Brain surgery in 3-D

CHICAGO (Ivanhoe Newswire) -- Neurosurgeons now have a new approach to brain surgery using the same 3-D glasses you'd put on at an IMAX movie theater.

Keeping up with his son was almost impossible for Lenin Cuevas last year when his vision began to fail.

Cuevas told Ivanhoe, "I started seeing flashing lights. And then it came to a point that my wife and my mother-in-law had to drive me to work."

Lenin's doctor told him it was stress, but his vision kept getting worse.

Cuevas told Ivanhoe, "I was kind of scared that I would go blind."

A MRI revealed a golf ball sized tumor pressing up against his optic nerve. Lenin had lost 80 percent of his vision in his right eye and nearly half in his left.

That's when he was referred to James Chandler MD a Neurosurgeon at Northwestern Medicine and a new 3D mini microscope for surgery.

Chandler told Ivanhoe, "We gain that depth perception, thereby potentially having a more efficient and safer surgical experience."

The surgery is done entirely through the nose with no visible scars. Surgeons wear 3-D glasses like the ones you wear to watch a movie.

Chandler told Ivanhoe, "Once we put on the 3-D glasses, it's as though we are right there working in the brain."

Just three months after Lenin's surgery, his vision has returned. Now he can focus on making new memories with his son.

Lenin says he's glad he kept pushing for a diagnosis because surgeons told him his blindness would have been permanent if he'd waited any longer for surgery.

Patients undergoing the new approach to surgery are out of the hospital within a day or two and recovery time at home is just days instead of weeks.

BRAIN SURGERY: Brain surgery has forever been a very risky procedure but is necessary to treat problems in the brain. Some of these risks include seizures, stroke, brain swelling and coma. When surgery is performed on any area of the brain there could be side effects on memory, speech, vision and other functions. Typically brain surgery is performed by cutting a deep hole into the skull and removing a bone flap. This is called a craniotomy. The bone flap is usually later replaced using small metal plates and screws. The time of recovery depends on the severity of the injury to the brain. The hospital stay usually lasts up to a week after the surgery. (Source: http://www.nlm.nih.gov/medlineplus/ency/article/003018.htm)

CAUSES: One of the primary causes for brain surgery is tumors. Brain tumors can grow and develop at any age and have no known cause. A tumor growing in the brain causes severe headaches, nausea and vomiting and must be removed through surgery or can become fatal. Brain surgery may also be performed to stop bleeding in the brain (hemorrhage), remove damaged brain tissue, treat epilepsy and free a nerve. (Source: http://www.nlm.nih.gov/medlineplus/ency/article/003018.htm)

NEW TECHNOLOGY: There's a new twist to how neurosurgeons are operating on the brain. 3-D glasses are now being worn in the operating room to aid doctors during brain surgery. The entire surgery is done through the nose and the glasses function the same as any normal pair of 3-D glasses you might wear in a movie theater. This technology is helping doctors see more when operating on the brain and can in turn help doctors remove more of the brain cancer. The surgeons wear these glasses and watch their movements on a monitor. This gives surgeons a better view of where they're operating and makes the brain surgery less invasive. There are currently three hospitals in the U.S. using the 3-D glasses during brain surgery. (Source: http://www.cbsnews.com/news/surgeons-use-3d-technology-in-brain-surgery/)

FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:

Sheila Galloro
Senior Media Relations Associate
Northwestern Memorial Hospital
312-926-0735
sgalloro@nmh.org

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

James Chandler, M.D., James Chandler, MD, is the Surgical Director of Neuro-Oncology at Northwestern Memorial Hospital and a Professor of Neurological Surgery and Otolaryngology — Head and Neck Surgery at Northwestern University Feinberg School of Medicine.

Can you give us an idea of the differences between the traditional surgery versus endoscopic approach?

Dr. Chandler: Sure. One of the exciting new frontiers in neurosurgery is endoscopic surgery and one of the reasons for that is it obviates the need for one of the larger transfacial or transcranial approaches.

Tell us about this new 3D mini microscope approach to surgery for tumors.

Dr. Chandler: It allows us to access corridors of the brain through the nose without the traditional large incisions or opening up the head. One of the really exciting new advances in the endoscopic technology is three-dimensionality. It allows us to have a broader view, a depth perception view which theoretically would make for a safer and more efficient surgical experience. The mini microscope is an alternative to the traditional microscope and this small device replaces the large cumbersome microscope that we ordinarily use for many of our brain surgical procedures, in particular surgeries that we were previously doing through the nose without the endoscope. The advantage of this is that it allows a hybrid view between what you would have with the microscope and what you have with the endoscope. So the large microscope which occupies a large amount of space that's difficult to maneuver around is no longer necessary. Endoscopic technology relies on a monitor. Historically monitor-based technology yielded a two dimensional view with some loss of perception. The 3D mini microscope restores that lost perception.

