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How Neurosurgeons Save Healthy Brain Tissue · Meaningful Medicine with Novant Health

• 0:03
  Joey Wahler (Host): It can be lifesaving.
• 0:05
  So we're discussing brain surgery.
• 0:07
  Our guest is Dr.
• 0:09
  Jeffrey Beecher.
• 0:10
  He's a neurosurgeon.
• 0:12
  This is Meaningful Medicine, a Novat Health podcast, bringing you
• 0:16
  access to leading doctors who answer questions they wish you would ask
• 0:20
  for routine care to rare conditions.
• 0:22
  Our physicians offer tips to navigate medical decisions
• 0:26
  and build a healthier future.
• 0:27
  Thanks so much for joining us.
• 0:29
  I'm Joey Wahler.
• 0:30
  Hi there, Dr.
• 0:31
  Beecher.
• 0:31
  Welcome.
• 0:32
  Dr Jeff Beecher: Hi, Joey.
• 0:33
  Thanks for having
• 0:33
  me.
• 0:34
  Joey Wahler (Host): Great to have you aboard.
• 0:35
  We appreciate the time.
• 0:36
  So first, in a nutshell, what would you say drew you to healthcare initially
• 0:41
  and specifically neurosurgery?
• 0:45
  Dr Jeff Beecher: Well, interestingly, I really originally
• 0:47
  wanted to be a psychiatrist.
• 0:49
  I had a great interest in the brain.
• 0:51
  Growing up thought I just wanted to kind of help people with their problems.
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  And then, in undergrad, I found out that I was really fascinated with the
• 0:59
  anatomy of the brain and my whole, mindset shifted towards surgery.
• 1:03
  And I just made a decision in college I was gonna be a neurosurgeon,
• 1:07
  so I went to med school at that point, just planning on it.
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  And my best friend outta med school actually all apologized when we
• 1:14
  graduated and I got my residency saying.
• 1:16
  I'm really sorry.
• 1:17
  I didn't believe you.
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  I just didn't think that could happen.
• 1:20
  And the rest is history.
• 1:22
  Joey Wahler (Host): And the brain even today.
• 1:23
  Am I right?
• 1:24
  Doc remains something of a mystery to a certain degree, even to
• 1:27
  experts like yourself, right?
• 1:29
  So I guess that makes it fascinating in a way, right?
• 1:33
  Dr Jeff Beecher: Sure.
• 1:34
  And not everybody's brain's the same.
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  there are some areas of the brain that are very well mapped, so we do know
• 1:40
  exactly what their function's gonna be.
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  Pretty much in everybody to some degree.
• 1:44
  But there's lot of areas that are, not well understood
• 1:47
  in terms of their function.
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  And so when somebody has a traumatic brain injury or a brain tumor or a
• 1:52
  stroke, we do get different neurologic findings, from time to time that are,
• 1:57
  uh, puzzling, unusual or circumstantial.
• 1:59
  And, it is a very exciting field for sure.
• 2:02
  Joey Wahler (Host): Even as a lay person myself, you know, I'll have
• 2:05
  those moments where, on the one hand I can't remember what I had for dinner
• 2:09
  last night, but then all of a sudden, decades after something happened in
• 2:13
  my life that may have been relatively insignificant, something triggers that
• 2:17
  thought to come from wherever the heck it is, that it's buried in that brain.
• 2:21
  Right?
• 2:22
  it's incredible.
• 2:23
  Dr Jeff Beecher: Our memory circuits are, very, interesting and very, complex.
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  one of the most associated things this might make sense when you
• 2:32
  hear it even as a lay person, is the sense of smell with memory.
• 2:35
  they're very closely connected.
• 2:37
  structurally in the brain And the amygdala, And in the temporal lobes.
• 2:41
  And so there's a strong association there, which is pretty interesting.
• 2:45
  Joey Wahler (Host): Sure.
• 2:46
  So.
• 2:47
  What are some of the signs of a brain emergency as we switch gears
• 2:51
  here, like stroke or an aneurysm?
• 2:54
  Because these are things that naturally can be life-threatening And that
• 2:58
  people need to seek immediate care for.
• 3:01
  Dr Jeff Beecher: Yeah, absolutely.
• 3:02
  That's very true.
• 3:03
  So a stroke when we're talking about, a blockage of a blood vessel, that's
• 3:07
  going to the brain, depriving the brain from the blood rich oxygen, that
• 3:13
  supplies it and lets it function.
