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Every year neurosurgeons advance the procedures performed to treat brain and spine conditions. Just a few short years ago minimally invasive surgery of any type was unheard of. Yet today, an incision of less than 2 inches allows a neurosurgeon to fix or replace a disc in the neck or spine.

Minimally invasive nasal endoscopy is yet another advancement to treat tumors of the brain. This approach allows the neurosurgeon to access the brain to remove a tumor without performing a craniotomy, which makes a “window” in the bone to allow access to the brain.

Dr. Jeffrey T. Jacob — Jeffrey T. Jacob, M.D. Neurosurgeon

Deciding between a craniotomy or using the nasal cavity to reach the brain, depends on what is best for the patient. “The goal is to be able to reach the tumor and remove all of it,” says Jeffrey Jacob, M.D. “Often, we are able to do that going through the nose with an endoscope, with a very small camera device.”

There are many types of brain tumors that can be treated with this approach. Brain tumors that are removed using the nasal endoscopic approach can be benign or malignant, and typically sit at the base of the skull or under the brain. This procedure removes the tumor and the blood supply to the tumor.

To perform a nasal endoscopy, Dr. Jacob partners with Adam Folbe, M.D., a rhinologist and endoscopic skull base surgeon at Michigan Sinus and Skull Base Center. Dr. Folbe goes through the nose and opens the window to the brain. He says, “There is no cutting of skin, muscle or fat resulting in no scars. Using this approach maximizes retrieval of the tumor with lesser disruption to the brain compared to the craniotomy approach.”

Patients who experience this approach have no signs of surgery on the outside of their body, because the nasal cavity is repaired with the patient’s own tissue, without stitches or sutures. During the post-surgical healing, patients are restricted from sneezing, blowing their nose, lifting and bending over for about three weeks.

Like any surgery, there can be side effects, like in Valerie’s case. Because of the location of her tumor, she lost her ability to smell. For Stephen, he experienced added restrictions as he waited for his vision to return to normal once the tumor was removed. Kevin didn’t experience difficulties after his surgery, but he did work hard to regain his strength and balance.

If you or a loved one is diagnosed with a brain tumor, consider all of your options and seek a second opinion. Like Valerie, you might find an option you didn’t expect.

Watch Stephen’s brain tumor story below:

Watch how a large pituitary tumor interrupted Kevin’s life:

Watch Valerie’s full story below:

To schedule an appointment with Dr. Jacob or any of the neurosurgeons at MHSI, call 248-784-3667 or visit MHSI.us

September marks another effort to raise awareness about Chiari malformation. Chiari malformation is a disease of the brain where brain tissue is pushed down into the spinal canal. It occurs when the base of the skull is abnormally small or misshapen, causing pressure on the brain which forces it downward. Chiari malformation may cause blockage in the flow of the cerebrospinal fluid, which may cause the normal fluid spaces in the brain to enlarge, also known as hydrocephalus.

It was estimated that the condition occurs in about one in every 1,000 births. However, the increased use of diagnostic imaging has shown that Chiari malformation may be much more common. Complicating this estimation is the fact that some children who are born with the condition may not show symptoms until adolescence or adulthood, if ever. It can also be hereditary, and often those with Chiari will recall a family member with the same symptoms. Family members such as siblings Ezra and Katelyn, and mother Tammy and daughter Sheena.

Watch Ezra and Katelyn’s journey with Chiari below:

Chiari Malformation Corrected for Mother Tina and Daughter Sheena:

Adults and children alike can go through life and from doctor to doctor, with severe symptoms and are not diagnosed until an aware physician recognizes the symptoms. Patients Tina, Lu Anna and Tyler each had a physician acknowledge their symptoms and refer them to the leading expert in Chiari decompression, Neurosurgeon Dr. Holly Gilmer.

To learn more about Chiari malformation, the symptoms, and treatments, click here.

For most patients, the diagnosis is elusive for many years until the patient meets a doctor who is aware of Chiari, and understands the symptoms presented can become more manageable with surgery. One of the goals of Conquer Chiari Walk Across America is to raise awareness and funds to support further research. At this event, patients, their families and friends, along with doctors join in to walk to raise funds every third and fourth Saturday in September.

