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Growing up in Winnipeg’s gritty North End, Howard Lesiuk liked to fix things: shortwave radios, old cars. His Uncle Phil taught him to make and repair cabinets.
“I’ve always been a hands-on sort of guy,” says Dr. Lesiuk, who, as one of Ottawa’s top neurosurgeons, now repairs brains.
Lesiuk is the director of cerebrovascular surgery at The Ottawa Hospital and chair of the neurosurgery division at the University of Ottawa’s medical school. He is a leading practitioner of minimally invasive brain surgery: a technique that allows neurosurgeons to operate inside the brain using the body’s network of blood vessels.
Surgeons deploy tiny, high-tech tools that pass through blood vessels to the surgical site, eliminating the need to open the skull.
For patients, this surgical revolution — it’s known as endovascular neurosurgery — means less physical trauma, shorter hospital stays and quicker recoveries.
For brain surgeons like Lesiuk, the revolution has its own rewards. In February, for instance, Lesiuk operated on a woman who was having a major stroke — something that, traditionally, surgeons could do little to arrest. The woman, in her 60s, had collapsed in a coffee shop not far from The Ottawa Hospital. She remained conscious, but her speech was slurred and she was paralyzed on one side of her body.
In the hospital’s emergency department, doctors rapidly assessed her condition and administered the clot-busting drug tPA before she was sent for detailed imaging of her blood vessels and brain.
The scans revealed that a large artery in her neck, the carotid, was blocked: the clot extended up into a nearby brain artery. Such large blood clots are difficult to treat with drugs alone. But the pictures also revealed that surgeons still had time to do something since much of the woman’s brain tissue remained intact.
Lesiuk decided to conduct an endovascular thrombectomy, a procedure recently hailed as a breakthrough in stroke treatment. (The Ottawa Hospital is the only centre between Montreal and Toronto that now performs this operation.)
Lesiuk inserted a thin catheter into an artery in the patient’s groin and threaded it through the body to the site of the blockage. He pushed the catheter through the blood clot and then deployed another tool, a stent retriever, to ensnare the clot and drag it out of the middle cerebral artery.
“The carotid artery was now open and all the main arteries in the head were open,” Lesiuk remembers. “It was a very gratifying procedure because the patient’s response was very quick: soon after the surgery, she was moving her arm and leg, and talking again.”
Lesiuk is one of only four doctors at The Ottawa Hospital qualified to perform the procedure. He is also one of only two neurosurgeons in Ottawa to ever perform deep hypothermic circulatory arrest surgery: an immensely complex operation in which a patient’s blood is chilled and heart stopped in order to effect the removal of a giant brain aneurysm.
“It’s a last resort,” explains Lesiuk. “It’s a horrific surgery because you are pushing a patient to the edge of death to get them out of this.”
Lesiuk did not grow up dreaming of a career as a brain surgeon.
He was the only child of John Lesiuk, a machinist at the Swift Meat Packing plant in Winnipeg, and his wife, Jeanette, a waitress. They were both second-generation immigrants from Russian-controlled Crimea.
The Lesiuks stressed the importance of school. “They believed the only way you got to be something other than a blue-collar worker was to get an education,” says Lesiuk. “My marks were pretty important to them.”
He did not disappoint. Lesiuk excelled in math and science and earned degrees — one in math and the other in physics — from Winnipeg’s two universities. He was about to pursue a doctorate in theoretical physics when a summer job changed the arc of his life: Lesiuk was hired as a lab assistant by a neuroscientist at the University of Manitoba.
“I said, ‘This is the coolest thing ever,’ and I completely changed my plans,” he says. “The idea of actually doing something with my hands was really appealing to me, so I was immediately attracted to neurosurgery.”
A fellowship in cerebrovascular surgery brought him to Ottawa in 1991 to conduct research on cell death in the brain.
He considers the brain to be the final frontier of medicine — and its deepest mystery.
“The brain is the most complex organ in the body: billions of neurons with myriad interconnections,” he says. “Theories are still evolving as to how it works. Most people imagine it as a conventional computer, but it’s nothing like that. The closest we can come to explaining it are theories of non-linear, near-chaotic systems, which are very efficient ways of processing massive amounts of information.”
Lesiuk operates on aneurysms, tumours, arterial blockages and malformations in the brain, and he’s excited by the prospect of applying minimally invasive techniques to more cases.
The technique is most commonly used now to remove brain aneurysms. Neuro-endovascular procedures were used in about two-thirds of the 150 brain aneurysm cases treated last year at The Ottawa Hospital — more than double the number from five years ago.
An aneurysm is a bubble or bulge that forms on an arterial wall inside the brain; its rupture can cause a life-threatening stroke.
Surgeons used to have to open the skull to find, deflate and clip an aneurysm. Now, they’re more likely to use tiny platinum coils, delivered through a catheter, to pack the bubble, slowing and then clotting its blood flow. Tiny stents, or mesh tubes, are used to support the coils in some cases.
“It’s like reinforced concrete: the coils are the rebar and the clotted blood is the cement,” explains Lesiuk, who says the method gets the job done without disrupting sensitive brain tissue. “You get there the way the blood does. It means you don’t have to open the head, cut window of bone out, and push on the brain.”
aduffy@ottawacitizen.com
twitter.com/citizenduffy
查看原文...
