Brain Surgery Takes A Remarkable New Turn With Subdural Hematoma

Jared Knopman, MD is a board-certified neurosurgeon and interventional neuroradiologist who specializes in cerebrovascular disorders, including aneurysms, AVM’s, brain tumors, and carotid occlusive disease, as well as subdural hematomas.

This interview is another cutting-edge report from Weill-Cornell Brain and Spine, following the previous exceedingly interesting report using Ultrasound for Essential Tremor with Dr. Kaplitt here at CBJ/232.

Minimally Invasive – Without Opening The Skull

Dr. Knopman reports here on his considerable experience in the use of embolization of aneurysms and Arterial-Venous Malformations [AVM’s] to prevent further bleeding and death. He is also deeply experienced in the use of carotid stenting/endarterectomy, and intra-arterial chemotherapy.

In addition, he performs spinal cord stimulation and microvascular decompression for chronic pain syndromes and trigeminal neuralgia. He is one of the few neurosurgeons in New York City with dual expertise in both open neurosurgical as well as minimally invasive interventional techniques for the treatment of neurologic disease, which affords him a unique perspective in determining the optimal treatment for each individual patient’s needs using the most cutting-edge technologies.

Dr. Knopman has been named to the SuperDoctors Rising Stars list, a distinction afforded the top 2.5% of physicians in his field. His expertise is widely sought and he serves as a consultant to other neurosurgeons, traveling the country to assist them in their development of advanced stenting techniques with complex aneurysms.

Just What Is This New Vascular Procedure?

Until recently, most subdural hematomas that needed to be removed required open brain surgery, with its own risks and complications, but now there is a new minimally invasive approach to these dangerous vascular roadblocks, pioneered at Weill Cornell Medicine Brain and Spine Center.  Known as an MMA1 embolization, this new procedure is performed by a surgeon with expertise in image-guided cerebrovascular treatments, who threads a microcatheter from a tiny needle into the upper thigh, up to the arteries feeding the hematoma, to cut off its blood supply.

Dr. Jared Knopman is the first and only neurosurgeon performing this procedure anywhere, and he is currently engaged in a clinical trial that is also yielding important new information about the nature of these clots.

Signs and Symptoms

Subdural hematoma symptoms typically include a headache, vomiting, drowsiness, dizziness, confusion, differing pupil size, slurred speech and eventual loss of consciousness. Symptoms may appear immediately, but in some cases, they can take weeks or even months to manifest, as was the case with Chicago White Sox pitcher Danny Farquhar, who collapsed in the dugout during a game April 20, was rushed to the hospital, diagnosed with an aneurysm and immediately operated on. (As of April 23, he was still in critical condition.)

Who Is Most Susceptible?

Elderly people are at highest risk for chronic subdural hematoma because brain shrinkage causes these tiny veins to be more stretched and more vulnerable to tearing. Seniors are also more susceptible to falling as they get older, and more likely to be on blood-thinning medications, which can contribute to hemorrhaging in case of trauma. Infants are also susceptible to falls, accidents or abuse that can cause a hematoma to form.

It can also occur spontaneously,