Brain Archives - Michigan Head & Spine Institute Blog


Dr. Richard D. Fessler

Richard D. Fessler, M.D.

Someone in the United States has a stroke every 40 seconds, and strokes are a leading cause of death and disability for Americans. One of the best ways to lower your risk of having a stroke is to know your risk factors so that you can work to reduce them. Now, innovations in healthcare and technology — like wearables such as smartwatches — are improving the way stroke victims, and those at risk for stroke, are monitored.

What Are the Main Risk Factors for Stroke?

Stroke risk factors can be divided into two categories: non-modifiable and modifiable. Non-modifiable risk factors are those that can’t be changed, such as sex and age. (Women are more likely than men to have a stroke, and your chance of having a stroke about doubles every 10 years after age 55.)

Some of the most common modifiable risk factors include health conditions such as high blood pressure, diabetes and cardiac disease. In terms of modifiable factors related to lifestyle, cigarette smoking is a big one — it doubles a person’s risk of having a stroke.

The Pitfalls of Traditional Stroke Risk Monitoring

For many people, preventive healthcare means seeing their doctor once a year for a check-up. At this appointment, a nurse checks your blood pressure and other vital signs, the doctor gives you an exam, and you’re on your way. But what if your appointment is at 8:00 a.m. and, unbeknownst to you or your doctor, your blood pressure goes up every afternoon between noon and midnight? There’s no way this stroke risk factor would be detected at your morning appointment.

Although better than nothing, this type of infrequent monitoring simply doesn’t gather enough information to be truly meaningful.

Wearable Technology Enhances Stroke Monitoring

In the same way that wearable technology such as fitness trackers and smartwatches have made it easier to track our activities, these tools can also help healthcare providers monitor risk factors for stroke around the clock. Instead of having their blood pressure checked once a year, people can have it monitored constantly, without needing to leave the house.

Wearable technology can also look for other possible stroke risk factors, such as sleep apnea, that may be affecting a patient without them realizing it — something that an annual check-up would never detect. And it can constantly monitor things like body temperature that, when elevated, may trigger a stroke. The patient’s provider has access to all of the information gathered by the wearable, and can reach out to the patient if they see anything that needs to be addressed.

Aside from the sheer quantity of health data that can be gathered by wearables to help detect stroke risk factors, their biggest advantage is convenience. All a patient needs to do is charge the device and put it on their wrist.

The Future of Stroke Prevention

The remarkable advances in healthcare technology currently happening have made it possible for us to achieve something we all want — peace of mind. Whether for yourself or older loved ones, wearables can be an invaluable tool for monitoring stroke risk, no effort required.

If you or a loved one is seeking treatment for neurosurgery, or to schedule an appointment with Dr. Fessler or any of our MHSI experts, visit or call 248-784-3667.



<div class="at-above-post-cat-page addthis_tool" data-url=""></div>Understanding some of the neurosurgery issues seniors face, including some of the most common surgeries and special considerations for this age group, can help older folks and their families determine if they’re dealing with a health issue that could be helped by surgery of the brain or spine.<!-- AddThis Advanced Settings above via filter on get_the_excerpt --><!-- AddThis Advanced Settings below via filter on get_the_excerpt --><!-- AddThis Advanced Settings generic via filter on get_the_excerpt --><!-- AddThis Share Buttons above via filter on get_the_excerpt --><!-- AddThis Share Buttons below via filter on get_the_excerpt --><div class="at-below-post-cat-page addthis_tool" data-url=""></div><!-- AddThis Share Buttons generic via filter on get_the_excerpt -->


Every year, around 2.9 million cases of traumatic brain injury (TBI) occur in the United States, and about 5.3 million Americans are currently living with a disability related to a traumatic brain injury.

Understanding traumatic brain injuries —symptoms, treatment options and how to prevent them — can help prepare you in the event you or a loved one sustain this type of injury.

What is a Traumatic Brain Injury (TBI)?

Any injury with an external cause that affects how the brain works is a traumatic brain injury, often abbreviated to TBI. These injuries are typically caused by a blow to the head — like a fall, or a car accident where the head hits the steering wheel at high speed — or a penetrating injury such as a gunshot wound.

A traumatic brain injury can be mild, moderate or severe. Fortunately, about 75 percent of traumatic brain injuries are mild. The most common type of mild traumatic brain injury is a concussion.

