Carl Maronich (Host): This is the FirstHealth and Wellness Podcast. I'm your host, Carl Maronich. And joining me today is Dr. Ryan Hess, neurosurgeon at FirstHealth of the Carolinas. And we're going to be talking about the future of neurosurgery and neuroregenerative medicine, how emerging science and technology are transforming the way we understand, treat, and even repair the brain and the nervous system. Doctor, welcome to the podcast.

Dr. Ryan Hess: Thank you very much, Carl. I really appreciate the time.

Host: Yeah. Well, a lot of exciting stuff here, so let's get right into it. And when people think of neurosurgery, they probably mostly think about the removal of tumors or repairing injuries. How would you describe modern neurosurgery and what it looks like today?

Dr. Ryan Hess: Yeah. So, we still do a lot of that. We do a lot of brain tumor removals and do a lot of spine work as well, you know, decompressing the nerves, infusions and those sort of things. And so, I feel like a lot of what we've been doing in the past and what we're doing to some degree now is, you know, addressing the problem that's there, but we don't repair any of the damage. And so, I think as things are going forward in the future, as technology's getting better, we're actually having the ability to repair the damage that was there either before the surgery or as a result of the surgery. And I think that is really a paradigm shift in our field.

Host: Yeah. You look like a relatively young man. But so far in the time you've been in medicine, what are some of the biggest changes you've seen in regard to neurosurgery and the topic of neuroregenerative medicine?

Dr. Ryan Hess: Yeah. Those are great questions. And so, I think, one is this idea of precision medicine, the idea of using specific gene mutations and things of that nature to properly identify and diagnose different sorts of brain tumors and then treat them more accurately. So instead of taking a shotgun approach and just sort of killing everything that's there, you can take a more targeted approach like a sniper rifle and target specific gene sequences, protecting the normal structures around it.

So, I think that's been a really big paradigm shift for brain tumor surgery. I think, in general, this idea of what we call like enabling technologies are really, really important. So, things like robotics and what's called neuronavigation, which is kind of, you know, using image guidance, so you can kind of see where your tools are in real time as you're doing surgery. That greatly reduces you know, surgical time, reduces complications, and has actually made, you know, neurosurgery extremely safe nowadays.

And then, I think this idea of neuroregeneration is really going to be big in the next five to 10 years where we're starting to be able to do things like brain computer interface, stem cell, and other stimulation-based therapies to actually repair damaged tissue or even fix genetic conditions in the brain and the spinal cord. So, it's going to be really, really awesome to help people regain function in the next few years here.

Host: That ability to pinpoint and really focus on where the issues are, I'm guessing also helps in recovery time for the patient.

Dr. Ryan Hess: Being able to do minimally invasive procedures from a neurosurgery standpoint now, whether it's in the spine or in the brain, is really, really reducing length of stay making people recover a lot faster. And that's all really, really important when you get down to economics of what we do, where you know, we all know that there's a cost crisis in the US healthcare system. And so, as we start to develop these minimally invasive techniques, people are able to leave same day or next day, and that greatly reduces the cost that they're going to bear.

Host: Let's go back to neuroregenerative medicine for a moment. And the name implies a regeneration. That a component of what happens through that type of procedure?

Dr. Ryan Hess: Yes, exactly. So, I use the term neuroregeneration just sort of, kind of—it's like an umbrella term to describe any sort of procedure or technology that allows people to recover function of some sort. There are some therapies that offer true regeneration, like stem cells, which help people kind of regrow some of the cells in their brain that have been damaged from a stroke or something like that.

There's gene therapy, which helps to activate or deactivate certain genes to either speed up the regeneration process or fix underlying genetic problems that have led to certain things like Alzheimer's or Parkinson's or something like that.

And then, finally, there's like these stimulation-based therapies that essentially help increase the brain's normal ability to repair itself or help people rewire around damaged areas. And then, there's also brain computer interface, which also kind of helps people regain function with the help of being able to control computers or technology with just their mind or control artificial limbs to help them move their actual limbs themselves. So, it's actually pretty cool.

Host: Yeah, it sounds like it. Why has repairing or regenerating the nervous system historically been a real challenge?

