqtani General Hospital in Iqaluit where a he had a CT scan. The results were bad news.
7-hour surgery and 52 stitches
Joellie Qaunaq from Arctic Bay, Nunavut.
“First, the doctor told us that Joellie had a tumour, then they told us he had brain cancer,” said Leata.
She had only been home less than 48 hours when she found herself headed back to Ottawa. The Ottawa Hospital Cancer Centre, through an agreement with the Government of Nunavut, provides cancer services to residents of eastern Nunavut. Usually, only one family member or close friend accompanies a patient. The Qaunaqs knew that cancer treatment could be lengthy—weeks, even months. They prepared to leave family, friends, and their community support network for an undetermined amount of time while Joellie had treatment.
The couple, who’ve been married for 29 years, have four children. So before heading south, Leata arranged for their two youngest (13 and three years) to stay with their oldest son, whose wife was expecting a baby in April. It would be Joellie and Leata’s first grandchild, and they knew they would miss the baby’s birth.
Joellie had a seven-hour surgery to remove his brain tumour. He woke up with the left side of his head shaved and 52 stitches curving up from his ear to his temple.
“That’s not a kind of cancer that we cure”
“Joellie had a tumour called a glioblastoma—it is the most common kind of brain tumour that adults get,” said Dr. Garth Nicholas, Joellie’s medical oncologist. “It’s not a kind of cancer that we cure with our treatment. The goal is to try and keep that cancer from progressing, or worsening, for as long as we can.”
Glioblastoma multiforme is a deadly, extremely aggressive form of cancer that starts in the brain. Its tumour cells reach like tentacles into parts of the brain where neurosurgeons can’t see them and, therefore, can’t remove them.
1,000 Canadians are diagnosed with glioblastoma every year.
It affects 2 out of every 100,000 people.
Accounts for 12% of all tumours in the head.
Affects more men than women.
Usually adults between 45 and 75 years of age.
Less than 10% survival rate, 5 years post-diagnosis.
Tragically Hip lead singer Gord Downie and Ottawa politician Paul Dewar both died from this type of brain cancer.
In addition to hearing loss―a result of a life of hunting and being close to the sound of hunting rifles―Joellie spoke Inuktitut and had limited English. Understanding his diagnosis and treatment options was challenging. Fortunately, Leata was fluent in English and could be a strong advocate for his treatment. But this is not the case for many Inuit patients.
“I think challenges and the difficulties―above and beyond his brain tumour―were not related to Joellie’s tumour but to being far from home, and the language barrier,” said Dr. Nicholas.
Realizing these challenges. Dr. Nicholas referred the Qaunaqs to Carolyn Roberts, the First Nations, Inuit, and Métis Nurse Navigator for the hospital’s Indigenous Cancer Program. She helps many Inuit patients understand and navigate the health-care system throughout their cancer treatment.
“Our whole system of ethical practice has autonomy as its foundation stone. People can decide what they want to do and people are meant to be involved in what they want to do with their health. But the combination of language and education and cultural expectation makes it hard for people from the North to be involved,” said Dr. Nicholas. “That’s where the program with Carolyn is useful, because she helps get them around to the idea that this is not being done to you, but with you and for you.”
“When I meet patients, I tell them I’m a different kind of nurse,” said Carolyn. “I’m not here to just answer questions about cancer. I’m here for any question at all―doesn’t have to be about health. That’s the message I give to every patient.”
There are few similarities between Ottawa and the small Arctic communities where many Inuit patients live. Undergoing cancer treatment in a place that is so fundamentally different than their home takes a toll on patients and their mental health.
Connecting with someone’s culture and breaking down barriers with the universal language of compassion and laughter helps patients feel more comfortable and confident about going through their cancer journey.
“What we really worked towards is not to focus too much on the cancer. It brought us together, but that doesn’t define who they are.” –Carolyn Roberts, First Nations, Inuit, and Métis Nurse Navigator.
Dr. Nicholas said he sees the difference Carolyn and the Indigenous Cancer Program make for patients. “I can think of individual patients who would not have been treated and who would’ve just gone home. They were overwhelmed by everything and they would’ve just left but they dealt with Carolyn. They ended up staying and having some treatment, and the treatments were useful,” said Dr. Nicholas. “The program’s got measurable medical outcomes.”
Joellie Qaunaq taught Arctic survival skills to Canadian Armed Forces members in Resolute Bay, Nunavut.
Back home, surrounded by family and friends
Leata Qaunaq hugs her husband Joellie.
Joellie had his last radiation treatment in Ottawa on May 29, 2018. He was then discharged and eagerly headed home, back to Arctic Bay—to family and friends.