Click the graphic below to download the flyer:

If you or a loved one is experiencing symptoms of Chiari malformation, call 248-784-3667 or visit MHSI.us to schedule an appointment with Dr. Gilmer.

It doesn’t get much more serious than being given the diagnosis that you have a brain tumor. Though brain cancer is rare and may be a life-threatening situation when detected, many forms of tumors can be successfully treated.

A brain tumor is a collection, or mass, of abnormal cells growing in, or next to the brain. But, what are the different types of brain tumors, and what are the symptoms to look out for?

Brain Tumor Symptoms
There are so many different types of brain tumors, and because each is so complex, brain tumors can cause different effects for each person. Physical problems and behavioral changes can occur throughout the body severely impacting one's life. The symptoms will depend on the individual's particular tumor, its location, and can result in:

Drowsiness
Personality changes
Confusion
Impulsiveness
Blurred vision
Balance problems
Headaches
Nausea
Vomiting
Seizures

Types of Treatable Brain Tumors
Though there are many different types, a brain tumor is classified by where it was originally formed. If it originated in the brain, it’s called a primary tumor and can be either noncancerous (benign), or cancerous (malignant). A tumor that originates in another part of the body and travels to the brain is called a meta tumor, and they are always cancerous.

Metastatic Brain Tumors - Also known as secondary tumors, they originate outside of the brain in another part of the body and then spread to the brain.

Meningiomas - Originating in the meninges, these thin layers of protective tissues surround the brain and spinal cord. Meningiomas usually grow slowly and most are not cancerous.

Pituitary Tumors - Found just under the brain, the pea-sized pituitary gland makes hormones that affect many of the body’s functions. A pituitary tumor can cause it to release too much, or too little, of these hormones which can cause serious problems.

Glioblastoma Multiforme - These are the most challenging forms of brain tumors to treat. MHSI physicians have access to the most current technology to deal with this cancer including image-guided surgical treatments.

Schwannoma - The most common type of benign peripheral nerve tumor in adults and rarely cancerous. When schwannoma grows larger, it can make removal more difficult. This type of nerve tumor can occur in any part of the body, and at any age.

Keith’s Brain Tumor Story
Before Keith, a patient at Michigan Head and Spine Institute, was diagnosed with his brain tumor he was an accomplished musician hoping for a big break.

“I got my first guitar when I was 12. It’s what calms me. It’s where I can focus on one thing and the thousand thoughts going on in my head will go away.”

But, that was all about to change when he started experiencing unexplained health problems and physical ailments.

“The first symptoms I had were the nausea, dizziness and headaches,” he said, “It got to the point where I couldn’t eat. The only thing that was staying down was water.”

Knowing something was wrong with his health, he went to an emergency room hoping it was just an ear infection. After undergoing some tests, his ER doctor came back with unsettling information.

“A brain tumor was not on my list.” - Keith, a patient at MHSI

Diagnosed with a sporadic case of hemangioblastoma, a benign tumor, Keith was seen by Michigan Head and Spine Institute, trusted experts for treatment and diagnosis of tumors, diseases and other conditions of the brain.

After reviewing his CT scan, it was confirmed Keith had a large mass at the back part of the head in the region of the cerebellum. This part of the brain also contributes to coordination.

“I just wanted it to stop hurting, to stop feeling sick,” Keith recalled.

While being prepped for surgery he also remembered the last thing he told the anesthesiologist, “I said, ‘I’m a musician.’ When I came back out, I still wanted to be a musician.”

Keith’s surgery was successful. He then underwent a second nonsurgical procedure called Gamma knife treatment to remove the last bit of his tumor.

“When I woke up after the surgery, I knew it was fixed. The pain I was having before was gone,” he said relieved, “I like the way my doctor had a very confident way about himself.”

As for Keith’s guitar playing and music career after his surgery at MHSI:

“I’ve been in a few bands, had a little stardom,” he updated, “I’ve met a lot of people in the industry since the surgery that say they’re going to help me, so we’ll see what happens.”