Dr. Ryan Hess: We just didn't have the technology, honestly. Being able to, you know, for example, with brain computer interface, properly synchronize with the brain and have it be able to control computer is actually very complex, because essentially you're reading electrical signals in the brain and getting them to, you know, essentially create an output, which is something we take for granted in our bodies.

But being able to do that with a computer or to control a limb is very complex. And so, we've just recently been able to do that. Then, in terms of something like stem cell-based therapy, it's really hard to actually get the cells in the right place, make sure they grow properly and differentiate into the proper cells you want. And so, you know, in order to do that, you have to be able to very carefully control some of the signals that those cells get so that they end up in the right lineage or the right type of cell that you want. And so, that's something that we again recently have really had some big breakthroughs for. So, those have been the main limitations.

Host: An exciting time to be in the field, it sounds like.

Dr. Ryan Hess: Yeah, it's very exciting. You know, I can't tell you how many times throughout my career we often don't do things for people because we know that there's not going to be a lot of hope. But now that we have the ability to regenerate tissue, this, you know, allows us to do a lot more. And it's going to give people a lot more hope in the future.

Host: Now, which leads into my next question about how is neuroregenerative medicine changing the way, you know, you approach a patient, whatever circumstance you, you know, receive them in?

Dr. Ryan Hess: Yeah, that's a great question. And I think a great example of that is something that we deal with every day, which are hemorrhagic strokes, right? Where you get a brain bleed spontaneously. And, you know, it rips through some of the brain tissue and people get, you know, weakness, speech difficulties, and those are often permanent.

And so, you know, for decades, we've tried to figure out does surgery help this? And it sounds like it would, right? Why would you not just take the blood clot out? Well, the blood clot has actually damaged all the tissue. And so, there's been a lot of question of whether or not taking out that blood clot really actually changes anything.

There's been some good data recently to suggest that these minimally invasive procedures to remove them do help people improve, but the gains are really marginal. And so, I think really the next step is going to be being able to regenerate that damaged tissue. And so, what that opens the door for is us being able to remove these blood clots to help people kind of get out of the hospital faster or decrease their length of stay in the ICU. But then, in the long term, actually being able to regenerate that damaged tissue so they can actually become functional again. And I think that's really what this is for.

Host: Yeah. you mentioned those patients, tumor patients. Are there other patients that really stand to benefit in a real significant way from these types of procedures?

Dr. Ryan Hess: Oh yeah, absolutely. Spinal cord injury patients for sure. Spinal cord injury is going to be, you know, one of the main things that we deal with in neurosurgery. It's very, very common. And so, people can oftentimes be paraplegic or quadriplegic after, you know, a car accident or something like that. And so, again, these people have really, really limited mobility after these injuries. And so, being able to help them walk again or be able to use their arms is really important. Patients with traumatic brain injury, so head injury patients, that has a lot of potential there. And there's many patients who are suffering from neurodegenerative conditions such as Alzheimer's, Parkinson's disease. All these people can benefit from this neurogenerative push, whether it's to help their thinking and help their problem-solving abilities or, you know, stop their tremor so they can hold a glass and feed themselves and, you know, these sort of things. So, it's a lot of people.

Host: You may have touched on this a bit, but I'll ask can you share an example of a treatment technology that would have seemed like science fiction just a few years ago but now are becoming a reality?

Dr. Ryan Hess: When I was training in Buffalo, we did one of the first clinical trials. It was called an early feasibility trial, which essentially is you're trying to see does this novel technology work. And so, we took a handful of patients who had really catastrophic brain injuries. I mean, people who had, you know, really bad strokes where they could barely move their arms or legs, and they were really just bedbound.

And so, what we actually did was we placed what's called a Stentrode, which essentially is a stent that you put over the blood vessels overlying some of the areas in the brain you want to modulate. And you're able to actually help them control computers and things like that with just their brain from a little stent that goes in minimally invasively. And they essentially can just go home the next day after that procedure and, you know, that's really profound.

Another example is there's been some recent work out of MIT looking at essentially nanobots and using those to actually help improve recovery after strokes or help people control things with their mind, which is, again, that's pure science fiction, but it is quickly becoming a reality.

