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OneThousandOne represents the amount of time, verbally, that it takes to count to one second. In this one second of time, a great thing happened at The Nebraska Medical Center. In fact, several great things probably happened. A patient was cured, a researcher found the missing link, a nurse treated an injury, a doctor comforted a family or maybe a child just smiled.
MOMENTS IN MEDICINE at THE NEBRASKA MEDICAL CENTER
Fall | Winter 2006

Field of Medicine

When Bill Thorell finished high school in 1988, he had only one thing on his mind and it wasn’t medicine. “I had no idea what I wanted to do,” Thorell recalls, “except play baseball.

His father, Jim, had grown up in a family of athletes in Loomis, Neb., where he and his three brothers and sister participated in just about every sport imaginable. A letterman in football, basketball and track, Jim played baseball for three years in the New York Yankees’ minor league system before turning his attention, as did his brothers and sister, to high school coaching. In 2001, Jim, his parents, Earl and Lenore, and his siblings received the Fischer Family Hall of Fame Award, an honor bestowed by the Nebraska High School Sports Hall of Fame for achievement in athletics and contribution to high school sports in the state. Together, Jim and his athletic-minded siblings tallied 133 years as high school coaches in Nebraska.

As a child, Bill’s days consisted of one sports event after the other. He played basketball and football, and at one point was a member of three different baseball teams.

When it came time for college, he packed his gear and followed in his brothers’ footsteps. One brother played baseball at the University of Arizona. The other had made the baseball team at the University of Nebraska-Lincoln (UNL). Thorell joined the UNL baseball squad as a walk-on.

innovative New techniques have advanced interventional and neuro radiology to support endovascular neurosurgery.

Fame eluded him at UNL, where his view of the field came chiefly from the dugout bench. After two years of waiting for his “big break,” he decided that perhaps baseball was not his calling. He had no clue where his true skills might lie, until he traded his leather baseball glove for a pair made for medicine.

Smart move.

Today, after 14 years of medical school and intense training, Bill Thorell, MD, is one of about 55 endovascular neurosurgeons in the United States and the only one in Nebraska. He is gaining recognition in a specialty field that gives patients a minimally invasive alternative in the surgical treatment of vascular diseases in the head and brain, neck and spine.

“Endovascular neurosurgery is a very specialized field that offers promising new options to patients,” Dr. Thorell says. “I’m very excited to be at The Nebraska Medical Center where I can provide these options. There is a commitment here to continually raise the level of patient care. I see this as an exciting environment to be part of an exceptional program.”

Endovascular neurosurgery has undergone a rapid evolution since its introduction in the 1980s. Its popularity has been fueled by dramatic advances in technology and equipment. Conditions in the past that would have required surgical intervention such as aneurysms, vascular malformations and tumors of the brain may now be considered for treatment by using an endovascular approach to reach the lesion. Endovascular surgery yields improved outcomes, reduced recovery times and fewer risks.

Approximately 50 percent of cerebrovascular conditions are being treated through interventional endovascular radiology techniques, a number that is expected to rise to 90 percent within the next five years.

“I saw a lot during that summer – from brain surgeries to patients in his clinic,” recalls Dr. Thorell. “I was totally fascinated by it all.”
Bill Thorell, MD

Dr. Thorell’s interest in medicine was sparked in Denver, Colo. It was summer vacation after his second year of college, and Dr. Thorell still had not decided on a career. While considering the medical profession, he accepted an invitation to shadow his neighbor, William Warmath, MD, a neurosurgeon at Exempla St. Joseph Hospital in Denver, for a couple days a week.

“I saw a lot during that summer – from brain surgeries to patients in his clinic,” he recalls. “I was totally fascinated by the complexity of the human brain. For all we know about it, many things are still a mystery.”

Aided by a knack for the sciences, Dr. Thorell embarked on a long and demanding journey to become a neurosurgeon. He found an ally in the late Lyal Leibrock, MD, a neurosurgeon at The Nebraska Medical Center and a professor of surgery and longtime chief of the Section of Neurosurgery at the University of Nebraska Medical Center (UNMC), where Dr. Thorell was attending medical school.

Dr. Leibrock, who died in 2005, shepherded Dr. Thorell through medical school, medical boards and the challenging process of securing residency and fellowship positions. It meant a lot of hard work – and precious little sleep. “I drank a case of Mountain Dew every day for two weeks while I was studying for medical boards,” Dr. Thorell says, professing a love for the high-caffeine soft drink. “Every night, I’d stop by the grocery store and buy a case.”

Bill Thorell, MD

Dr. Thorell completed medical school and his neurosurgery residency at UNMC. He returned to Nebraska after two years training in endovascular neurosurgery at the prestigious Cleveland Clinic Foundation in Ohio.

Since joining The Nebraska Medical Center staff in 2005, Dr. Thorell has focused on refining his skills in a variety of minimally invasive interventional neurosurgery techniques such as endovascular coiling, endovascular embolization and carotid artery angioplasty and stenting, some of which are not available anywhere else in the region.

A patient man with a passion for gumballs and his iPod, to which he has downloaded a curious cross-section of tunes ranging from AC/DC to Abba, Dr. Thorell begins each day with a five-mile run on his treadmill. He puts on his headphones, turns on the iPod and stares at a blank, white wall as he runs. “I like the solitude of it – staring at a white wall. It helps clear my head for the day.”

Each day has its share of low points. As in many medical fields, there are patients with brain trauma or severe neurological conditions whose chances for recovery are slim. “You have to be a very compassionate individual,” Dr. Thorell says. “You have to sit and do some hand holding with the patient and family. At the same time, you have to display a level of competence that you’re doing everything possible.”

He balances those moments with his work in the classroom. “I really enjoy teaching medical students and residents. It provides a respite from the stress of caring for critically ill patients.”

