Supertoys for the medical boys

IT sounds like science fiction, but brain specialists at a North-East hospital can now "operate" without having to open up your head. Until very recently, the only way to treat a variety of dangerous blood vessel conditions in the brain was to cut through the skull. But thanks to a multi-million pound investment at the revamped and expanded James Cook University Hospital in Middlesbrough, specialists can now penetrate deeply into the brain and carry out a wide range of repairs and preventative measures without laying a finger on your scalp.

The method used is very similar to the way in which heart specialists have been examining and treating their patients for years, by making a small incision in the groin and feeding a thin tube up through the pathways of the vascular system.

One of the main differences between the two specialisms is the size of the blood vessels which have to be navigated and the miniscule scale of the therapeutic devices which can be inserted.

Dr James Dervin, consultant neuroradiologist at James Cook hospital, says the new approach to diagnosing and treating many brain conditions has only been made possible by the advanced imaging equipment which is at the heart of the neuroscience department's vascular suite.

Some of the equipment installed at the new neurosciences department is the most advanced in Europe. "The state-of-the-art equipment we now have at this hospital gives us a much better idea of what we are dealing with. In the past it was almost as if we were looking through a fog, now we can see much more clearly," he says.

Pointing to a pink spaghetti-like tangle of blood vessels displayed on a flat-screen monitor, Dr Dervin says the superb imaging now available to his team allowed them to do so much more inside the brain without having to operate conventionally.

"What we can do now has modified dramatically in a few years. With this equipment you can now see where you are going and what you are doing much more easily," says Dr Dervin.

In the same way that heart specialists will inject a dye containing a mildly radioactive substance which will show up on x-ray scanners, the neuroangiographers can watch in real time how a particular area of the patient's brain is coping with blood flow.

If a potential weak spot is found - a blister on the side of a tiny blood vessel which could burst at any time - a variety of miniscule devices can be inserted into the tiny tube and steered into place to ensure that the blood continues to flow around the brain and preventing a potential catastrophe.

"We can put in a variety of devices, including coils and mini splints made from platinum alloy. With the equipment we have we can decide which piece of equipment should be used and place it precisely where we want it to go," he adds. "The skill comes in interpreting what you see and then manipulating the instruments to achieve what you want to achieve."

Dr Dervin sees a variety of patients with suspected brain problems, including acutely ill people who need lifesaving treatment. "In acute cases, when an aneurysm has occurred and there is bleeding into the brain, the patient might be unconscious, or complain of a severe headache, like being hit by a hammer on the back of the head," he says.

Other symptoms which point to possible neurovascular problems and can be investigated by Dr Dervin's team are an aversion to light, slurred speech or fits and seizures.

The team's ability to tackle complex problems could be enhanced even further if plans to acquire an advanced Japanese-made Flat Panel Detector goes ahead. The ultra-slim detector is made of selenium and can directly convert x-rays into photons, producing incredibly sharp and detailed images.

Then there is the equally impressive Computerised Tomography (CT) scanning suite. "This really is a state-of-the-art scanning machine. It has 16 rows of detectors, which allows us to repeatedly scan patients much faster than previous machines," says consultant neuroradiologist Dr Vijay Jayakrishnan, who says the advanced equipment now at his disposal has transformed what his department can do.

A few decades ago, a CT brain scan could take three hours. Now, with the equipment available at James Cook, the same detailed information can be assembled after just four or five seconds under the ultra-fast scanner.

"Apart from speeding up appointments, it is very good for patients, particularly ones who are restless," says Dr Jayakrishnan.

Typical patients who find themselves on the hi-tech scanning couch are people being investigated for suspected tumours, after seizures, bad falls, persistent headaches or infections. "Our new equipment operates in multiple planes, which means we can do a more thorough investigation," the specialist adds.

Vibha Barchia, the South Tees trust's neuroradiology manager, was part of the group which visited more than a dozen locations to chose the best possible equipment, including France, Germany and Holland.

She is thrilled with the quality of equipment which is available to the neuroscience team to treat the people of Teesside, South Durham and North Yorkshire.

"The people of this area are very lucky. The equipment means far fewer invasive procedures than they would have had in the past, and cuts down recovery time and the risk of infection. It is wonderful," she says.

While neuroscience probably has the shiniest new toys on the block, their colleagues in other departments have also got plenty to shout about.

Paul Willetts, the South Tees trust assistant director of commissioning who helped supervise the transfer of many departments from Middlesbrough General Hospital and the North Riding Infirmary to the new single site hospital on Marton Road, believes the expanded James Cook hospital is probably the best equipped hospital in the UK at this moment.

"Apart from the neuroangiography equipment we can be particularly proud of our cardiothoracic equpment. The new cardiac intensive care unit is truly state-of-the-art and we also have three brand-new catheter labs," he says.

Elsewhere on the sprawling site, the hospital has taken delivery of an ultra-modern Magnetic Resonance Imaging (MRI) scanner which is probably the most advanced in Britain.

Apart from all this new hardware, the James Cook hospital is unique in the UK in having a complete range of medical specialisms all on one site.

Dr Paul Brennan, the consultant in medical genetics who heads the new Teesside Genetics Service at James Cook, is also hoping for a UK first.

He is looking for funding to open the UK's first automatic sampling unit, which will use robots to simultaneously check the genetic make-up of hundreds of blood samples.

Dr Brennan is delighted to find himself sharing the main hospital corridor with a galaxy of different specialisms.

But the specialist, whose team will work with families which are at increased risk of inheritable genetic disorders, is expecting a few confused patients will come to his clinic by mistake.

"We are next door to the genito-urinary medical clinic. People are going to be knocking on the door because genetics and genitals sound quite similar," he laughs.