Neil Martin, M.D., Chairman of the Department of Neurosurgery at UCLA in Los Angeles, California, talks about new technology that is making brain surgery more precise than ever.
Interview conducted by Ivanhoe Broadcast News in October 2016.
We’re talking about the surgical theater today, what is that?
Dr. Martin: This is a new virtual reality application that allows us to take two dimensional traditional scans, MRI and CT scans and turn them in to realistic three dimensional reconstructions. Real that with the virtual reality headset on, you can get inside the skull and fly around a tumor or an aneurysm. You understand it totally and you can envision and plan a surgery in the most effective and safe way.
How is the system able to access that information?
Dr. Martin: The system generates a three dimensional model for virtual reality by importing MRI and CT scans in high resolution, stacking the images and turning them in to a full three dimensional reconstruction.
How is that helpful to a surgeon?
Dr. Martin: Brain surgery has two critical goals. One is to deal with the pathology or the lesion, the abnormality, the tumor or the aneurysm; and the second is to protect all the incredibly fragile structures that surround that, small blood vessel, nerves, and brain tissue. In order to see the relationship between the abnormality and the normal structures, it’s extremely helpful to explore it in three dimensions, almost walking around it so that you can see the angles, the proximities, the relationships between normal structures and the abnormality. That allows you to plan the right approach and allows you to plan the treatment of the abnormality.
How has this changed neurosurgery for you and for other surgeons who are able to use this?
Dr. Martin: This has changed our practice in a huge way, in my opinion. This allows us as the next step in pre-surgical visioning, in pre-surgical planning, even in rehearsal to understand exactly how to take care of the abnormality in the safest possible way and disrupt normal structures minimally. In today’s world we’re often going in through very small openings the size of a half dollar. We see a fraction of the abnormality at any one time. You have to have a very accurate mental image of exactly what you’re dealing with. Using virtual reality allows us to get there. The world of medicine and surgery is changing at an incredibly fast rate outcomes as new technologies come to be used to improve our care. Virtual reality has been presented to us as an incredibly technology in to which billions of dollars have been invested by the gaming and entertainment industry so we’re leveraging that kind of investment to make surgery safe and better.
Is there a way to measure out surgeries that are not using virtual theater?
Dr. Martin: Early studies have already demonstrated it has the potential to make the surgery more efficient and shorter. There’s a lot more work to do to, we really have to establish the overall benefits of this. But subjectively, as somebody who has done five thousand operations, there’s no question in my mind that this is tremendously useful and improves the quality and efficiency of the surgery that I’m doing. That’s what translates into better outcomes. Because our goal is to improve the quality of life of the patient after the surgery solve their symptoms, deal with the pathology and allow them to get back to normal life.
Is this system anywhere else in UCLA or is it only at UCLA?
Dr Martin: The virtual reality surgical planning system that we’re using was developed right here at UCLA and it’s really only eighteen months old. The pace of development has been incredibly fast working with this innovative company Surgical Theater. It’s now in use at several major medical centers around the country including Stanford, Mayo Clinic, NYU, Mt. Sinai, Case Western Reserve and new centers are adopting this every month.
How does this help patients or does this help patients as well?
Dr. Martin: It can be very useful when we show the patient ahead of time in a realistic looking three dimensional reconstruction exactly what the surgery is going to be about. They can see exactly where the opening in the skull will be made, they’ll see what the tumor or the aneurysm looks like, so it gives them deeper insight into the operative procedure that’s about to be done. It makes it a little less mystical and a little more weighted towards a practical engineering project that we can really accomplish.
Tell us a little bit about how this helped in Lucas’s case, how you used this for him.
Dr. Martin: In Lucas’s case, he had a tumor that was located near the center of the cranium, right near the center of the brain. It was an area that is dense with small nerves with the carotid artery and it’s surrounded by brain tissue. It was extremely helpful in order to explore different avenues to get to the tumor safely and to understand exactly where these critical structures were in relationship to the tumor. One of the key things in his case was that the carotid artery was partially engulfed by the tumor. The tumor was wrapped around the carotid artery. Knowing that in detail greatly facilitated removing the tumor safely.
Is there anything that you think is important to include in the story?
Dr. Martin: Virtual reality is a surgical planning tool. I think it is going to be adopted by every major surgical specialty where preoperative imaging and intraoperative planning is a key element. I see it having a role in other types of head and neck surgery: in retroparataneal surgery, in cardiac surgery, and in complex spinal surgery. I think this is going to become a standard both for preoperative visualization, and it’s going to replace black and white two dimensional images. I see this as also a way where we can plan and rehearse and even simulate surgery so that we get it right before we ever get in the operating room.
Right now it’s just brain surgery that you’re using this for?
Dr. Martin: Right. At UCLA it’s primarily being used for brain surgery although the plastic surgeons have begun using it for complex reconstructions of the bones, of the skull, and face. But I see it spreading very rapidly throughout the other surgical specialties.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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