Symptoms of a traumatic brain injury may include:

  • Amnesia
  • Confusion
  • Trouble concentrating
  • Difficulty speaking or understanding language
  • Inappropriate expression of emotion, either laughing or crying
  • Aggression and irritability
  • Blurred vision
  • Slurred speech
  • Dilated or unequal pupils
  • Headaches
  • Ringing in the ears
  • Nausea or vomiting
  • Anxiety
  • Problems with balance

People who have suffered a traumatic brain injury may also experience symptoms of post-traumatic stress disorder (PTSD) alongside those of their injury.

It’s important for athletes, fall-prone individuals (like persons with disabilities or who are elderly) or anyone else who may be vulnerable to a traumatic brain injury to know the signs and symptoms, so they can seek care immediately upon noticing them.

Treating Traumatic Brain Injuries

Many people with TBIs — particularly mild ones such as concussion — will be first seen and treated by their primary doctor or an urgent care provider. Then, depending on the severity of the injury, they may be referred to a specialist — like a neurologist or neurosurgeon — for further evaluation and treatment.

In the case of mild traumatic brain injuries, recovery often involves rest and over-the-counter pain relievers, and can be done at home. Moderate traumatic brain injury typically requires more intensive treatment such as surgery.

What to Expect After a Traumatic Brain Injury

Most people who sustain a mild traumatic brain injury will stop having symptoms within days or weeks. However, up to 25 percent of these people may experience lingering effects such as inability to concentrate, head and neck pain, and memory issues for much longer — possibly months after the event that caused the TBI.

For the small percentage of people who do experience long-term effects after a traumatic brain injury, ongoing treatment is key. Ideally this treatment is overseen by a multidisciplinary team that includes a neurosurgeon, neurologist, and rehab doctor or physical therapist, among other specialists.

Preventing Traumatic Brain Injury

While some TBIs might be more mild or less symptomatic than others, there’s no ideal situation with traumatic brain injury. Every situation is unique and presents its own set of challenges to recovery and treatment.

So how do we prevent TBIs entirely? While you can’t prevent the type of TBIs that come from accidents like tackles on the football field or a car accident, the most powerful tool we have is knowledge. The organization ThinkFirst is an excellent source of trustworthy and comprehensive information on preventing traumatic injuries, offering tips for people of all ages on how to protect the brain.

If you or a loved one is seeking treatment for a traumatic brain injury, or to schedule an appointment with any of our MHSI experts, visit or call 248-784-3667.


Every year, about 80,000 people are treated by neurosurgeons with a tool called the Leksell Gamma Knife®, which treats small and medium-sized brain tumors.

Understanding Gamma Knife treatment, including how and when it is used, can help you determine if you may be a good candidate for this highly effective, non-invasive procedure.

Contrary to its name, the Leksell Gamma Knife® doesn’t involve a knife or blade, and the surgeon makes no incisions. The treatment is a type of radiation based on the concept of concentrating beams of radiation into a very small point. It was invented by a Swedish neurosurgeon, Professor Lars Leksell, in 1967, and is also called radiosurgery or stereotactic radiosurgery.

The Gamma Knife functions similarly to a magnifying glass that, when held up in the sun, concentrates the sun’s rays into a tiny, powerful beam. The Knife is used to deliver focused radiation to small areas of the brain in a very exact way.

Gamma Knife treatment can be used for:

  • Small to medium-sized brain tumors that arise from the brain itself
  • Malignant (cancerous) brain tumors that have spread from other parts of the body such as the breast, lung or kidney
  • Small blood vessel abnormalities such as arterio-venous malformations.

Benefits of Gamma Knife Treatment

If the Gamma Knife is like a magnifying glass, conventional radiation treatment is like being at the beach — when you get a sunburn, you get it over your whole body. And when conventional radiation is used to treat brain lesions, it also irradiates (and damages) otherwise healthy brain tissue surrounding the lesion.

Because Gamma Knife treatment uses highly focused radiation to very exact points of the brain, it minimizes damage to the brain while maximizing the positive outcomes for the patient.

What Does Gamma Knife Treatment Involve?

Gamma Knife treatment is a painless, outpatient procedure that only needs to be performed once. On average, the procedure takes around two hours.