Dr. Nicholas’s follow up with Joellie and his treatment to help keep the cancer at bay continued. Every month, he would have blood work done and the results were faxed to Dr. Nicholas who then called Leata about whether Joellie could go ahead and take the chemotherapy pills he was prescribed to use at home. After Joellie finished the six-month chemo treatment, he had follow up CT scans that Dr. Nicholas received on his computer as if Joellie was a local patient.
Fortunately, Joellie was still relatively well when he went home last May and was able to enjoy time with his new granddaughter and family.
Glioblastoma is one cancer that always returns. And Joellie’s did. After almost a year since his discharge, Joellie’s health deteriorated and sadly, he passed away on May 5, 2019. He was cared for by people who loved him and his family beside him.
14-year-old Spencer’s eye became reddish and tearing for more than a week; and this strange blockage was protruding from his nose. Despite repeated efforts, it would not come out.
That’s when Spencer’s mom, Ellen, knew he needed help and they would ultimately end up in CHEO’s emergency department. Doctors ordered a CT scan. It was around midnight; Ellen recalls when the results came in.
“A gravely concerned looking doctor asked me, ‘Did you know that Spencer has a tumour in his head?’”
It was not the news any parent wants to hear.
The growth, which was protruding from Spencer’s nose, was biopsied. While benign, that tumour was resulting in the quick deterioration of Spencer’s health. When Ellen asked to see the CT scan, she recalls searching the picture for a grape or golf ball sized image attached to a nose growth.
“I didn’t see any and asked where it was. ‘It’s the grey area’, the doctor said.”
The grey area was over half of his face.
“I didn’t even want to think about what his face would end up looking like after all the cutting they’d have to do to remove so much material, but I had to ask.”
The doctor revealed the tumour was larger than any he had ever worked with. It was for that reason and the fact it was reaching up to the floor of the brain, he told Spencer’s parents they couldn’t perform the surgery.
This type of tumour would need a specialized team of an ear, nose and throat doctor along with a neurosurgeon working together. Ellen recalls thinking she would take her son anywhere in the country to get the help he needed.
Specialized care at The Ottawa Hospital
However, the specialized care was nearby at The Ottawa Hospital. A highly skilled team would perform minimally invasive surgery and remove the tumour through Spencer’s nose.
Just over a week later, with his condition worsening, Spencer was to be admitted to The Ottawa Hospital. He had another CT, an MRI, and the specialized team was monitoring his optic nerve behind his bulging eye to ensure it wasn’t being severed by the growing tumour.
Two days later Spencer underwent a 4-hour surgery, which helped stop 80% of the blood flow feeding the tumour. The remaining 20% would maintain blood flow to his brain.
The next day the highly skilled team, which included Drs. Fahad Alkherayf and Shaun Kilty performed an eight-hour surgery. With expert precision, and state-of-the-art technology, they would remove the large tumour from Spencer’s face and base layer of the brain. They also rebuilt that layer to prevent the fluids that protect the brain from leaking out.
This minimally invasive surgery, removing the tumour and rebuilding the layer, was performed through Spencer’s nose by Dr. Alkherayf who has the greatest number of surgical hours of training for this procedure in Canada.
Dr. Fahad Alkherayf
Dr. Shaun Kilty
A Canadian Medical First
In order to rebuild the brain layer, 3D printing technology also aided doctors during the surgery. Ellen says it’s remarkable. “It’s really pretty cool the advancements which have been made to help patients in our community.” In 2016, The Ottawa Hospital became the first hospital in Canada to have an integrated medical 3D printer.
Ellen says her initial concerns of recovery completely faded thanks to this minimally invasive technique. “It was incredible. Spencer was home again only three days after surgery!”
When she thinks back to the fear of the initial diagnosis to where Spencer is today, back at school and active, several thoughts comes to mind.
“I was immensely grateful to God and The Ottawa Hospital, and I truly feel that we were in the best hands.”
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Innovation and Technology, Technology, Technology
Update: Sadly, Ida Chen passed away on November 6, 2019. The following story was written earlier this year, after Ida had undergone fluorescence-guided surgery at The Ottawa Hospital.
Symptoms strike and reveal shocking brain cancer diagnosis
While out on a bike ride enjoying the warmth of Palm Beach, Florida, in December 2016, Ida Chen noticed something was wrong with one of her legs. She had experienced some minor symptoms in the weeks prior, but suddenly, her right leg stopped working. Unable to balance, she fell and couldn’t continue her ride.
The fall left her stunned. “After I fell, I could walk. It wasn’t a permanent issue,” said Ida. However, a gash in her leg sent her to a walk-in clinic near where she and her husband, Clarence Byrd, have their vacation property.
When Ida recounted what happened to the doctor, he assured her there wasn’t an infection in the leg but he was deeply concerned about what had led to the fall. He advised her to contact a neurologist.