To learn more about conditions of the brain and brain tumor procedures, please visit our MHSI Patient Education page at: Conditions of the Brain.

If you or a loved one is seeking treatment for a condition of the brain, or are seeking a second opinion on an existing diagnosis, schedule an appointment online or contact MHSI at 248-784-3667.

To view more information about MHSI’s neurosurgeons, visit: https://www.mhsi.com/doctors/neurosurgery-physicians/. For more information about MHSI’s neurologists, visit: https://www.mhsi.com/doctors/neurologists/

The Importance of Getting a Second Opinion and Gaining Peace of Mind
If your body is telling you one thing, and your physician another, it may be time to seek a second opinion regarding surgery or treatment. When uncertain of an original diagnosis, or continuing to experience pain or discomfort – a second opinion can allow you to take control of your health and put your mind at rest.

Why Should You Get a Second Opinion?
The Mayo Clinic conducted a study of 286 patients that found as many as 88% of the people seeking a second opinion will leave a physicianʼs office with a new or redefined diagnosis. Of those patients, 21% will leave with a “distinctly different” diagnosis. Whereas only 12% will learn that the original diagnosis was correct. These results showed that one out of every five patients was incorrectly diagnosed.*

Percentages such as these prove the importance of looking for a second opinion when necessary, and that patients should follow to their instincts.

When You Should Get a Second Opinion?
If you are not getting the answers that help you make an informed decision regarding a surgical procedure, or treatment option, you should ask more questions of your doctor. Ask yourself if pursuing the diagnosis will have lifelong consequences to your lifestyle and wellbeing. Would it be invasive or a risk to your quality of life? Focus on chronic and serious conditions when questioning treatment outcomes, and when inquiring about exploring other treatment options.

A physician should accept and respect your wishes for seeking a second opinion. They can also assist by offering referrals, and providing all of your medical records and test results. This will help your physician to communicate with the second physician, if needed.

Watch Valerie’s full story below:

Angela’s Second Opinion Story
“I was hit by a drunk driver, and immediately had this pain down my arm and wrist,” Angela said.

She’d gone to her primary care physician who diagnosed her injury as a pulled muscle from the seat belt. After seeing a chiropractor, and a neurologist, her pain still continued to worsen. Frustrated, Angela knew she required a second opinion.

“I was devastated and couldn’t do this anymore,” she explained, “My husband said to phone our insurance company and have them recommend another doctor for me, or we were going to find one.”

Angela’s insurance adjuster gave her the phone number for Michigan Head and Spine Institute.

“From the very first appointment I had a new diagnosis, a plan of action and was set up with a physician for pain management,” Angela said, finally relieved, “This doctor literally saved my life. Between his pain management and conservative treatment, Michigan Head and Spine Institute went above and beyond.”

Watch Angela’s full story below:

How a Patient Can Get a Second Opinion

Patients have rights – you have the right to a second opinion. MHSIʼs multidisciplinary team can offer further knowledge and peace of mind for a brain, neck or spine diagnosis or surgery. If you, or a loved one, need more information about getting a second opinion contact Michigan Head and Spine Institute at 248-784-3667 or visit MHSI.us to schedule an appointment.

Immediate Telehealth Appointments Available.

*Mayo Clinic, 2017. Journal of Evaluation in Clinical Practice

Michigan Head & Spine offers Telehealth appointments through Zoom Cloud Meetings. The following tips will help you prepare for a Telehealth visit.

Schedule an appointment
Your appointment can be scheduled through the office where you see your MHSI provider. On the day of your appointment you will receive a Zoom link and passcode. If you need to reschedule your appointment, please contact us within 24 hours of the appointment via the patient portal or by calling 248-784-3667.

Find the right location
Find a quiet place to communicate with your physician. Make sure this is a location where you won’t be disturbed by others coming into the room or background noises like the television, radio, pets, or noisy appliances. Be sure to have plenty of space around you – you may be asked to move around during your appointment so your physician can see your movements. DO NOT hold your Telehealth visit while you are driving or sitting in a vehicle – MHSI will reschedule your appointment as a result. Make sure there is plenty of light in the space where you hold the meeting so your provider can see you clearly.