Patients remain awake throughout the procedure and are generally able to go home and return to normal activities a few hours after treatment. Within a few months, tumors may begin to shrink. In many cases, the tumor shrivels down and disappears.

Are You Eligible for Gamma Knife Treatment?

Many brain abnormalities that can be treated with conventional radiation may also be treatable with Gamma Knife radiation, if they are small enough.

For example, a woman with a brain tumor that came from her breast could be an excellent candidate for Gamma Knife treatment, provided the tumor is less than one inch in diameter. After using an MRI to pinpoint the tumor’s location, a neurosurgeon trained to use the Gamma Knife would work with a radiation oncologist to devise a treatment plan.

Working together, the neurosurgeon and radiation oncologist would perform the Gamma Knife treatment to eventually eliminate the tumor.

If you or a loved one are dealing with a small brain tumor or other abnormality, consider reaching out to a Gamma Knife specialist who can help you determine if this noninvasive, highly effective treatment is an option for you.

If you or a loved one is seeking treatment for a brain tumor, are interested in Gamma Knife radiosurgery, or to schedule an appointment with Dr. Diaz or any of our MHSI experts, visit or call 248-784-3667.



Holly S. Gilmer, M.D.
Holly S. Gilmer, M.D.
Adult & Pediatric Neurosurgery
Peripheral Nerve Surgery

Approximately one in 1,000 people is affected by a group of brain abnormalities known as Chiari malformations. Named for Hans Chiari, the Austrian pathologist who first described them, Chiari malformations affect the brain in the place where the skull meets the spine. Brain tissue extends into the spinal canal because part of the skull is misshapen or undersized and presses the brain downward.

While it’s possible to have a Chiari malformation without knowing it, these abnormalities can cause symptoms that may affect a person’s quality of life. Understanding Chiari malformations, including potential symptoms and treatment options, can help you determine whether you might have one of these malformations.

Chiari Malformation Types and Symptoms

There are at least five types of Chiari malformations, but the most common types are Chiari I and Chiari II.  Chiari I may be congenital, or may develop over time as the brain and skull grow. The main symptom is headaches, but people may also experience:

  • Neck pain
  • Problems with balance and coordination
  • Dizziness
  • Numbness and tingling in the hands and feet
  • Trouble swallowing
  • Gagging and choking
  • Difficulty speaking clearly
  • Weakness
  • Curved spine (scoliosis)

Chiari malformation type II is congenital, meaning a person is born with it. People born with type II almost always have myelomeningocele, a type of spina bifida in which the backbone and the spinal canal don’t close properly before birth. Symptoms of type II include:

  • Difficulty breathing regularly
  • Gagging/trouble swallowing
  • Arm and leg weakness
  • Involuntary eye movements

Diagnosing Chiari Malformations  

Congenital types of Chiari malformation can often be diagnosed with an ultrasound of the unborn baby. For children and adults, the most reliable way to spot a suspected Chiari malformation is with an MRI of the brain.

Treating Chiari Malformations

Many people with Chiari malformations experience no symptoms and may not even realize they have one. Others may deal with mild or infrequent symptoms that don’t bother them or can be easily managed with over-the-counter medications like Tylenol.

For those with a Chiari malformation who’ve had symptoms for more than six months, occurring more often than not and interfering with their ability to function, surgery is an option.

Surgery to treat Chiari malformation is an inpatient procedure that requires a hospital stay of a few days. But many patients report feeling much less pain immediately after surgery and typical recovery takes about 3 – 6 weeks, but individual experiences vary.

When to See a Doctor

If you struggle with frequent headaches or other symptoms of Chiari malformation that are affecting your quality of life, consider reaching out to a specialist who can make a diagnosis. Together, you can discuss next steps, including whether you’re a good candidate for surgical treatment.

If you or a loved one is seeking treatment for Chiari malformation, or to schedule an appointment with Dr. Gilmer or any of our MHSI experts, visit or call 248-784-3667.


Although it’s relatively new, endovascular neurosurgery is being used to treat an increasing number of health problems — with remarkable results. Through research and collaboration, experts from a variety of fields are coming together to innovate a type of surgery that is helping some of the highest risk patients.

What is Endovascular Neurosurgery? 