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  that kind of stroke typically presents with, whether it's, Facial droop.
• 3:18
  So one side of the face will start drooping.
• 3:21
  they'll have arm, weakness or it'll be dropping or they can't control
• 3:25
  their arm, their speech will change, whether it's a garbled speech or words
• 3:29
  just don't even make sense completely.
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  That's called an aphasia.
• 3:32
  So speech is part of it.
• 3:34
  And then, time to your point, time becomes, very, very
• 3:37
  critical for these patient's.
• 3:38
  'cause time is brain.
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  And so that becomes our pneumonic for identifying a
• 3:42
  stroke called fast or nowadays.
• 3:44
  B.
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  Fast 'cause balance and eyes also come into play into, some stroke findings.
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  A different, circulation of the brain that can have, more,
• 3:52
  control over those functions.
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  And so, we certainly stress the BFA pneumonic.
• 3:57
  We want people to understand that these are all, stroke-like findings.
• 4:01
  And, And this can, lead to a patient, being diagnosed with a brain tumor as
• 4:05
  well, because sometimes the, pressure on the brain from the tumor being
• 4:09
  there can cause stroke-like symptoms.
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  So we'll find different things like that from time to time.
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  but none of those things should ever be downplayed.
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  One of our biggest concerns as healthcare providers in the neuroscience
• 4:20
  field is, when patient's say, oh, I got some tingling in my arm.
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  It'll go away.
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  or My arm feels a little weak.
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  It'll be fine.
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  It'll get better.
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  And they go to sleep.
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  And then they wake up and now they're having a full blown stroke.
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  and now they've lost a lot of time, and sometimes that's minutes.
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  Sometimes it's hours.
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  And, that's a big difference in their outcome.
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  on the flip side, a brain aneurysm, well they only present really,
• 4:46
  one of two ways, most commonly.
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  One is if it ruptures, and That is absolutely a medical emergency.
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  And, that's usually when we see a patient, with a, brain aneurysm is
• 4:56
  'cause it's bled And that, causes a sudden severe headache, the worst
• 5:01
  headache of a patient's life That is.
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  almost always how it's described.
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  so when a patient has the worst headache of their life, maybe they're confused or
• 5:09
  stumbling around, or often they'll get nauseous and maybe have some vomiting,
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  and sometimes the patient's will pass out.
• 5:16
  And so these are all medical emergencies that, we, need to get
• 5:19
  them to us as fast as possible.
• 5:21
  Joey Wahler (Host): And just to pick up on that, the importance
• 5:24
  of speed here, if you will.
• 5:27
  You're trying to preserve healthy brain tissue, And so explain to the
• 5:31
  lay person please, why is getting that attention and care as soon as
• 5:38
  possible of the utmost importance here?
• 5:41
  Dr Jeff Beecher: Yeah, so especially with stroke, there's a part of the
• 5:43
  brain that often is still functioning.
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  It's still getting blood from other networks, but maybe just barely.
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  Or the cells are able to kind of hang on long enough, and they're not actually
• 5:54
  dead cells yet where a stroke has occurred and it's permanent at that point.
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  so in that timeframe, when that's occurring, we call that actually a
• 6:02
  penumbra, the area of brain that's salvageable, And we can identify
• 6:06
  that with some pretty sophisticated imaging and, and CAT scans.
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  And when we find patient's that are having a, a stroke and they have a penumbra.
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  All of that tissue often can be saved by a medical intervention, whether
• 6:18
  it's, a clot busting medication that we give intravenously or, through the
• 6:22
  veins, or if my services are needed, where I have to go through the artery
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  and up into the brain and pull the clot out, whether it's with suction
• 6:30
  or a device that pulls the clot out.
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  And we often do this through the wrist And we can do it in like under 10 minutes.
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  Commonly, And we are, very efficient at this.
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  So the biggest delay is often the patient getting to us, once they're
• 6:43
  to us, we take over And the stroke protocols here are phenomenal.
• 6:48
  So we have, great outcomes.
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  We just gotta get the patient's to us.
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  So time is absolutely brain.
• 6:53
  Joey Wahler (Host): And so once that happens, once the patient is in
• 6:57
  your hands and you get to work, be it for a stroke or for an aneurysm.
• 7:01
  How about being able to use a minimally invasive approach versus when you
• 7:05
  may need to do open brain surgery?
• 7:07
  In a nutshell, is there a line that determines whether
• 7:11
  you go one way or the other?