The neurologist scheduled an MRI, which revealed Ida had a 4 cm sized tumour in her brain which had features concerning for a malignancy. Recognizing that she may not survive a trip back to Canada for surgery, the neurologist contacted a neurosurgeon at the University of Miami Hospital who performed surgery only days later. Ida’s tumour was identified as a glioblastoma multiforme, an aggressive form of brain cancer. Unfortunately, not all the tumor could be completely removed, with 25% left behind due to the involvement of the tumor with the motor control areas for Ida’s leg.
Glioblastoma multiforme – brain cancer
For Clarence, it was hard news to absorb.
“It’s a particularly nasty cancer because it has fuzzy edges and they have trouble ensuring they get all of it.” Clarence Byrd, Ida’s husband
Ida advised her Ottawa doctor of the situation. Despite the fact that it was Christmastime, Dr. Lisa Lezack of the University of Ottawa Health Services made great efforts to ensure that when Ida returned to Canada, she would get prompt treatment.
Once back in Canada in early January, Ida was scheduled for radiation and chemotherapy. However, a new MRI showed that the tumour had returned to almost 100 percent of its original size.
Once again, just weeks after her first surgery, Ida was wheeled into the operating room, this time at The Ottawa Hospital under the care of neurosurgeon Dr. John Sinclair. It was a seven-hour surgery, followed by six weeks of radiation treatment and chemotherapy.
Ida’s initial prognosis was 12 – 15 months to live. Eighteen months after her diagnosis she had surpassed the odds, but the cancer was back, and she needed another surgery – her third in less than two years. This time, Dr. Sinclair had access to a revolutionary microscope, which was on loan to The Ottawa Hospital.
Ida, at home, enjoying every moment she gets to play piano.
Illuminating cancer
Dr. Sinclair had traveled to Switzerland to receive training for fluorescence-guided brain surgery and was able to perform such surgery in the context of a trial using a microscope on loan to The Ottawa Hospital. The technique requires patients to drink a liquid containing 5-aminolevulinic acid (5-ALA) several hours before surgery. 5-ALA concentrates in the cancerous tissue and not in normal brain tissue. As a result, malignant gliomas “glow” a fluorescent pink color under a special blue wavelength of light generated by the microscope while the normal brain tissue does not fluoresce. This permits surgeons to achieve a complete resection of a tumour in many more patients, with recent studies demonstrating that this can now be achieved in 70% of surgeries as opposed to the previous 30% average.
“Seeing the brilliantly coloured tumours helps neurosurgeons remove more of the cancerous cells,” said Dr. Sinclair. “It’s like turning on the lights. You can actually see the difference between the tumour and the brain tissue. It’s dramatic.”
Added Dr. Sinclair, “Survival and quality of life are both dramatically impacted by this technology.”
In later discussions with Dr. Sinclair, it was clear that, without the use of the microscope Ida would have lost the use of her right leg. Ida explained, “He would have had to take out more of my brain matter and disable me to be sure he had all of the cancer cells.” She also learned that, because the microscope was available for a limited time on loan from the manufacturer, she was one of only ten people in Canada who benefited from the loan of the microscope.
Shortly after Ida’s surgery, a fundraising campaign was initiated to acquire a permanent microscope for Fluorescence Guided Surgery at The Ottawa Hospital. Recognizing how vital this piece of equipment was, Ida and Clarence made a substantial contribution towards its purchase. Dr. Sinclair performed the first surgery with the new microscope on August 26th.
“He saved my life.”
Thanks to the revolutionary care she received right here at home, Ida is enjoying a normal life style. “The Ottawa Hospital has given her outstanding service. Dr. Sinclair in particular has been very impressive,” said Clarence.
Ida is quick to add, “He saved my life. Twice.”
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Cancer, Donors
A bystander only sees neurosurgeon Dr. Adam Sachs wearing large goggles, looking at the air between the two wands he moves back and forth in front of him. What Dr. Sachs sees is a three-dimensional image of a patient’s brain, with its electrical activity superimposed. This isn’t a video game. It’s the cutting-edge of deep brain stimulation and neurosurgery technology.
Wearing virtual reality goggles, Dr. Sachs can view an accurate, computer-generated 3D image of a patient’s brain with Parkinson’s disease, created using the patient’s own MRIs. The patients’ brain activity recorded from microelectrodes can be visualized in this virtual world. With the two wands, or joysticks, he can move the three-dimensional brain around, seeing it from all angles. He can also remove layers of the brain to look inside at the exact spot where he will place a DBS electrode during deep brain stimulation (DBS) surgery. He is hoping to soon use this technology in the operating room.