Endovascular neurosurgery is a subspecialty of neurosurgery that combines multiple types of expertise. Incorporating both neurosurgery, which treats conditions of the brain and nervous system, and interventional radiology, which uses imaging and minimally invasive techniques to diagnose and treat injuries and health conditions, endovascular neurosurgery uses small catheters to diagnose and treat health problems affecting the brain and spinal cord.

What Conditions Endovascular Neurosurgery Treat?

Endovascular neurosurgery can be used to diagnose and treat a variety of injuries, diseases and health conditions including:

  • Strokes
  • Brain aneurysm
  • Cerebrovascular malformations including arteriovenous malformations (AVMs) and dural arteriovenous fistula (dAVF)
  • Carotid artery disease
  • Atherosclerosis (narrowing) of the vessels of the brain
  • Idiopathic intracranial hypertension (formerly pseudotumor cerebri)

This is merely a partial list of the many health concerns that can be addressed with endovascular neurosurgery — a list that will continue to grow as neurosurgeons, interventional radiologists, and interventional neurologists work together to advance the science surrounding these techniques.

What Are the Benefits of Endovascular Neurosurgery?

The blood vessels of the brain are deep within the brain itself, meaning they’re not readily accessible without open surgery. Because it involves the use of catheters to pass through blood vessels, endovascular neurosurgery is a minimally invasive technique that provides an alternative to more invasive options.

Rather than opening the skull to get into the brain, endovascular neurosurgeons often only need to make a tiny puncture to insert the catheters they use in surgery.

The minimally invasive nature of endovascular neurosurgery means that some patients who receive elective (non-emergency) types of this procedure can go home the same day.

Even in cases where recovery takes a little longer, patient outcomes are generally very good. Many people can go home within one day of surgery and are back at work within a week.

Another major benefit of endovascular neurosurgery is that it offers hope for people with diseases or conditions that would have been otherwise untreatable. These are patients who didn't have a different treatment option — or at least a good treatment option — and these endovascular techniques are allowing neurosurgeons to provide life-altering or even life-saving care for them.

Advancing Technology, Saving Lives 

Endovascular neurosurgery is an exciting field that allows surgeons to greatly improve outcomes for patients who were otherwise at the mercy of their disease.

Treatment options that weren’t available only a few decades ago are now saving people’s lives — and will continue to do so as the field grows and expands through continued collaborative research and innovation.

If you or a loved one is seeking treatment for a condition of the spine, or to schedule an appointment with any of our MHSI experts, visit or call 248-784-3667.



Migraines affect more than 10 percent of the world’s population, and migraine disease is considered to be one of the main causes of disability worldwide.

One study of people with migraine disease in the United States found that over half were unable to engage in day-to-day activities, including work or school, because of migraines.

Women are hit especially hard by migraines; migraine disease is 3 times more common in women than men, affecting around 1 in 5 American women.

Understanding migraines including how they're different from other headaches and what can trigger them and why the triggers might change may help you manage them better.

Symptoms, Phases Set Migraines Apart

Migraine is produced by chemical activity in the brain, nerves and blood vessels surrounding the skull and muscles of the head and neck.

Migraine is different from other headaches because it comes as a cluster of symptoms, and usually occurs with the same triggers and symptoms every time, though triggers can change over time, especially with hormonal changes.

Classic migraine is also unique in that it typically occurs in four phases.

During prodrome (pre-migraine) phase, you might experience:

  • Sensitivity to light, sound and smells
  • Mood changes
  • Pain and/or stiffness in the neck
  • Yawning
  • Food cravings
  • Constipation
  • Diarrhea

Aura phase, which doesn’t happen for everyone, is usually characterized by visual and sensory changes such as:

  • Seeing flashing lights and/or zigzag lines
  • Blurred vision
  • Tingling
  • Numbness
  • Slurred speech
  • Difficulty thinking or writing clearly

Headache phase is characterized by:

  • Intense pain on one or both sides of the head

Postdrome phase is the post headache phase when symptoms generally include:

  • Exhaustion
  • Confusion
  • Feeling unwell

Although not everyone with migraine disease goes through all four phases, the symptoms and phases an individual experiences tend to be the same every time. Recognizing this pattern helps people know they’re having a migraine.