So you are talking about adding depth perception.

Dr. Chandler: Whenever we use endoscope technology we generally have a 2-D view; we're looking at a monitor as we're maneuvering and as such there's a compromise in depth perception and we end up having to rely on visual and tactile cues. With the 3-D glasses and the special application that's present, using both the mini microscope and the endoscope, we gain depth perception thereby potentially having a more efficient and safer surgical experience.

So the glasses work just like anyone who was going to the movies. They see the same way?

Dr. Chandler: Exactly the same. There's this sense of objects moving and a sense of depth perception.

Can you tell us just how much more precise that allows you to be with surgery?

Dr. Chandler: It allows us to have more precise movements in that the depth perception is there. With the mini microscope and the endoscope we can have a broader view by a significant percentage, maybe by 100 percent over a traditional microscope.

And also with the incision, we're looking at just a very tiny incision; you wouldn't even see it for the layperson.

Dr. Chandler: When we're doing surgery through the nose which we can do with the mini microscope or with the endoscope, we make an incision through the back of the nose where there's no visible scar.

And recovery time is much shorter as well?

Dr. Chandler: The idea is if we're not doing the large craniotomy (the large opening through the face or through the head) and just going through the back of the nose, the patient recovery time is reduced. Most patients are in and out of the hospital within a day or two and the recovery time at home is just days instead of weeks.

That's huge for both you and the patient.

Dr. Chandler: Absolutely. You know the two things that concern a patient are ‘will I be disfigured?' and ‘can you do a better job with the technology that you're describing?'. This allows us to do a better job than we were historically preforming.

How big of a breakthrough would you say this is?

Dr. Chandler: I think that this is building on the existing endoscopic technology that's been around for a while. It's making surgery of the cranial basis a little bit more efficient and a little bit safer.

Is it a little more fun in the operating room as well?

Dr. Chandler: I think in time it may be, but there's a bit of a learning curve with any new technology and at first it's a little bit more cumbersome, it takes a little while to get used to things. This is something that the surgeon has to adjust to. Once you've made that adjustment it's not fun but rather intriguing.

I was speaking with some of the surgeons before. They told me it was almost like playing a videogame.

Dr. Chandler: Laparoscopic surgery has been around for a while working off the screen and neurosurgery is one of the last specialties to adopt the technology. I'm the first generation that's trying to make that adjustment.

And this is the first center to do this?

Dr. Chandler: We're the first center to utilize the mini microscope in conjunction with the endoscope with the 3-D technology.

We'll be able see it on the monitor and is a video?

Dr. Chandler: Correct. So we're really talking about two different 3-D technologies here; the mini microscope and the endoscope. The endoscopic technology has been around for quite some time, the 3-D component is what's new and novel and potentially makes it safer and more efficient. We're the pioneering center and we're still trying to sort out all of its applications but for now it seems that it can replace many of the procedures that we do with the conventional microscope. So it's two different technologies. Ordinarily we would do that surgery exclusively with the endoscope or with a large microscope and I don't know if in the video you'll see the large cumbersome microscope. What was novel was we used the mini microscope to do much of that procedure. This comes off and you can attach the endoscope. That was what was really novel and kind of cool about the procedure. It's a little bit easier if we're just talking about the endoscope and the 3-D component to it.

Right, it's the 3-D that's new.

Dr. Chandler: The 3-D is the new dimension to both of these, but what's particularly unique is this small device replacing the large microscope and actually giving a better view than the microscope would give.

It depends where the tumor is right? You can't do endoscopic surgeries on every brain tumor?

Dr. Chandler: The mini microscope or the endoscope is most useful for tumors along the front of the head and the under surface of the skull base between the eyes and behind the nose.

Can you go through the part about being able to take the microscope off and put the endoscope on?

Dr. Chandler: Oftentimes we will start a procedure with the mini microscope which again gives an enhanced view that you might not get with a traditional microscope. For deep in-depth viewing we can take off the camera here for the mini microscope and replace it with the endoscopic component. Once we put on the 3-D glasses it's as though we're right there working in the brain with the same level of depth perception and three-dimensionality that we get with the microscope.

So the 3-D glasses are with the endoscope right?

Dr. Chandler: The 3-D glasses are with both the mini microscope and the endoscope.


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