The Cold That Cures

Surgeons listened in wonderment when Dr. Irving S. Cooper first described his "ice scalpel" and a new way to shoot liquid nitrogen through the brain to freeze part of the thalamus as a treatment for Parkinson's disease (TIME, July 6, 1962). Now, Dr. Cooper's cold is surgery's hottest technique -- a tool for treating a dozen or more conditions in all parts of the body.

Called cryosurgery, from the Greek kryos (cold or frost), the new method actually involves neither ice nor scalpel. The surgeon inserts a thin cannula (tube) that kills offending tissue with liquid nitrogen's intense cold (-- 196DEG C., or 321DEG below zero F.). Usually no tissue is actually removed, and the body's natural clean-up system removes the debris. Virtually bloodless and almost painless, cryosurgery can be done on patients who remain fully conscious or only lightly anesthetized. In some cases cryosurgery is used only to relieve symptoms, but in others it achieves actual cures. Among the areas in which it shows conspicuous promise:

sb PITUITARY GLAND. Just about the hardest part of the body for a surgeon to get at is the pea-sized pituitary gland (see diagram), producer of a few master hormones that govern the production of dozens of "slave" hormones. An overactive pituitary causes Cushing's syndrome, some forms of gigantism and adult overgrowth, and some cases of virilism in girls and women. Removal or deactivation of even a normally active pituitary helps some patients with advanced cancer of the breast or prostate, and diabetes victims going blind from bleeding of retinal arteries.

Merely to locate the pituitary, encased in a bony box like a bomb shelter in the middle of the skull, is a highly delicate, dangerous procedure, and surgeons have tried several approaches. Dr. Robert W. Rand and his team at U.C.L.A. go in through the nasal passages and the sphenoid bone that lies behind them. First, the patient's head is clamped in a stereotactic device that enables the surgeons to take bearings in three dimensions. Then the surgeons saw through the intervening bone and insert the ultracold cannula. Dr. Rand found that temperatures as low as --70DEG C. maintained for as long as 17 minutes had no appreciable effect on the stubbornly resistant pituitary. So he dropped the temperature inside the gland to between --170DEG C. and -190DEG C. With a probe--or sometimes with two, one in each lobe--held at this freeze level for 15 minutes, Dr. Rand's group has safely achieved the desired degree of pituitary destruction in more than 50 cases. Other neurosurgeons agree that for the pituitary, the supercold technique is "superior to all the rest"--such as scooping out the pituitary with a tiny, long-handled spoon, always with the danger that too much of the pituitary would be left.

sb TUMORS. A noncancerous but far from benign tumor is the angiofibroma, which develops in the nasal passages and equips itself with a huge blood supply. When the tumor is removed by ordinary surgery, patients lose an average three pints of blood; some have lost as much as eight, and died on the operating table. At the University of Michigan, Dr. Walter Work and Dr. Mansfield F. W. Smith pioneered a cryo-surgical technique for the removal of angiofibromas with negligible bleeding.

So sharp is the line of demarcation between the deeply frozen tumor and adjacent warm tissue that the mass can be cleanly removed. Seven patients treated by this technique have also been spared the discomfort of repeated nasal packings, which usually followed old-style surgery.

sb CANCER. A challenging case treated by Dr. William G. Cahan at Manhattan's Memorial Sloan-Kettering Cancer Center involved a cancer of the tongue, 2 in. by 1 1/4 in., in an 84-year-old man. After only a mouthwash sort of anesthesia, Dr. Cahan froze the surface of the cancer. Later he inserted the liquid nitrogen probe deep into the tissue. In each of three required operations, the tissues were frozen and allowed to thaw. The patient complained of only a mild burning sensation that lasted a few hours after each treatment. In three weeks, the cancer shrank to the size of a small pea and was cut out.

sb TONSILS. For adults and for all victims of leukemia or hemophilia, tonsillectomy is a major operation with grave risks. Dr. Cahan has performed several tonsillectomies by freezing; within three weeks after the ten-minute treatment, the tonsils simply wither away.

sb CATARACTS. Despite striking technical advance in recent years, eye surgeons are still haunted by the fear that during removal of a cataract the casing of the lens will break and spill some of its contents into the eyeball. Several ophthalmic surgeons are now using an especially small probe (cryostylet) in the eye. Inserted under local anesthesia, the stylet adheres to the cataractous lens, freezes it, and permits removal with no danger of spillage, because there is no liquid left to spill, and no damage to the remainder of the eye particularly important for patients with sight in only one eye.

sb RETINAL DETACHMENT. In two years, surgeons at New York Hospital have used ultracold for 150 patients to "re-glue" the retina to the back of the eye ball after it has become detached (for reasons unknown), a condition that may quickly lead to blindness. By one of science's quirks, another recent treatment for retinal detachment involved use of the laser beam to produce a pinpoint of tremendous heat.

sb UTERUS. In many cases of excessive bleeding from the endometrium (lining of the uterus) caused by tumors, application of ultracold through a larger cannula for two to ten minutes will usually destroy the tumors and thus make a hysterectomy unnecessary, reports Dr. Cahan. He also suggests using cryosurgery instead of "tying off the tubes" to sterilize women who, for medical reasons, must have no more children. The procedure takes two minutes.

sb PROSTATE. In aging men, disorders of the prostate gland, which surrounds the urethra, are likely to be a source of pain or the cause of death. The gland may hypertrophy (grow to excessive size) and squeeze the urethra shut by simple pressure, or it may become cancerous. At the Millard Fillmore and Veterans Administration hospitals in Buffalo, Dr. Ward Soanes and Dr. Maurice J. Gonder have devised special instruments and an ingenious technique. They give light anesthesia and introduce the cold cannula through the urethra. To make sure of the placement, the surgeon's finger can check the position of a button on the side of the probe as it nears the prostate. The cold is then turned on. The patient needs a catheter (a plastic tube) through the urethra for a few days to permit urination, but has far less discomfort than with older procedures and is in much less danger of infection. So far, the Buffalo doctors have used this method in 50 cases, 17 of them with cancer. The results: "Most encouraging."

Other imaginative surgeons are investigating the possible use of cryosurgery in such disabling conditions as Meniere's syndrome, marked by extreme dizziness from a disorder in the middle ear. Meanwhile, at St. Barnabas' Hospital in The Bronx, pioneer Dr. Cooper is working on removing tumors from inside the brain by freezing them first. Already he has shown that cryosurgery will bring dramatic relief in some cases of muscular dystonia, restoring hopelessly deformed children to near-normal posture and gait.

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