Host: That's amazing stuff. You know, Doctor, maybe I'll take a moment to ask you what led you into neurosurgery and this field of medicine?

Dr. Ryan Hess: It was something I actually really developed an interest in very early on during my time in undergrad. So, I did research with the Department of Neurosurgery in Buffalo, which is where I'm from originally. And this is when they were doing a lot of their big stroke trials trying to prove, you know, the efficacy of taking out the blood clots in the arteries to help an ischemic stroke or the kind of stroke you get when there's a blockage in the arteries.

And so, they were some of the first people in the country to do this and I was just absolutely blown away by the innovation, the technology creation and just, you know, how technology was able to dramatically impact people. And, you know, the results of these trials speak for themselves. I mean, the efficacy of taking out a blood clot in the artery to help someone with a stroke is like giving someone antibiotics for an infection. That's how powerful it is. It's clearly better. People make amazing recoveries. We've had a lot of great saves over the years.

And so, that really right there was kind of what sold it for me, was being able to use technology to dramatically impact the lives of people who are suffering from very severe conditions like brain tumors, spinal cord injury, traumatic brain injury, strokes, you name it.

And so, that's what really drew me to the field. In addition to the procedures are amazing to do, you know, it's really, really cool to look at someone's brain and, you know, something that's a once in a lifetime thing for most people, but I get to do this every day. And so, I couldn't be more, you know, more happy with the choice I made.

Host: And your passion comes through, and that's reassuring for all your patients, I have no doubt. Well, Doctor, you mentioned the cool things you get to do in the OR and other places. So, I'm going to ask you to grab your crystal ball, which I'm sure you have, and look, say, 10 years into the future. Where do you see all this technology and neuroscience and the regenerative medicine going in 10 years?

Dr. Ryan Hess: Yeah. I think it's going to be commonplace, to be honest with you. I think, you know, in 10, 15 years from now, once this technology becomes enabled, I think people are going to, let's say, have a stroke. They're going to go through the normal recovery process, and then we're going to see them in clinic, and we're going to get them in for one of these regenerative procedures to either inject stem cells or help them set up a brain computer interface sort of thing, so they can help control things around their house or control robotic limbs.

And I think this is all going to be done in hospitals near people. And so, I'm actually part of a research initiative here trying to actually make this vision a reality, because what we've seen is that the example I usually use is gene therapy. You know, gene therapy is now a reality for many common conditions such as sickle cell is one that I think, you know, it affects a lot of people.

What we're seeing is that it's actually really not feasible from a cost standpoint to treat all these people, which is horrible as a physician to think you'd ever have to think about that. But simply, the healthcare system can't sustain some of these costs. And so, what I'm doing is I'm trying to find ways to how can we deliver this groundbreaking therapy at low cost so people can actually afford to get it.

And so, one of the ways we're trying to do that is actually create what's called an ambulatory neuroscience center. And this is a lot of this stuff has actually come out of Buffalo where I trained, and this is where I got the idea from. And it's not my idea. It's the idea of the people in Buffalo. I just happened to really gravitate towards it. But this idea that you can create these little ambulatory centers like an urgent care where people go, they get these procedures because they're going to become so common.And people go home the same day. It's a nice, friendly, clean environment, very efficient and very low cost.

If we don't think about that sort of idea, that sort of how you roll this out en masse to get to people and make it low cost, it'll never be feasible. And so, I truly see this being like, kind of like, you know, people going to car shops instead of going for your car, you're going for your brain. You get a little tune-up, and then, you know, you go home the same day. It's going to be like science fiction, but I think it's going to be reality.

Host: Amazing. Well, it's come a long way already, So, it'll be interesting to see how these things develop. Dr. Ryan Hess, Neurosurgeon of FirstHealth of the Carolinas. Thanks so much for being with us. A lot of great, amazing really, information.

Dr. Ryan Hess: Oh, thank you so much for having me. It's my pleasure.

Host: For more information, go to firsthealth.org/neurosurgery. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. And this is the FirstHealth and Wellness Podcast. Thanks for listening.