Prepare your personal details
Come prepared to discuss your medical history or any pre-existing conditions you have. Be sure to mention any symptoms you may be experiencing since your last appointment. Check your prescriptions so you can discuss refills if they are needed. And, be sure to write down any questions or concerns you may have so you don’t forget to ask during the appointment.

Set up technology
Telehealth appointments require an internet-connected device and use of a video source from a smartphone, computer with camera, or tablet. Make sure that your equipment is fully charged or plugged in and reliably connected to the internet before your appointment. Headphones or earbuds provide the best sound quality and can help reduce feedback or background noise.

Our virtual appointments are available through the Zoom Cloud Meeting application. Be sure that you have downloaded the most current program from the App store for your phone, tablet or computer. The application is free to download.

Test your software in advance of your scheduled appointment by visiting the Zoom website at https//zoom.us/test.

Get connected
Be sure to be connected to the internet and locate the meeting link. Follow these steps to connect:

Click the Zoom link in the email or text to launch the Zoom application.
Enter the Meeting ID and Passcode from the email appointment to join the meeting.
You will see a preview window and a button that states “Join with Video,” click the button to begin.
You may be asked by Zoom to allow permissions or enable video and audio.
Join the audio by selecting “Call via device audio” or “Call via internet”
Please be patient with your provider if they do not arrive precisely at the appointment time.

For more assistance a short video on How to Join a Zoom Meeting can be viewed here.

We will try to assist you in getting connected the best we can – but we cannot provide IT support. Please have assistance available with you at your appointment time if you have difficulties connecting. If you are unable to get connected, your appointment may be rescheduled.

Click here to download our connection tips sheet and keep it for future reference during your scheduled appointment.

Michigan Head & Spine Institute extends congratulations to our own Richard D. Fessler, M.D., who has been named The Detroit Medical Center’s (DMC) Specialist-In-Chief of Neurosurgery. In addition to continuing to treat patients at MHSI, Dr. Fessler will provide medical direction and leadership for the DMC’s Department of Neurosurgery assisting in the growth of the program as well as serving as Chief of Neurosurgery at DMC Detroit Receiving Hospital. The DMC’s CEO has stated that Dr. Fessler will be integral in the efforts to build upon the program’s rich history and tradition of providing the community with advanced, high quality and compassionate care.

Dr. Fessler is one of the founding partners of MHSI where he treats complex vascular abnormalities of the brain, neck and spinal cord for the treatment of aneurysms, carotid artery disease and stroke. He has been named an HOUR Detroit Top Doc for more than 12 consecutive years.

Dr. Fessler has been affiliated with the DMC over the years. He formerly served as Chairman of the Department of Surgery at Ascension St. John Hospital in Detroit and as the Medical Director of the health system’s Stroke Network and Telemedicine Program. He is responsible for creating several statewide programs offering state-of-the-art care to stroke and aneurysm patients. Prior to joining Ascension, he served as Vice-Chairman of the Department of Neurosurgery at William Beaumont Hospital in Royal Oak.

For more details about Dr. Fessler, read his profile page on the MHSI website by clicking here.

A subspecialty of neurosurgery and neurology, a neuroendovascular specialist surgically treats complex brain and spinal cord vascular lesions from inside the blood vessels using minimally invasive techniques.

The goal of an endovascular procedure is to keep blood flowing through the blood vessels or to prevent a blood vessel from bursting. Catheters (small hollow tubes) and very small devices, some no thicker than a strand of hair, are used to fill the space in the vessel and seal it. This helps prevent blood flow and the potential for the blood vessel to burst. In some situations, to keep the blood flowing and relieve pressure on the vessel a stent or flow diverter is inserted.

A special x-ray called angiography is performed in a special procedure room at the hospital. This helps the neuroendovascular specialist determine where the blood flow is restricted in the vessel, where the vessel is bulging or tangled and preventing proper blood flow. Angiography is also used to guide the catheters through the vessels from the groin to the treatment area where the repair is made during a minimally invasive procedure.