Common Migraine Triggers

While not all migraines are triggered, some people find that certain factors tend to kick off a migraine for them. Common migraine triggers include:

  • Stress
  • Sleep disturbances, including a change in sleeping patterns such as sleeping late on the weekends
  • Hormone changes
  • Foods that contain a compound called tyramine (including fermented foods, certain aged cheeses, red wine, smoked foods and cured meats)
  • Changes in weather/humidity fluctuations
  • Dehydration
  • Altitude changes
  • Strong smells such as perfume
  • Medications

Another surprising (and surprisingly common) migraine trigger? Chewing gum. Up to 50 percent of people with migraine disease also have temporomandibular joint (TMJ) disorders, conditions affecting the jaw joints and surrounding muscles and ligaments that can be aggravated by gum chewing.

It’s a good idea to pay attention to your personal triggers; if you’re able to identify and avoid them when possible, you may be able to lessen the number of migraines you experience.

Why Triggers May Change Over Time

Some people — especially women — may find that their migraine triggers change as they get older, or that they experience fewer or more migraines at certain times (such as during pregnancy or menopause). This is because hormone levels fluctuate throughout a woman’s life, and hormone changes can trigger a migraine.

Other things that might cause triggers to vary over time include nutrient deficiency (such as low vitamin D levels) and thyroid problems. But you shouldn’t assume that these things are triggering your migraines without talking to a healthcare provider.

When to See a Doctor

If you notice a change in the pattern of your headaches — particularly if they become more frequent and you have them more than three times per week — it’s a good idea to talk to your doctor about an evaluation.

More concerning are headaches that occur during physical activity such as exercise or bending over, or if a headache is severe enough to wake you from sleep. If you’re awoken by a headache or suddenly develop a headache more painful than any you’ve had before, it’s an emergency and you should seek care immediately.

Other headache symptoms that necessitate emergency treatment:

  • Neck stiffness with fever and/or rash
  • Shortness of breath
  • Dizziness
  • Neurological symptoms such as loss of balance, slurred speech or paralysis on one side of your body
  • Nausea and vomiting (if severe and you’ve never had it with a headache before)

In general, it’s better to be safe than sorry when it comes to headaches, so don’t hesitate to reach out to your doctor if you’re concerned.

If you or a loved one is seeking treatment for a condition of the brain, or to schedule an appointment with any of our MHSI experts, visit or call 248-784-3667.



Dr. John Steele
John J. Steele, M.D., Ph.D.

Knowing the signs and symptoms of a stroke, and what to do when you spot them, may save someone’s life. The acronym, BEFAST, can help.

Catching Stroke Quickly Increases Chances of Survival

In the last three decades, medicine has made huge strides in stroke management — but the window of treatment is very narrow.

A stroke can get very bad, very quickly, meaning you have a limited amount of time to respond if you hope to have a good outcome.

In most cases, stroke can be treated with either medical or surgical therapy. But stroke remains the fifth leading cause of death and the number one cause of loss of independence, which is why it’s so important that people know the signs and act quickly.

Because of this, experts created the acronym BEFAST to help people remember and recognize the most common stroke symptoms.

  • Balance problems, dizziness, and/or loss of coordination
  • Eye trouble, including blurred vision and difficulty seeing out of one or both eyes
  • Facial drooping or numbness on one side of the face
  • Arm weakness or numbness on one side
  • Speech difficulty, including stuttering and/or slurred speech
  • Time to call 911 if a person shows any of these symptoms, even if they go away

Even with an acronym to remind you of stroke symptoms, you might not recognize the signs right away. It may be helpful to focus on the physical signs; if someone is unable to speak, has a facial droop or can’t move one side of their body, or if their hand flops down when you raise it, there’s a good chance that person is having a stroke.

The Importance of Comprehensive Stroke Treatment

Once you’ve identified signs of a stroke using BEFAST, it’s time to get help.

When you call 911, request that the person be taken to a comprehensive stroke center to ensure the most accurate diagnosis and best possible treatment.

The most crucial step when it comes to diagnosing a stroke is getting an image of the brain with a CT or CAT scan to determine the cause and type of stroke. Ideally, imaging will be followed by a more comprehensive evaluation using the stroke scale developed by the National Institutes of Health (NIH). This 42-point evaluation goes far beyond BEFAST, allowing healthcare providers to learn details about a stroke that help them determine how best to treat it.