Neurosurgeon Dr. Adam Sachs is planning to use 3D virtual reality in his deep brain surgery for patients with Parkinson’s.
This medical 3D virtual reality system was developed at The Ottawa Hospital, and is expected to be the first of its kind in the world to be used for deep brain stimulation surgery. Drs. Justin Sutherland and Daniel La Russa are clinical medical physicists in the hospital’s radiation oncology department. The two used their imaging expertise to develop a virtual reality system that combines a patient’s MRIs and CT scans to create a 3D image of a patient’s organ or body part to give surgeons a detailed, accurate representation of the surgical area.
Historically, medical virtual reality programs were used by patients mainly for rehabilitation. Patients would wear VR-goggles to help relearn how to move through and cope with different environments. Until recently, the technology wasn’t good enough to create images of organs or tissue that could be used by clinicians in a manner that improves on current practice.
“What we are trying to do in our virtual reality lab is come up with new ways to leverage technology to help doctors and nurses, or any medical professional, do what they do better. And how better than with 3D visualization,” said Dr. Sutherland who is also an assistant professor in the University of Ottawa’s Department of Radiology. “We think the technology has only reached that point now. We’re now at a place where we want to pursue the avenue of clinicians-as-users.”
“Nowhere else in the world are they using virtual reality in this fashion.”
— Dr. Adam Sachs
One Ottawa Hospital surgeon interested in using 3D virtual reality was Dr. Sachs, who performs deep brain stimulation surgery for people with Parkinson’s. During this procedure, a microelectrode, no wider than a human hair, is implanted into a very specific area of the brain. The microelectrode then records activity from and stimulates that part of the brain and alleviates some of the patient’s symptoms, such as tremors and akinesia or the loss of ability to move their muscles voluntarily. The virtual reality system allows the electrical activity, stimulation effects and the MRI to be visualized together.
“In deep brain stimulation surgery, because the target is very small and in the middle of the brain this leaves the surgeon with the problem of how to visualize the person’s brain to understand the area and where to put the electrode,” said Dr. Sachs.
Neurosurgeon Dr. Adam Sachs uses virtual reality wands to manipulate a 3D image of the brain.
He said neurosurgeons use MRIs and brain atlases to get a mental image of what the patient’s brain looks like. The problem is these atlases are maps created from many different people’s brains, but each patient’s brain is unique. As well, the brain atlases are only two-dimensional, while the brain is three-dimensional. This makes it difficult to place the microelectrode in the exact spot in the patient’s brain where it will have the best chance of halting or reducing the Parkinson’s tremors.
Dr. Chadwick Boulay, a senior research associate in the neuroscience program, understands the challenges faced by neurosurgeons when implanting an electrode at the optimal position in the brain. When Dr. Boulay learned about the 3D virtual reality technology being developed at The Ottawa Hospital, he realized the potential this had for increasing the accuracy of deep brain stimulation surgery. He and Dr. Sachs worked with Drs. Sutherland and La Russa to develop a virtual reality program that would enable them to see the patient’s brain in three dimensions.
“This is really exciting,” said Dr. Sachs. “The deep brain stimulation electrodes will be more precisely placed because we’ll be able to integrate accurate images from the patient’s anatomy and visualize it in three dimensions,” said Dr. Sachs.
He anticipates that the resulting precision of the placement of the electrode will improve outcomes for patients with Parkinson’s disease, but this will be confirmed through research. About 15 people undergo deep brain stimulation surgery at The Ottawa Hospital every year.
“We’re excited about working with the Sachs Lab because it is a perfect clinical example of using 3D visualization to better understand a spatial problem,” said Dr. Sutherland. “In this case, actually seeing a target for deep brain stimulation removes the burden on the surgeons of trying to create a 3D model in their head.”
Drs. Daniel LaRussa, Justin Sutherland, and Chadwick Boulay have teamed up to design a 3D virtual reality program for Dr. Adam Sachs’ deep brain stimulation surgery.
Dr. Sutherland foresees that this 3D virtual reality technology will one day be in every department throughout the hospital. He says the overall system is surprisingly inexpensive, as the computer that runs it and the goggles only cost a few thousand dollars. The possibilities for this technology are endless. He said it has huge potential for education—teaching medical anatomy—and for surgical planning. Dr. Sutherland sees Dr. Sachs’ endorsement of this system as a shining example of how doctors can use this technology to improve what they do.
“Nowhere else in the world are they using virtual reality in this fashion,” said Dr. Sachs.
The Ottawa Hospital is quickly being positioned as leaders in 3D virtual reality technology and has already gained international attention. Drs. Sutherland and La Russa have given demonstrations and been invited to talk at large medical conferences, and other institutions have contacted them with interest in using this technology.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
