Brain Surgeon Repairs 
Disfiguring
Injuries

By Anita Lienert  

Dr. Michael's surgical technique utilizes computer-assisted design for a perfect fit.  After a mold is made, it is cast with a natural substance that grows into the real bone.

 
As a CNN camera crew recorded the historic event unfolding on 5T, the neuro-intensive care unit at the Detroit Medical Center’s Receiving Hospital, Dr. Daniel Michael slowly unwrapped the bandages enshrouding Elaine Nakis’ head.

It was the culmination of a grueling medical journey for the 41-year-old woman, who had a ruptured brain aneurysm and then later lost a jagged, 17-inch portion of her skull surrounding her eye to a post-operative infection.

For months, Nakis used a scarf to cover the disfiguring hole in her head to avoid stares and cruel remarks. Now, she was an instant celebrity – and so was Dr. Michael.

That’s because Dr. Michael, chief of neurosurgery at Detroit Receiving and Wayne State University professor, became the first neurosurgeon in the world to use “bone source” or hydroxyapaptite – a powdered substance that is found in real human bone – to create an implant. The substance eventually grows into real bone, thus becoming a part of the patient’s skeletal system.

It was a major step in cranioplasty – a procedure that replaces damaged parts of the skull. In the past, doctors typically used steel or titanium plates that were never quite a perfect fit. Five thousand years ago, Peruvian physicians used gold to patch skulls.

Jerry Ruelle was Dr. Michael's first laminoplasty patient.  Due to severe spinal stenosis, Jerry needed repairs to four vertebrae.  The procedure was a success and Jerry's bones are slowly fusing together, thanks to the handiwork of Dr. Michael.

Dr. Michael understood the medical significance of the moment; his patient’s immediate worry was her looks.

Holding a pocket mirror, she stared at the neurosurgeon’s work.

“Oh, my,” she said. “It’s beautiful.”

Then, turning to her beaming husband, Nakis asked, “How do I look?”

A year later, Dr. Michael sits in his office in the University Health Center, recalling those events in October 1999. His patient has since developed a fungal infection and the implant was removed. A second surgery is planned in several months to repair it.

“The look on her face was really indescribable,” he said, of those first satisfying post-surgical moments. “It looked like one of those old Ben Casey TV shows. She almost had tears in her eyes. She was so happy.”

Dr. Michael’s historic surgery was a collaboration between two Michigan companies – Ann Arbor-based CyberOrthology and Kalamazoo-based Stryker Leibinger – and Wayne State University.  

“Two brave people were the pioneers,” Dr. Michael said, referring to Nakis and a 35-year-old gunshot victim who was the second patient to undergo the new cranioplasty. “The goal is to make Wayne State and this consortium of Michigan companies the leaders in terms of cranial replacement. And we’re off to a great start. We’ve proved that we can do it.”

The new procedure is critical in the treatment of traumatic head injuries. An estimated 53,000 Americans die every year from brain injuries; another two million lose their ability to work and function. Dr. Michael calls those statistics a “national tragedy.”

The new technique for cranioplasty is just one piece of exciting news coming from Dr. Michael’s office.

Another line of research focuses on examining genes in the brain and studying how and when they’re being switched on and off after injury. Researchers here are zeroing in on one gene called “heat shock protein,” which Dr. Michael describes as “your body’s own first-aid mechanism.” It’s a gene that is triggered after injury and may hold the key to explaining why some brain cells recover from injury and some don’t.

Dr. Michael points to a picture on the wall that looks like a piece of bizarre abstract art, but is really human neurons stained purple to show heat shock protein.

It’s a serious element in an office that contains such oddities as Ren and Stimpy cartoon-character dolls, a Far Side cartoon about neurosurgeons and a child’s toy version of the brain.

The genial, goateed 45-year-old is at the pinnacle of his profession. But he’s not above wearing a tie scattered with skulls. Dr. Michael is also the bass player in a Detroit rock band called X.communication. When asked to describe himself, he says, “I’m just your average brain surgeon.”

The son of a General Motors chemical engineer, Dr. Michael recalls his greatest joy as a five-year-old was playing at his mother’s sink with the beakers and flasks his dad would bring home from work. At age 12, inspired by a 1960s TV show, the native Detroiter decided that neurosurgery would be his life’s work.

“Ben Casey was my hero,” Dr. Michael said. “There were two doctor shows in those days. There was Dr. Kildare, with Richard Chamberlain, and all the girls liked him because he was cute. But I liked Ben Casey because he was tough.”

As a WSU undergraduate, he majored in psychology. “It was this brain thing,” Dr. Michael said. “The final frontier. How does it work? Why does it work? Why does it make us who we are?”

His whole career has been centered around WSU, where he received his medical degree and then went on to complete a PhD in anatomy and cell biology. Detroit Receiving Hospital, in particular, felt like a perfect fit.

These scans show one of Dr. Michael's patients before (above) and after his unique method of cranial replacement.

“Receiving always seemed like it was home to me,” he said. “It’s kind of a strange thing to say, but I just always got a thrill out of working in the emergency room. I was always excited. The people, the general surgeons were characters. But they were always able to keep their heads when the whole world was falling apart. That’s what I admired.”

WSU and the DMC seem to be an excellent Petri dish for incubating Dr. Michael’s ideas. Another new avenue he’s studying is unorthodox ways to treat brain injuries. 

“Right now, I’m interested in looking at alcohol and similar drugs and studying novel mechanisms to treat brain injury,” he said.

At a recent international symposium here on brain injury, Dr. Michael mused in his opening remarks about the direction in which he’d like to see the neurosurgery field move.

“Maybe the big question in brain injury isn’t ‘why do people never get better after a brain injury?’” he said. “Because the brain is the most complicated thing we can conceive of. It would be like pushing my computer off a second-story window and turning it on and expecting it to work. Maybe what we ought to be looking at is why do some people EVER get better and then study them and find out why they did get better.

“We actually have the tools right here at Wayne State in the School of Medicine to investigate those questions. And get some answers.”