• 7:13
  Dr Jeff Beecher: So for stroke, it's always minimally invasive the way we
• 7:16
  are dealing with, a clot going to the brain is always through an artery,
• 7:20
  through a small puncture, whether it's through the wrist or through the leg.
• 7:23
  When we have to, And we go up to the brain and, we fix what we
• 7:26
  gotta fix through the blood vessels in a minimally invasive fashion.
• 7:30
  I mean, these patient's, when they do like really, really well,
• 7:33
  they can go from not being able to speak on the table to speaking.
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  'cause we do this with conscious sedation so the patient's not.
• 7:40
  Put to sleep.
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  There's no breathing tube commonly.
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  And so we can see really dramatic improvement, like instantaneously,
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  And Those are just the most fulfilling situations that we have.
• 7:49
  When it comes to brain aneurysms, there are minimally invasive ways
• 7:52
  to treat brain aneurysms, and there are more traditional or standard,
• 7:56
  ways of treating a brain aneurysm.
• 7:58
  And that's with open, microsurgical, open cranial clipping of the aneurysm where
• 8:03
  we do have to put the patient to sleep.
• 8:06
  With a breathing tube and, position them in the OR and make an incision
• 8:10
  and, do what's called a craniotomy to open up the skull to then go underneath
• 8:14
  the brain to get where aneurysms are.
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  And that's one thing that patient's often do not know is that our blood vessels
• 8:21
  are actually underneath our brain.
• 8:22
  they kind of go through it, but in normal planes.
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  We don't have to go through the patient's brain to get to an aneurysm.
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  Almost always we can go underneath and that's where the aneurysms are
• 8:34
  gonna be, and that's where we can then put a clip on them to make
• 8:37
  it so they don't rupture again.
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  And the line, as you described, really is the safety profile
• 8:44
  of treating the aneurysm.
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  In that minimally invasive fashion.
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  Some aneurysms are a perfect balloon shape sack, where if you go up through
• 8:52
  the artery and you can fill it with coils and not worry about those coils falling
• 8:56
  out into the normal blood vessel, which would then inevitably cause a stroke.
• 9:01
  When that happens, we always will go towards the minimally invasive
• 9:04
  fashion because it's just, faster, great outcomes still and less
• 9:08
  for the patient to go through.
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  That's not always less risky.
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  Some people think minimally invasive means less risk.
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  That's not always the case.
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  If you have an aneurysm that's not shaped appropriately or it's too small
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  and you put a wire or a catheter in it, you could rupture that aneurysm
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  And that risk of that happening actually goes up with the different.
• 9:26
  smaller, less favorably shaped aneurysms.
• 9:29
  So the risk is actually higher to do that rather than the open traditional surgery
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  where we can go down, find the aneurysm and put a clip on the outside to seal it
• 9:38
  off so blood no longer can get in there.
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  Because the biggest risk with a brain aneurysm is if it reeds.
• 9:45
  And That is when a patient can really, have a worse outcome.
• 9:49
  Joey Wahler (Host): How would you, in a nutshell illustrate just
• 9:52
  how successful treatment of these conditions is if caught earlier?
• 9:56
  Enough.
• 9:56
  Dr Jeff Beecher: Yeah.
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  Well, with brain aneurysms, I mean, it's like night and day.
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  So if we do find a brain aneurysm, incidentally, so if somebody has
• 10:04
  headaches, that are more mild, not the worst headache of life, like I described.
• 10:07
  But if they have an unruptured brain aneurysm, we have a whole
• 10:11
  armamentarium of endovascular, minimally invasive techniques that
• 10:15
  can almost treat any brain aneurysm.
• 10:18
  and now you don't have to go through a craniotomy And that recovery and,
• 10:22
  and just that whole experience.
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  And you can have a brain aneurysm treated and go home the next
• 10:26
  day, often through your wrist.
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  So it's pretty remarkable if we do find that aneurysm on the early side.
• 10:34
  With strokes.
• 10:35
  it's just, again, time is brain.
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  the faster a family member or a patient's able to identify somebody
• 10:42
  who can call 9 1 1, I mean, it's a big difference in that patient's outcome.
• 10:47
  Joey Wahler (Host): Switching gears again here and talking brain tumors.
• 10:52
  Give us an idea please, doc, of the latest
• 10:56
  advanced surgical approaches to treating them.
• 10:58
  Dr Jeff Beecher: There's been a lot of, changes in the way we manage a brain
• 11:01
  tumor, especially the aggressive malignant brain tumors that most people fear, which
• 11:06
  is called GBM or glioblastoma multiform.