Managing Expectations About Stroke Treatment and Recovery

How effectively a stroke can be treated, and how well a person recovers, depend largely on how early the stroke is diagnosed; the earlier the stroke is detected, the better the outcome is likely to be. When blood flow to the brain is blocked, which is what happens during a stroke, there’s going to be a certain amount of damage even after normal blood flow is restored.

This means stroke patients who have been successfully treated can still experience effects such as weakness on one side of the body or problems with speech, but often will recover to the point of independence. Recovery from a stroke usually takes between three and six months, but is highly dependent on the extent of the stroke.

Even better than catching a stroke early is not having one at all. Preventive measures such as maintaining a healthy weight and keeping blood pressure and cholesterol in check can go a long way in keeping your heart healthy and reducing your risk of stroke.


If you or a loved one is seeking treatment for a condition of the brain, or to schedule an appointment with Dr. Steele or any of our MHSI experts, visit or call 248-784-3667.



Dr. John Whapham
John Whapham, M.D., MS, FSNIS, FAAN

Surgery has always been an option for certain types of intracranial cerebral aneurysms, but in recent years, minimally invasive procedures have greatly reduced both physical trauma as well as recovery times.

Cerebral aneurysms occur when part of a blood vessel wall weakens, allowing it to bulge, widen and potentially burst or rupture, which can be life-threatening.

Aneurysms can exist for years without detection. Because of this, there are often no symptoms until an aneurysm ruptures. Once that happens, symptoms may develop suddenly and violently, depending on the location of the aneurysm.

Usually, symptoms come on quickly and are unlike anything you might have experienced before. If you don’t often get headaches but suddenly experience an intense migraine, a ruptured brain aneurysm could be the culprit.

Call 911 and seek immediate medical attention if you or someone you know is having aneurysm signs and symptoms including:

  • Severe headache
  • worst headache of life
  • Stiffness or swelling in the neck
  • loss of consciousness
  • speech difficulty
  • focal motor or sensory symptoms weakness or numbness
  • Dizziness
  • Vision changes
  • Confusion
  • Hoarseness
  • Difficulty swallowing
  • Nausea and vomiting
  • Shock (low blood pressure, rapid heart rate, clammy skin, decreased awareness)

Sometimes an unruptured aneurysm is found when performing unrelated diagnostic testing such as MRIs or CAT scans.

Minimally Invasive Aneurysm Surgery Saves Lives

Aneurysm treatment has greatly improved in the last 25 to 30 years. In the past, major surgery, such as open craniotomy, was commonplace. In this procedure, a small metal clip is placed across the base of the aneurysm bulge that seals off blood flow to the ballooned blood vessel.

However, modern advances have made this major procedure less common.

These days, minimally invasive procedures such as coiling and stenting are the norm. Both divert the flow of blood away from the aneurysm making it less likely to rupture and are performed without opening the skull.

  • Coiling, also called endovascular embolization, uses a catheter passed through the groin up into the artery containing the aneurysm where tiny platinum coils are released. The coils induce clotting of the aneurysm and that clotting prevents blood from entering the aneurysm.
  • Stenting is when a catheter is used to place a stent (a soft, flexible mesh tube) into the blood vessel where an aneurysm has formed. The stent prevents blood from entering the aneurysm. In time, new cells grow on the stent, sealing the aneurysm and healing the vessel.

These minimally invasive procedures allow for a much shorter recovery period, and it is possible to return to daily living as early as one day after hospital discharge.

In fact, some patients with an unruptured aneurysm check in at the hospital, undergo a procedure that is finished in a couple of hours, stay overnight for observation and are discharged the next morning with only a small bandage covering the spot in the groin or wrist where the needle access was made.

Quick Treatment Is Key

It’s crucial to contact first responders at the first sign of an intense, sudden headache since that may indicate a ruptured aneurysm.

If you are diagnosed with an unruptured aneurysm, call us right away to make an appointment.

Depending on the aneurysm’s size and location, you may require regular checkups from a physician trained in aneurysm treatment and surgery. A treatment plan, including lowering your blood pressure, quitting smoking and medical intervention, can help you reduce the risk of rupture.


If you or a loved one is seeking treatment for a condition of the brain, or to schedule an appointment with Dr. Whapham or any of our MHSI experts, visit or call 248-784-3667.


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