“I’ve always been a hands-on sort of guy,” says Dr. Lesiuk, who, as one of Ottawa’s top neurosurgeons, now repairs brains.
Lesiuk is the director of cerebrovascular surgery at The Ottawa Hospital and chair of the neurosurgery division at the University of Ottawa’s medical school. He is a leading practitioner of minimally invasive brain surgery: a technique that allows neurosurgeons to operate inside the brain using the body’s network of blood vessels.
Surgeons deploy tiny, high-tech tools that pass through blood vessels to the surgical site, eliminating the need to open the skull.
For patients, this surgical revolution — it’s known as endovascular neurosurgery — means less physical trauma, shorter hospital stays and quicker recoveries.
For brain surgeons like Lesiuk, the revolution has its own rewards. In February, for instance, Lesiuk operated on a woman who was having a major stroke — something that, traditionally, surgeons could do little to arrest. The woman, in her 60s, had collapsed in a coffee shop not far from The Ottawa Hospital. She remained conscious, but her speech was slurred and she was paralyzed on one side of her body.
In the hospital’s emergency department, doctors rapidly assessed her condition and administered the clot-busting drug tPA before she was sent for detailed imaging of her blood vessels and brain.
The scans revealed that a large artery in her neck, the carotid, was blocked: the clot extended up into a nearby brain artery. Such large blood clots are difficult to treat with drugs alone. But the pictures also revealed that surgeons still had time to do something since much of the woman’s brain tissue remained intact.
Lesiuk decided to conduct an endovascular thrombectomy, a procedure recently hailed as a breakthrough in stroke treatment. (The Ottawa Hospital is the only centre between Montreal and Toronto that now performs this operation.)
Lesiuk inserted a thin catheter into an artery in the patient’s groin and threaded it through the body to the site of the blockage. He pushed the catheter through the blood clot and then deployed another tool, a stent retriever, to ensnare the clot and drag it out of the middle cerebral artery.
“The carotid artery was now open and all the main arteries in the head were open,” Lesiuk remembers. “It was a very gratifying procedure because the patient’s response was very quick: soon after the surgery, she was moving her arm and leg, and talking again.”
Lesiuk is one of only four doctors at The Ottawa Hospital qualified to perform the procedure. He is also one of only two neurosurgeons in Ottawa to ever perform deep hypothermic circulatory arrest surgery: an immensely complex operation in which a patient’s blood is chilled and heart stopped in order to effect the removal of a giant brain aneurysm.
“It’s a last resort,” explains Lesiuk. “It’s a horrific surgery because you are pushing a patient to the edge of death to get them out of this.”
Lesiuk did not grow up dreaming of a career as a brain surgeon.
He was the only child of John Lesiuk, a machinist at the Swift Meat Packing plant in Winnipeg, and his wife, Jeanette, a waitress. They were both second-generation immigrants from Russian-controlled Crimea.
The Lesiuks stressed the importance of school. “They believed the only way you got to be something other than a blue-collar worker was to get an education,” says Lesiuk. “My marks were pretty important to them.”
He did not disappoint. Lesiuk excelled in math and science and earned degrees — one in math and the other in physics — from Winnipeg’s two universities. He was about to pursue a doctorate in theoretical physics when a summer job changed the arc of his life: Lesiuk was hired as a lab assistant by a neuroscientist at the University of Manitoba.
“I said, ‘This is the coolest thing ever,’ and I completely changed my plans,” he says. “The idea of actually doing something with my hands was really appealing to me, so I was immediately attracted to neurosurgery.”
A fellowship in cerebrovascular surgery brought him to Ottawa in 1991 to conduct research on cell death in the brain.
He considers the brain to be the final frontier of medicine — and its deepest mystery.
“The brain is the most complex organ in the body: billions of neurons with myriad interconnections,” he says. “Theories are still evolving as to how it works. Most people imagine it as a conventional computer, but it’s nothing like that. The closest we can come to explaining it are theories of non-linear, near-chaotic systems, which are very efficient ways of processing massive amounts of information.”
Lesiuk operates on aneurysms, tumours, arterial blockages and malformations in the brain, and he’s excited by the prospect of applying minimally invasive techniques to more cases.
The technique is most commonly used now to remove brain aneurysms. Neuro-endovascular procedures were used in about two-thirds of the 150 brain aneurysm cases treated last year at The Ottawa Hospital — more than double the number from five years ago.
An aneurysm is a bubble or bulge that forms on an arterial wall inside the brain; its rupture can cause a life-threatening stroke.
Surgeons used to have to open the skull to find, deflate and clip an aneurysm. Now, they’re more likely to use tiny platinum coils, delivered through a catheter, to pack the bubble, slowing and then clotting its blood flow. Tiny stents, or mesh tubes, are used to support the coils in some cases.
“It’s like reinforced concrete: the coils are the rebar and the clotted blood is the cement,” explains Lesiuk, who says the method gets the job done without disrupting sensitive brain tissue. “You get there the way the blood does. It means you don’t have to open the head, cut window of bone out, and push on the brain.”
aduffy@ottawacitizen.com
twitter.com/citizenduffy
查看原文...
