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Big Advances in Minimally Invasive Neurosurgery

Pediatric NeuroNews
December 16, 2016

Cohen, Alan

Alan Cohen, MD

The field of neurosurgery is practically unrecognizable compared with when it got its start at Johns Hopkins more than a century ago, says Chief of Pediatric Neurosurgery Alan Cohen. Antibiotics and corticosteroids are available now to reduce the risk of infection and damage to the brain. Preoperative imaging allows surgeons to craft a plan based on each patient’s unique anatomy, feeding information to image guidance systems in real time during surgery. Intraoperative imaging can give surgeons an update on how successful a procedure might be before they even finish it.

“These are things that the founders probably never dreamed would exist,” Cohen says.

One of these seemingly far-flung innovations has been a central focus of his career: Cohen’s main clinical and research interest is minimally invasive techniques—those that access the brain and other neurological structures through keyhole openings, rather than the large, open incisions performed decades ago. He uses these techniques to treat a wide range of conditions, including brain and spinal cord tumors, craniosynostosis, hydrocephalus and arachnoid cysts. In the lab, he and his colleagues are working on developing new techniques and new tools that have the potential to transform this field.

Since joining Johns Hopkins from Boston Children’s Hospital earlier this year, he’s worked to set up a laboratory in Johns Hopkins’ Carnegie Building, a structure that was erected around the time that neurosurgery was just gaining traction as a field. In his new lab, he’s working with a host of researchers from other disciplines, including biomedical engineering and computer science, to innovatively solve current problems in neurosurgery. He’s invited some of these researchers to directly witness surgery to point out some of the difficulties plaguing the field and invite ideas on how to fix them.

“By putting people from different disciplines together,” he says, “we can benefit from the wisdom of the crowd.”

That wisdom is already being put to good use. He and his colleagues are working now on improvements, such as endoscopic forceps that can control bleeding and a smart balloon that gently pushes tissues away, avoiding the need for manipulation that can lead to collateral damage in surgery.

Working with fellow surgeons, Cohen and his colleagues are also investigating new techniques that could eventually make tumors currently considered unresectable amenable to surgery. Through the use of cadavers and models made through three-dimensional printing, the researchers can assess the feasibility of these techniques and perfect them before testing them in patients.

Additionally, Cohen and his colleagues are using three-dimensional models to practice conventional procedures in complex cases using a patient’s own anatomy prior to procedures. “It’s like a golfer taking a practice swing,” Cohen says. “This ‘operation before the operation’ allows us to plan out the best route to structures without compromising a patient’s safety.”

With the help of colleagues across Johns Hopkins, Cohen is hoping to revolutionize minimally invasive neurosurgery. “I feel lucky to be part of the Johns Hopkins community,” he says. “With collegial talent in different specialties, we can cross boundaries to accomplish things that otherwise wouldn’t happen.”


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