Laser-assisted, MRI-guided Brain Surgery

Robert Wood Johnson University Hospital in New Brunswick has become the first hospital in the country to perform laser-assisted surgery on an intracranial ependymoma, a tumor that grows from the cells that line the ventricles in the brain.
By: Andres Schulz
Aug. 6, 2010 - PRLog -- Dr. Shabbar F. Danish and his neuroscience team successfully completed this surgery on Susanna Denude of Riverdale on July 6 in just three minutes — and Denude was awake the entire time. She even was in and out of the hospital in 24 hours.

“This is a tool for patients with tumors who have been told they do not have other options,” said Danish, the director of stereotactic and functional neurosurgery and an assistant professor at Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital. “I felt that she was a good candidate for this based on what her tumor looked like.”

Denude’s tumor had been around since 2003, when she underwent the first of two open craniotomies (the second was in September 2009) and endured a full dose of radiation. But those conventional methods did not stop the tumor’s growth.

Denude came to Danish in early June for a screening MRI, and once Danish saw what was going on, he approached the Denude and her husband, John, about the laser surgery, known as a complete thermal ablation.

“Thirty seconds into his presentation, we decided this is what we were doing,” John said. “We understood what was going to take place, and we knew this was right.”
How it works

The technique involves placing the laser directly into the tumor and then guiding the laser to perform the thermal ablation, which kills the tumor with heat while leaving the surrounding areas of the brain untouched.

The entry hole that is made through the skull is about the size of the end of a pen and requires just one stitch and a small bandage following the procedure. Denude was alert, talking and free of pain throughout the operation.

“In order to find the exact spot where the tumor is located, we use a GPS system for the brain so that we can identify the exact target location during laser placement, load and then map out a path in the operating room,” said Danish, who estimates that only 5 percent to 8 percent of brain tumors are intracranial ependymomas.

After the laser is placed in the brain, the patient is moved to an MRI unit, where the operating team can observe in real time how the brain changes temperature with respect to the laser.

“It uses a light energy in order to deliver the thermal therapy,” Danish said. “During the surgery, we could watch everything that was going on, and I was able to talk to her. She’s been under close observation to see what happens with the tumor over time, and so far, everything looks perfect.”
Not available to everyone

Many brain surgery patients are terrified of their pending operations. Denude handled it with relative ease.

“At first I was a little skeptical, but after listening to Dr. Danish, I felt that it was right for me to do this,” said Denude, a schoolteacher. “I don’t remember anything bad about it. There was no pain at all.”

Denude is just glad she had this option available to her. Not everyone does. Only six locations in the country — Hackensack; Manhasset, N.Y.; New Haven, Conn.; Baylor, Texas; and Denver — have this kind of technology, a fact from which Danish and his team derive much pride.

“These options don’t exist where you think they would exist, in Manhattan or Philadelphia. They exist here,” Danish said. “We get offered the ability to use new toys all the time . . .

“What I saw was an opportunity to use this as a tool for patients who had run out of options,” he continued. “Mrs. Denude had a tumor that was growing — we were watching it grow — and we thought this would be a good option for her.”

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Visualase, Inc. is focused product development, clinical evaluations, and manufacturing of advanced laser and image-guided technologies for thermal ablation markets.
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