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State of the Art Equipment

Dr. Lopes in surgery

Dr. Lopes and team in surgery

ENDOVASCULAR PROCEDURES

Dr. Lopes performs all endovascular procedures with the most advanced angiography suite technology.

Rush University Medical Center has 16 high-end imaging suites on its Interventional Platform. This state-of-the-art facility enables Dr. Lopes to capture and view detailed images of the vessels of the brain and the body.

Surgical imaging screen

Surgical imaging screen

He uses a Siemens biplane angiogram room with rotational angiography and three-dimensional reconstruction capabilities to perform these procedures. This machine, one of the most advanced available, has two x-ray tubes that can move independently but operate simultaneously, allowing images to be taken from two directions at once. This provides Dr. Lopes with more information and makes the procedure quicker and more efficient. In addition, one of these tubes can rotate around the patient’s head, collecting a large number of images, which can then be reconstructed on the computer to create three-dimensional images of the blood vessels in the brain. This facilitates safe planning of minimally invasive procedures such as aneurysm treatments, vessel stenting and injection of substances to block weakened or diseased blood vessels in malformations or tumors.

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Intravascular imaging of a brain vessel using optical coherence tomography (OCT).

He uses a Siemens biplane angiogram room with rotational angiography and three-dimensional reconstruction capabilities to perform these procedures. This machine, one of the most advanced available, has two x-ray tubes that can move independently but operate simultaneously, allowing images to be taken from two directions at once. This provides Dr. Lopes with more information and makes the procedure quicker and more efficient. In addition, one of these tubes can rotate around the patient’s head, collecting a large number of images, which can then be reconstructed on the computer to create three-dimensional images of the blood vessels in the brain. This facilitates safe planning of minimally invasive procedures such as aneurysm treatments, vessel stenting and injection of substances to block weakened or diseased blood vessels in malformations or tumors.

MICROSURGERY

Dr. Lopes performs all microsurgical procedures in a state of the art operating theater. This area is equipped with Zeiss microscope, Penumbra Apollo system, Storz endoscopes and a hybrid Zeego angiography suite.

STEREOTACTIC RADIOSURGERY

Dr. Lopes works with the TrueBeam stereotactic radiosurgery for treatment of patients with complex Arteriovenous Malformations, or AVMs.

What is stereotactic radiosurgery?

Stereotactic radiosurgery precisely aims radiation beams at the AVM from multiple angles. Over time, the radiation causes the AVM blood vessels to narrow and eventually close off, eliminating the risk of hemorrhage or stroke.

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Dr. Lopes on syngo DynaCT SMART, advanced imaging technology. View all four videos in this playlist. Go to the syngo Dyna4 video playlist.

The primary advantage over surgical removal is that radiosurgery is noninvasive and doesn’t carry the risks of open surgery. Moreover, some AVMs are located in areas of the brain that cannot be approached safely with conventional surgery. In those cases, radiosurgery may be the only feasible treatment option.

Radiosurgery also can be used in conjunction with other AVM therapies. Doctors can use radiosurgery, for example, to eliminate an AVM remnant not removed during surgery. Radiosurgical treatment for AVMs is an outpatient procedure and allows patients to immediately resume normal routines.

Radiosurgery for AVMs carries a few disadvantages.

First, the radiation can take up to three years to fully destroy the malformation, during which time patients remain at risk for additional AVM bleeding. It’s also possible patients can experience significant neurological damage as a result of an AVM hemorrhage after radiosurgery, even if the treatment is in the process of destroying the malformation.

Second, not all AVMs disappear after radiosurgery. Small AVMs, those with a diameter of 3 centimeters or less, have an 80 percent chance of disappearing after a single treatment. Larger AVMs have a lower rate. As a result, it’s not uncommon for only a portion of an AVM to disappear after radiosurgery. Such patients are often treated with a second course of stereotactic radiosurgery.

Finally, even if an AVM is cured with radiosurgery, symptoms can persist. Some patients who suffer headaches or seizures before AVM treatment, for example, continue to experience them even when the AVM is destroyed. In such cases, the cause is thought to be scar tissue that develops around the AVM during its formation as well as the process of destroying it.

What is the difference between TrueBeam and other types of radiosurgery?

TrueBeam STx differs from other radiosurgery systems in that it doesn’t require a rigid metal frame screwed to the patient’s skull for targeting tumors and immobilizing patients. The TrueBeam STx achieves highly accurate targeting with computer imaging that continuously updates the AVM location and, therefore, eliminates the need for a metal frame. Moreover, other radiosurgery systems are limited to treating AVMs located only in the head. TruBeam STx can treat AVMs in the spinal cord as well.

Videos and images courtesy of Rush University Medical Center.