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Music to his ears
Jazz Musician Walter Bell Benefits from Gamma Knife Surgery
Left: Less than 48 hours after Gamma Knife® surgery, Walter Bell is playing with his band, The Latin Jazz Unit.
The human brain may be the universe's most complex creation. It controls and regulates all human activity, from the involuntary processes of respiration and heart rate to the complexities of emotion and reason. But as singularly important as the human brain is to life, it is also singularly delicate. In the case of Walter Bell, dangerously so. In October 2004, a fragile mass of expanding blood vessels suddenly burst in his head, releasing blood into the brain.
Bell suffered a stroke, the second leading cause of death in the United States. But he was fortunate. The nationally renowned jazz flautist and West Philadelphia native, whose higher brain function helped him release 10 albums under his own record label, survived the bleed. A happy ending? More like one successful chapter in a longer story.
Bell still faced a frightening reality. He was not cured. The stroke only helped provide the diagnosis: a malformation in the cerebellum--the region that controls balance, coordination, and fine movements of the hands.
What followed is an example of how Temple University Hospital clinicians--and advanced technology--are treating sometimes deadly arterio-venous malformations (AVMs) without surgery and sending patients back to work in days, not months. Seems like science fiction? It's music to Walter Bell's ears.
Bell's stroke was caused by an AVM, abnormal blood vessels where arteries connect directly to veins, instead of properly supplying blood through the capillaries.
For Bell, his stroke was mercifully just a very severe warning sign. He received immediate treatment, spending a month in recovery at a downtown hospital. But a follow-up embolization designed to stabilize the AVM dealt the world-class musician a severe blow to his motor skills, making it difficult to walk and impossible for him to play.
Bell was concerned with more than just a return to form. The AVM remained a time bomb with a new fuse. What do you do when you need surgery on the brain that took you to the Kimmel Center, to tours in the Americas and the Caribbean, and made you a teacher of Black History and Musicology?
Bell looked for less-invasive ways to treat the AVM. Like the melody and harmony in a song, a delicate balance must be struck between destroying the runaway vessels that threatened his life, while protecting the tissue that made his music, his memories, and his very life possible.
Temple's Gamma Knife® uses 201 intersecting beams of radiation to pinpoint lesions of the brain as small as 4mm in size.
In September 2006, Bell came to Temple University Hospital. He'd seen the Temple Lifelines show on the Temple Cancer Center, in which the benefits of Gamma Knife® surgery were profiled.
Gamma Knife® is one way to treat AVMs and other malformations of the brain, particularly when the malformation is close to areas that cannot be harmed without impairing the patient. While embolization therapy is a common treatment, Gamma Knife® surgery is the latest technique.
"Being able to provide the very best for patients is a satisfying feeling," said Curtis Miyamoto, MD, Chief of Radiation Oncology. "Now many patients who would have previously required brain surgery have the non-invasive option of the Gamma Knife® at Temple."
To successfully employ the Gamma Knife® requires a team of specialists. It begins with an oncologist and a neurosurgeon, in this case Miyamoto and Michael Weaver, MD, a neurosurgeon with experience in the use of the Gamma Knife® . They assured Bell this was the right step, and convinced him that even a December 15 treatment date wouldn't keep him from playing on December 17, his late mother's birthday--a gig he'd never missed.
The Gamma Knife® is not a knife at all, but rather an instrument that harnesses 201 cobalt-60 sources into precise beams of ionizing radiation. For AVMs, the beams are directed into the malformation, where they damage the DNA of the cells. Gamma Knife® specialists spend hours and multiple examinations ensuring that the gamma irradiation is guided to the proper target. During treatment, all 201 beams pass through hair, skin, and bone to intersect at a single point within the brain, leaving neighboring tissue unharmed. The radiation damages the tangle of vessels, forming scar tissue that eventually clogs and seals off the vessels.
Once Bell arrived at TUH, Jungyoon Ro, RN, walked him through the procedure. First, a lightweight aluminum frame was placed on his head to prevent movement during the procedure. The frame also acted as a map during the imaging process. When the goal is to leave normal tissue out of harm's way, precise brain imaging is required. The frame provides a map "around" Bell's head, labeled with precise coordinates that showed up on subsequent angiograms, MRIs or CT-Scans.
Bell's final scans provided clinicians with the remainder of the information they needed to confirm the radiation dosage and location of the malformation. The information was then locked into the computer as Bell's personal treatment plan.
Bell was treated with 17 bursts of gamma radiation. Clinicians watched him on two separate cameras while the musician listened to his music through the hour-long procedure.
Two hours after the procedure, Bell was discharged.
He will now return to Temple periodically to ensure the runaway blood vessels are shrinking. Once they are completely closed, he can return to his normal life without the fear of having another stroke from the AVM.
In fact, two days after surgery, Bell led his usual Sunday morning "gig"-- playing for a crowd at a local waterfront restaurant on Penn's Landing. Patrons, friends, and family listened to Bell's jazz quartet and were noticeably impressed when Bell revealed he was playing less than 48 hours after brain surgery.
"It wasn't just the technology that led me to Temple," he said, "but the way everyone made me feel. I knew I could trust Temple."
***
By Jordan Reese
jordanr@temple.edu
February 13, 2007
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