Language arts teacher Susanna DeNude looks happy and relaxed these days. That's a big deal for the 58-year-old Riverdale resident, who has been battling a brain tumor for seven years.
Mrs. DeNude is the first patient in the nation to undergo laser ablation surgery for an intracranial ependymoma, a tumor that grows from the cells lining the ventricles of the brain.
Robert Wood Johnson University Hospital (RWJUH) is one of just eight institutions in the country to offer this new, minimally invasive approach that can reduce a patient's hospital stay from a week to 24 hours. The technology is a welcome relief for Mrs. DeNude, who initially underwent surgery in 2003 after an MRI revealed the tumor. Then, in 2005, she began having seizures that medication didn't fully alleviate.
Four years later, she met Shabbar F. Danish, MD, Assistant Professor and Director, Functional Neurosurgery at Rutgers-Robert Wood Johnson Medical School and RWJUH. He said the tumor had grown back, causing the seizures. Dr. Danish performed her second surgery in September 2009. "My recovery out of this surgery was much quicker than the first," notes Mrs. DeNude.
"I had fewer side effects, was able to do things sooner and came out of the anesthesia easier." This time, though, she underwent radiation to shrink a small portion of the tumor that was left intact because it was in a region of the brain that carries a high risk for bleeding and stroke. By spring, it was clear radiation had not stopped the tumor's growth.
"The DeNudes came in to discuss their options," Dr. Danish says. "From their perspective, the pros to laser ablation were huge because her scalp had not healed perfectly from her prior operations. The laser ablation technique gave us an option to potentially ablate the tumor without opening the scalp."
The DeNudes agreed and quickly decided to move forward.
"I realized that if they didn't get the entire tumor," husband Michael DeNude says, "they could repeat the procedure without causing any serious side effects."
Laser ablation involves using a GPS system to identify the exact location of the tumor. A laser is then placed directly into the tumor and is guided to perform thermal ablation (killing it with heat), while leaving the surrounding areas of the brain untouched.
The patient is then moved to an MRI unit, where the operating team can observe how the brain changes temperature with respect to the laser. "It uses a light energy in order to deliver the thermal therapy," explains Dr. Danish.
The entry hole through the skull is about the size of the end of a pen and requires just one stitch and a small bandage following the procedure. Only local anesthesia is used.
Mrs. DeNude now has new hope. This is the longest period she has gone without a recurrence, Dr. Danish notes. Should the tumor recur, the laser ablation procedure can be safely repeated.
"I think with everything that I've gone through and the way I've recovered, I feel everything's going to be OK," Mrs. DeNude says.