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  Or sometimes people would just say a glioma.
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  and some of the, best things that we've had recently come out this drug that a
• 11:17
  patient actually can drink before surgery.
• 11:19
  It's called glin.
• 11:20
  And when you drink this drug before surgery, it makes it so that, your tumor,
• 11:25
  that tumor will then light up under our microscope under a special blue filter so
• 11:30
  that we can actually see tumor and brain.
• 11:33
  And so what this has translated to for patient's and outcomes and greater
• 11:39
  success is we're, able to perform a more thorough operation before this existed,
• 11:45
  you had to go by what's called navigation.
• 11:48
  So everybody has a brain, MRI, And we find the tumor.
• 11:51
  We use that MRI to use basically like GPS of the brain.
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  I could put a little pointer that's sterile on the field.
• 11:58
  On the patient's head or inside the cavity of the tumor while I'm operating.
• 12:02
  And it'll tell me where I am in space, relative to the patient's brain.
• 12:06
  And I can point to this part of the tumor And that part of the
• 12:08
  tumor, and I can know where I'm at.
• 12:10
  But as you're operating, things change.
• 12:13
  The tumor's less there, the brain can become relaxed more.
• 12:16
  And so there can be millimeters of, of shift.
• 12:20
  And when that happens, you can feel less reliable, with that navigation.
• 12:25
  And so with this new medication that we can have the patient drink before.
• 12:29
  you don't have to rely on that as much.
• 12:31
  You still absolutely use it every single time.
• 12:34
  It's great for planning and customizing our approaches, but for the actual
• 12:38
  resection to say, when we feel like we're done, we can now say, Hey, look,
• 12:43
  there's no more fluorescein lighting up.
• 12:45
  And it's a bright pink, so there's, no mistaking it.
• 12:47
  So, it's really helped our ability to maximally resect the tumor to give the
• 12:53
  patient the opportunity for the best.
• 12:54
  Outcome and recovery.
• 12:56
  also, keeping it away, as possible.
• 12:59
  And also we have what's called brachytherapy.
• 13:01
  It's a radiation, seed, that we can implant for specific cases,
• 13:06
  glioblastoma being one of 'em.
• 13:08
  sometimes on the front end, sometimes if there's a recurrence.
• 13:12
  That actually gives immediate radiation to the tumor one centimeter deep
• 13:17
  into the brain beyond what we can see that lights up with the, drug that I
• 13:21
  was referring to or the navigation.
• 13:23
  Because these tumor cells are so infiltrative, they go beyond where
• 13:27
  the contrast shows it on the MRI.
• 13:30
  And so by giving immediate radiation, it gets that patient, immediately
• 13:34
  to the radiation step of their care.
• 13:36
  instead of having to wait.
• 13:38
  Two or three weeks to get radiation after you've had fresh brain surgery.
• 13:41
  'cause you don't wanna radiate externally, a, a fresh incision and fresh surgery.
• 13:45
  'cause we gotta make sure that wound heals and all those things.
• 13:48
  So This is that bridge to get that radiation process already going.
• 13:52
  So that's another novel thing that we have here, at Novant.
• 13:56
  Joey Wahler (Host): couple more questions for you.
• 13:57
  While naturally doc brain surgery cases vary greatly, I'm sure,
• 14:02
  generally speaking, what does a typical recovery involve?
• 14:07
  Is there physical rehabilitation included in that?
• 14:10
  Dr Jeff Beecher: Yeah.
• 14:11
  very much so.
• 14:12
  Obviously we hope that our patient's, have their surgery recover from their
• 14:16
  surgery and get some physical therapy while in the hospital And then get cleared
• 14:20
  to go home, which is commonly the case.
• 14:22
  But unfortunately in our line of work, patient's often come
• 14:25
  to us with neurologic deficits.
• 14:27
  Of course.
• 14:28
  That's why we're neurosurgeons.
• 14:30
  And, when they have a neurologic deficit, sometimes with surgery it
• 14:33
  can get a little worse before it gets better as things start to kind of calm
• 14:36
  down after a tumor's been removed or the patient's recovering from aneurysm
• 14:41
  surgery, and spine surgery as well.
• 14:43
  And it is certainly, Not uncommon that a patient will require, physical
• 14:48
  rehabilitation, uh, and rehab, stay.
• 14:51
  And I think our rehab does an excellent job of taking care of these neuro specific
• 14:55
  patient's, especially stroke patient's.