Rarely does a patient have the option to choose a neuroendovascular specialist. The treatment for conditions like an ischemic or hemorrhagic stroke or an impending rupture that can occur with a brain aneurysm or an arteriovenous malformation or AVM in the brain or spine begin in the emergency department.

It is comforting to know that MHSI’s Richard Fessler, M.D., is the area’s leading neuroendovascular specialist. In fact, he was one of the first neurosurgeons to bring this specialty to metro Detroit. He also trains other neurosurgeons with this subspecialty, including Neurosurgeon John Steele, M.D.

MHSI neurosurgeons and interventional neurologists are on staff at all the southeastern Michigan health systems, and are on-call in all the major emergency departments to treat conditions requiring neuroendovascular procedures and neurosurgical cases.

Watch Heather's, Duane's and LaMonte's stories in their own words:

Downriver Communities Now Have Neurosurgery Expertise

When looking for a neurosurgeon, you want someone you can trust with head, neck and spine conditions. Someone who has expertise with a good reputation. Someone close to home.

MHSI opened a new office, conveniently located on the campus of Beaumont Hospital, Trenton. Staffed by neurosurgeons Ratnesh Mehra, D.O., Pradeep Setty, D.O. and Jeffrey Jacob, M.D., we offer the caliber of care and treatment you expect, only closer to home.

Neurosurgery is delicate, and you want the best, most experienced surgeons. The team at MHSI – Trenton has a complex set of skills including minimally invasive and robotic surgery, superior knowledge of brain tumors, and leading-edge experience with skull base and spine surgery.

Patients have long traveled to MHSI to be seen by specialists who provide the full spectrum of care for head, neck and spine conditions, because we provide a range of treatment and diagnosis options that are unparalleled in Southeast Michigan. And with the new Trenton office so close to home, receiving our care just got easier.

This is our tenth location and our first Downriver. Opening another office cements our mission to you: Provide the best, most experienced care. Spine, neck and head conditions are complex, and you want the best surgeon. With the team at MHSI working for you, helping you make the best decisions for your health, you know you have the professionals you want on your side.

The new location on Fort Street, on the campus of Beaumont Hospital, Trenton, opens up conveniences for patients as well. Imaging, testing, therapies and more are within arm’s length at the hospital, while the doctors you trust are right there with you.

We are accepting new patients, seeing post-op patients and continuing to provide care for those in the follow-up stage of care. You can call 248-784-3667 for an appointment, or request one online.

Expertise makes a difference, and the difference is MHSI.

Several months ago we shared how the Michigan Legislature had passed sweeping changes to the Michigan No-Fault Insurance Law and the Michigan Insurance Code – known as SB1. A “trailer bill,” HB4397 was passed on by the Michigan House and Senate that included some modifications, which was signed into law on June 11, 2019.

These changes take effect on July 1, 2020. It requires you to consider the level of personal Injury Protection (PIP) coverage should you be in an auto accident. The default amount caps at $250,000. It also removes lifetime medical benefits, should they be needed.

While on the surface a reduced auto insurance payment sounds great to all of us, but what is the level of risk you are willing to take? Here’s a guide of cost savings to help you make an educated decision:

$0 personal injury protection (a 100% savings on the PIP coverage but risks having no medical care as a result of an auto accident).
$50,000 of personal injury protection, plus $200,000 for immediate trauma care (a 45% savings for those who opt out of PIP).
$250,000 of personal injury protection (a 20% savings for those who opt out of PIP).
$500,000 of personal injury protection (a 10% savings for those who opt out of PIP).
Unlimited personal injury protection (Insurers are mandated to offer it).

Also To Consider:

Does the cost of purchasing added PIP coverage outweigh the cost of an ambulance ride which can cost between $500 into the thousands depending on the care rendered? An emergency room visit or surgery could be thousands of dollars depending on the nature of the injury and care provided. If rehabilitation or physical therapy is needed, depending on the type and length of time could be a lifetime financial burden on a family.

