Local surgeon performs new procedure

The key to medical advancement is not only the invention and discovery of new methods but also the skilled physician who is willing to learn and enter the latest frontiers of medicine.

Onyx, a liquid embolic material, is one of those new discoveries available for patients with cerebral aneurysms, classified as “wide-neck.” George Rappard M.D., a neuroendovascular surgeon from La Cañada Flintridge, performed the first aneurysm embolization surgery using Onyx in California on Sept. 23 at Glendale Adventist Medical Center.

The Food and Drug Administration only recently approved the treatment and just 25 hospitals in the United States have used this new method. About 60-70 brain surgeries are performed each year at Rappard’s clinic, the Los Angeles Brain and Spine Institute in Glendale. Due to this volume of work, and Rappard’s mission to bring new technology to a wider group of patients, he was approved to perform this new surgery using Onyx.

Rappard grew up in La Cañada, attending La Cañada Elementary School, graduating La Cañada High School in 1984 and then serving in the military. After his tour of duty he went to Pasadena City College, then to UCLA and George Washington University in Washington, D.C.

He moved back to La Cañada with his family where his children now attend Palm Crest Elementary.

He wasn’t always certain what field of medicine he wanted to practice, but after learning more about the brain, he was hooked.

“I thought the brain was fascinating,” Rappard said. “But I wasn’t really attracted to drilling into the head.”

The brain is a delicate organ, therefore the surgeries performed on it should be equally as delicate, Rappard said.

Cerebral aneurysms are vascular abnormalities in the brain that are characterized by a bulge in the wall of a blood vessel that can balloon out and rupture.

“When [aneurysms] rupture and bleed it can be catastrophic,” Rappard said. “The risk of death is 50% and the risk of severe disability is 70%.”

His recent surgery using Oynx was the type of technology he looks for in his practice. His patient suffered from a cerebral aneurysm. In the past, her surgery would have required months of recovery time.

“She left the hospital [the day] after her surgery,” Rappard said.

Rappard said 2% of the American population is affected by a brain aneurysm. According to a report by the University of Maryland Medical Center, “wide neck” aneurysms make up about 25% of the people with brain aneurysms.

In the past, the treatment had been a surgery where coils were inserted through a small catheter passed through the blood vessels of the brain.

“They came up with this [surgery] in the 1990s where we would take a little catheter and run it from the groin to the brain,” Rappard said. “[Onyx] is less evasive.”

The surgery takes a few hours and is done under general anesthesia.

The Onyx liquid is injected through a catheter into the blood vessels at the location of the abnormal vessels. And, much like a caulking material, it fills the aneurysm and solidifies to block the flow of blood to the damaged vessels.

“What is marvelous about this is that we can completely fill the aneurysm,” Rappard said. “But it is still brain surgery.”

He added that the field he has chosen has some of the most technically advanced discoveries in medicine, but that many times those advancements are not available for the general population.

“A lot of times [patients] have to go to a university hospital to have access to cutting edge [discoveries],” said Rappard. “UCLA hasn’t been trained in this [procedure] yet.”

His goal since opening his clinic in 2004 has been to reach out to the general population to give them the most advanced treatments available. When he returned to California from Washington, D.C. he discovered that patients had few choices in advanced facilities.

“We got very busy and tried to capture all the patients that couldn’t make it to a university,” he said.

The result was a busy practice and the chance to use new innovations in medicine.

The patient he operated on last month is recovering and Rappard is looking forward to being able to offer the procedure more patients in need of this type of treatment.

“I have trailed a lot of devices,” Rappard said. “This is a knock-your-socks-off [procedure].”