• 14:58
  I, I think they really feel a special bond to our stroke population.
• 15:02
  partially because we just have so many stroke patient's.
• 15:04
  They've almost become like an expert in rehab for stroke.
• 15:08
  I think it's like 60%.
• 15:09
  Of the rehab is stroke patient's.
• 15:11
  'cause we just are that, busy unfortunately with stroke.
• 15:15
  And so they have just all the, different techniques, modalities, and, all the
• 15:19
  different, necessary equipment to help these patient's maximize their recovery.
• 15:23
  but yeah, after brain surgery, once in a while, patient's will need that as well.
• 15:26
  I would tell you, And what I tell most patient's, I have some patient's that
• 15:30
  I call rock stars and they go home in two to three days after brain surgery.
• 15:35
  And then there's the patient's that are probably more kind of standard
• 15:37
  recovery, which is where I think I would probably fall in the five to six days
• 15:42
  after a pretty complex brain surgery.
• 15:44
  And then sometimes we have patient's who just need a little bit more time.
• 15:47
  sometimes it's pain, sometimes it is a physical limitation
• 15:51
  and they need some rehab.
• 15:52
  but we're fortunate here at New Hanover Regional Medical Center that we have a,
• 15:56
  rehab center on campus, And we, maximize our utilization of that when necessary.
• 16:01
  Joey Wahler (Host): In summary here, Dr.
• 16:03
  This is what's most fascinating to me about what you do.
• 16:07
  You often literally have someone's life in your hands.
• 16:12
  I wonder what that's like, not just the difference between life and death
• 16:16
  perhaps, but even if they live, it could be a difference in what kind
• 16:21
  of quality of life they have to have that kind of responsibility.
• 16:26
  Can you tell us what that's like?
• 16:28
  Dr Jeff Beecher: It is immense.
• 16:29
  I have a great deal of respect, for that.
• 16:32
  I think about it all the time.
• 16:33
  I think about how amazing it is.
• 16:36
  That we are able to help so many people And that we're given the
• 16:39
  privilege, And that patient's trust us to do what it is that we do.
• 16:44
  I mean, you know, specifically, there are a few instances where I have performed
• 16:49
  a few surgeries that just haven't been done anywhere else the way we did it,
• 16:54
  and with the technology that we use.
• 16:57
  Commonly when we are doing our aneurysm surgery, it's the next time in the
• 17:00
  world it's been performed with that technology all used on an individual
• 17:05
  at one time, it's pretty remarkable what we're capable of doing and how
• 17:10
  much we can affect a patient's life.
• 17:13
  And, is never lost on me and, all my mentors and my partners as well.
• 17:18
  we always say it's almost a joke in neurosurgery when you lose that.
• 17:22
  If you lose that, you're done, you should retire.
• 17:25
  because it's really what draws you to neurosurgery is the ability to have
• 17:31
  that much effect on the patient's life quality and just to change the
• 17:38
  trajectory of how their life's going.
• 17:40
  Even in spine surgery, when, maybe it's not so life and death, it's
• 17:44
  more quality of life, like you said.
• 17:46
  I mean, it's still super satisfying.
• 17:49
  To have a patient come in with severe leg pain, to a point where, I
• 17:53
  mean, they're like, cut my leg off.
• 17:55
  there's nothing that's made it better.
• 17:56
  And, you know, of course they're kidding.
• 17:58
  and you go and you do a pretty small surgery to remove a disc herniation, and
• 18:02
  they go home the same-day with no pain.
• 18:04
  it is very satisfying.
• 18:06
  I mean, I really think there's nothing like it,
• 18:09
  Joey Wahler (Host): Yeah, the passion you have for it certainly comes through
• 18:11
  and we're certainly all very fortunate that there are people like you that
• 18:15
  have made this their life's work.
• 18:18
  Well, folks, we trust you are now more familiar with brain surgery.
• 18:22
  Such a fascinating topic.
• 18:23
  We could talk about it forever.
• 18:25
  Dr.
• 18:25
  Beecher, keep up all your great work.
• 18:27
  I hope we can do it again and thanks so much again.
• 18:31
  Absolutely.
• 18:32
  And to find a physician, please do visit novant health.org.
• 18:36
  For more health and wellness information from our experts,
• 18:39
  please visit healthy headwinds.org.
• 18:42
  If you found this podcast helpful, please do share it on your social media.
• 18:46
  I'm Joey Wahler, and thanks so much again for being part of Meaningful
• 18:49
  Medicine on Novant Health Podcast.