With the new cap levels, if you hit someone who has the lowest amount of mandatory liability insurance of $50,000 in Michigan, and you have selected a lower PIP cap amount, medical bills can mount up with no insurance available to pay for it. That leaves Michigan drivers dangerously medically and financially exposed.

If you think your medical insurance will cover the cost of care from an auto accident, you might be wrong! Be sure to talk with your health insurance company or employer representative about how to coordinate medical benefits with your auto insurance PIP coverage.

As of July 1, Michigan becomes a Tort state. What that means is that without additional liability coverage on your auto insurance policy, if you are found to be 51% at fault the other individual in the auto accident has the right to sue you personally for their financial losses related to the accident. What Michiganders have come to think of as a ‘No Fault State’ has changed and put the burden of liability on the auto owner.

Why Are We Sharing This Information?

The changes to the Michigan No-Fault law are many and very complex. This is new territory for insurance companies, and we believe the impact of this change is not clearly understood by legislators, yet it’s now law.

We treat many patients who were injured in an auto accident. We know the physical damage an auto accident can cause. We know how it changes our patient’s lives. Adding a financial burden on top of physical injuries may severely impact those involved in an auto accident.

Under this new legislation, you may be sued and held financially liable for medical expenses, if you are held responsible for the accident and the person (s) involved in the accident should they reach the cap of their medical coverage. It is important to protect your family and financial assets should you or a child be in an auto accident, regardless of who is at fault.

We are physicians, not lawyers or insurance agents. We want our patients to be informed about the potential of health and financial consequences as a result of changes to the Michigan No-Fault Auto Insurance. We can’t advise what is right option for you, we suggest to at least have a conversation with your auto insurance provider to learn your options.

Republished from the Grosse Pointe News (Written by GPN Staff – March 19, 2020)

5:30 a.m. David Wegener made his first cup of coffee. Then strange things started happening. He dropped his cup on his desk. He tried to send a text, but couldn’t quite hit the letters. He told his wife he might need to go to the doctor, but it never occurred to him he might be having a stroke.

He went on to his tile shop to get his crew ready for the day. With a little numbness and weakness in his right hand, he decided to go to the Ascension Providence Rochester ER.

His initial neurological exam didn’t indicate a stroke. But a CT scan did in fact show a blocked artery to his brain. The ER immediately sent the scan to neurosurgeon Richard Fessler, M.D., FAANS, FACS. Using specialized software, Dr. Fessler could determine the right treatment for the stroke within two minutes.

Life-saving treatment. David was transferred immediately to Ascension St. John Hospital, a Comprehensive Stroke Center and a Level 1 Trauma Center, where Dr. Fessler had a team waiting. David went straight into a minimally invasive stroke procedure that saved his life.

David Wegener now makes healthy living a priority after receiving lifesaving stroke treatment at Ascension Providence Rochester ER. Courtesy photo

Ascension Michigan specializes in acute stroke care, with the busiest stroke care system in Michigan and the only system in the state using the advanced imaging software.

“Timing is critical in treating stroke and I could see Mr. Wegener didn’t yet have permanent damage,” said Dr. Fessler. “We were able to dissolve a potentially disabling blood clot by injecting medication into his artery. He got better while he was still on the table.”

Care with compassion. “The entire team that cared for me was wonderful,” said David, “from the people who transferred me to the nurses who answered all my questions. They really listened to me.”

David went home in a few days with none of the typical aftereffects of stroke. The week after, reality sank in.

“I realized I could’ve died,” he said. “I dodged a bullet.”

With his own business and three daughters in college, David acknowledges he has a lot to live for. And he’s committed to putting his health first. His new priorities: losing weight, increasing physical activity and reducing stress.

“The changes I’ve needed to make in my life, I used to put them in pencil,” he said. “Now they’re in ink.”

Check in for any Ascension emergency room at GetAscensionMichiganCare.com.

Remember: If you’re having a serious emergency, get to the nearest emergency room or call 9-1-1.

To learn more about stroke and stroke symptoms, click here to visit our information page. To schedule an appointment with a MHSI expert, visit our website at www.mhsi.us.

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