“The part that’s unique is not knowing at any given time what is coming my way.”
Bill Thorell, MD

It’s not uncommon for him to log 80 or more hours a week at work. “A lot of people put in long work hours,” he says. “The part that’s unique is not knowing at any given time what is coming my way. Inevitably, the unpredictability of human illness causes me to miss out on family time or activities.”

That time away from home can also be difficult for his wife, Angie, and his children, Brett, 4; and Evan, 6. “I never promise my children that I’ll be at something because I never know for sure. My children know that when I’m not there, it means that I’m doing something really important.

“I pray that as they get older, they will continue to be understanding of the fact that their dad may not be at every activity, but that doesn’t mean I didn’t want to be.”

He makes the most of the time they do spend together, coaching Evan’s T-ball team, a commitment for which his patience comes in handy; and accompanying him to Tai-Kwan-Do classes.

The personal commitment can be rewarding. “I’ve had patients make gifts for my kids because they know that all the time that I’m spending with them means I’m not home with my family,” he says. “I got a Christmas card from a patient who wrote, ‘Thank you for the tremendous gift you gave me on Christmas Day 2004. You saved my life.’ That’s what I love about my job.”

Messages like that help Dr. Thorell understand the importance of providing patients with options.

“Neurosurgery is an expanding field that is offering more hope for people with neuro-related issues,” he says. “I think we will see advancements in technologies and techniques that continually improve the outcomes for these patients.”

For Dr. Thorell, being able to offer hope to a critically-ill patient beats hitting a baseball out of the park any day.

Brain Power

Like a GPS system for the brain, neuronavigation systems register a patient’s physical space to the corresponding images on the CT or MRI scans.

Important advances are being made in interventional and neuroradiology to support endovascular neurosurgery. Initially, neurosurgeons performed surgical procedures with an operating microscope. Endovascular neurosurgery therapies are now accomplished through micro catheters inserted in the groin area and threaded through the blood vessels leading into the brain or spinal cord.

These techniques are aided by utilizing the most advanced radiology imaging techniques such as X-ray fluoroscopy (real-time X-ray technology to monitor movement inside the body; three dimensional, rotational angiography (injection of X-ray contrast or dye to obtain pictures of blood vessel anatomy); ultrasound; computerized tomography (CT) and magnetic resonance imaging (MRI).

This technology allows physicians to visualize operative procedures without making a skin incision and physically looking inside.

“We can see vessels more clearly now,” says Bill Thorell, MD. “These imaging techniques are providing us with improved speed, clarity, decreased risks and reduced costs of imaging.”

Other technological advances include neuro-navigation systems that allow neurosurgeons to perform brain surgery with greater accuracy and precision. Like a global positioning system (GPS) for the brain, neuro-navigation systems register a patient’s physical space to corresponding images on the CT or MRI scans. Provided with a “roadmap,” surgeons use these real-time images to guide their instruments.

“These imaging techniques are providing us with improved speed, clarity, decreased risks and reduced costs of imaging.”
Bill Thorell, MD

Neuro-navigation systems help surgeons perform preoperative planning to determine the best approach to employ. This can minimize the length of the incision. The technology is used primarily for biopsies and resection of brain tumors, surgery for arteriovenous malformations and spinal surgery.

New radiation delivery technology offers more options and improved outcomes for treating tumors in the brain, spinal column and other parts of the body. One of the most significant tools is Novalis shaped-beam surgery. This delivers a carefully shaped, precise dose of high-energy radiation to treat tumors in these areas. The Nebraska Medical Center is the only hospital in the state to acquire this technology. Research indicates higher radiation doses may result in increased cure rates and improved tumor control.

“Novalis gives physicians a tremendous advantage in treating tumors and conditions inside the brain,” says Dr. Thorell.

Innovation and Experience

Until recently, Omaha surgeons had one way to treat brain aneurysms: surgical clipping. This involves opening the skull to locate and exclude cerebral aneurysms from normal cerebral blood vessels. Bill Thorell, MD, is providing patients with an option: endovascular coiling, a less invasive procedure that is proving in some patients to be safer.?

During endovascular coiling, the surgeon places a catheter from the femoral artery into the aneurysm using fluoroscopic imaging. Platinum coils are then fed through the catheter and packed into the aneurysm to exclude blood flow from the aneurysm and reduce the risk of rupture.

Bill Thorell, MD

“Having a choice allows us to tailor the procedure to the patient and choose the procedure that presents the fewest risks,” Dr. Thorell says.

Neuro-interventional techniques are also being used at The Nebraska Medical Center to treat arteriovenous malformations. An arteriovenous malformation (AVM) is a congenital abnormality of the blood vessels in the brain, brain stem or spinal cord. An AVM may go unnoticed until complications such as hemorrhaging or seizures occur. A diagnosis of AVM may be confirmed through a computerized tomography (CT) scan, magnetic resonance imaging (MRI) or brain angiogram.

AVM treatment options include surgery, endovascular embolization and radiation therapy. “Some patients are better suited for one type of treatment versus another, depending on the size and location of the AVM,” says Dr. Thorell. “That is why it is best to go to a hospital where a patient has all options available to them, as at The Nebraska Medical Center.”

For stroke patients who have narrowing of the carotid artery in the neck due to plaque, carotid artery angioplasty and stenting is a valuable option. With carotid artery angioplasty and stenting, Dr. Thorell maneuvers a balloon-tipped catheter into the obstructed area of the artery and inflates it to compress the plaque against the artery walls. A stent is usually left in the artery to prevent recurrent narrowing. The procedure is still in clinical trials.

Next article in the Fall | Winter 2006 issue of One Thousand And One:
A Night in Emergency