At first, 44-year-old Vivian Conboy of Petersburgh thought she was getting the flu.

“I was at work on Wednesday, January 16, and I had a headache. So I went home early,” recalled Conboy, director of the Project Management Office for the New York state Department of Taxation and Finance.

When she began vomiting on Thursday, she stayed home again. By Friday, when she felt worse, she called her doctor. A few hours later, she was admitted to Albany Medical Center.

Conboy learned she had hydrocephalus, or excess fluid in the brain, caused by a tumor deep in her brain.

“I knew it was serious when I was admitted, and my family started arriving,” said Conboy. “I was very scared. I wanted to stay alive, and I wanted to be able to talk and move.”

The next day, Conboy became one of the first patients at Albany Medical Center to have minimally invasive neurosurgery.

The procedure aims to achieve the same results as traditional open surgery with less disruption of normal tissue, said Dr. Yu-Hung Kuo, a neurosurgeon with a special interest in minimally invasive neurosurgery.

“Incisions are frequently smaller and more cosmetic and operations are done through keyhole openings,” said Kuo.

Endoscope is the key

Traditional brain surgery requires opening up the skull to access the brain.

For patients, minimally invasive techniques result in less pain, shorter stays in the hospital and less risk of complications.

One of the tools that enabled the development of minimally invasive techniques is the endoscope, a surgical tool that looks like thin pieces of tubing.

“Most endoscopic cases can be done through a skin incision of approximately 1 inch, with a dime-size hole in the skull,” said Kuo, who has done about 12 cases since arriving at Albany Med last November.

The endoscope is a 7-inch-long fiber-optic lens attached to a digital camera that permits neurosurgeons to work in areas deep within the brain while viewing their work on a video screen.

“In fact, it permits for access to areas that in the past may have been deemed inoperable,” said Kuo. “The endoscope provides for better visualization and lighting than classic open techniques, circumventing that sensation of working in a deep dark hole.”

Patients like minimally invasive techniques because of the smaller scars.

“In fact, with many of the endoscopic procedures we do, the incisions are no longer than 1 inch or so to get quite deep into the brain,” said Kuo.

Kuo used the endoscope to operate on Conboy to make a small opening in her brain to bypass the blockage and treat the hydrocephalus by draining the fluid without having to place a device called a shunt.

Follow-up procedure

While some tumors can be entirely removed with the endoscope, Conboy’s, which was about 1 inch, was too large. So Kuo took a biopsy of the tumor, before sending her home two days later.

“Then we had her come back to the office, and we were able to talk about what we wanted to do,” Kuo explained.

Conboy learned she had a benign tumor called a pineocytoma, an uncommon slow-growing tumor of the pineal gland.

Because of its location and size, Kuo determined that he could not use an endoscope to reach the tumor.

“In our discussion, we determined that preservation of function was most important,” said Kuo.

“My husband and I live on a farm and we have horses, goats and chickens,” added Conboy. We make maple syrup, and I drive an ATV and tractors. I really have to do all those things to be happy. That’s my goal.”

Through a three-and-a-half inch incision on the back of Conboy’s head, Kuo said he removed as much of the tumor as he safely could with a microscope instrument.

“By doing the bigger operation, it let me get the lesion down to a size where it was amendable to other treatment options,” said Kuo. “And I could do that without having to go after portions that were in critical parts of the brain.

Treating lesions

Next, Conboy will have radiosurgery, a technique of treating lesions with the use of external radiation that does not require an incision.

In radiosurgery, beams of radiation are delivered from multiple areas outside the body, said Kuo. The beams of radiation focus down on the targeted lesion. Therefore, the target receives a high dose required for treatment, but the surrounding normal tissues are exposed to a low dose.

Lesions that are suitable for this form of therapy include both benign and malignant tumors, as well as arteriovenous malformations — a congenital disorder of the connections between veins and arteries in the vascular system.

“This also represents a possible treatment option for patients who are medically unfit for open surgery,” said Kuo.

Most radiosurgical cases require a single treatment that is performed as an outpatient.

Conboy said she is confident that she will be cured after the radiosurgery.

“I have a lot of confidence in Dr. Kuo,” she said.