With other surgeries I guess it’s possible for the surgeon to identify the different tissues, nerves, and blood vessels through an X-ray or CT scan and plan the surgery accordingly
But with the brain, doesn’t everything look like a big blob of brain tissue? How can the surgeon tell what part of the brain performs what function and what’s safe to cut so that he can access the tumor? How would he avoid a Phineas Gage type outcome?
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Im a bit late to the party, but maybe have some interesting stuff to share. I work in the IT department of an academic hospital in the Netherlands. One of the software packages I support is Brainlab, which is used mainly for neurosurgery.
And that stuff is mindblowing. They are not the only provider who make such software, there are different options around.
Here’s what the software does:
You load in a CT and/or MRI scan that conforms to certain scanning protocols, i.e. thickness of “slices”, sort and amount of contrast injections used, etc.
The software then is able to mash together these images into one 3D reconstruction of the patients brain. Thanks to some extremely smart maths involved, you can then use different functions of the software to map out tumors, brain regions, and even single strands of nerves running through the brain. I’m not a neurologist, so some things I say may technically be called differently.
With these 3d mappings you can then make a plan on how to operate on the patient. And here comes the amazing stuff: the software is coupled to a few devices in the operation room. Those include computer monitors and infrared positioning cameras. Think Nintendo Wii. The patient will get a frame attached to their head (it’s screwed on, literally…) which has positioning balls in it that get recognized by the IR cameras. The patient then is run through another CT to be able match up the previously made 3D models with the currently installed frame attached to the head.
Why would you do all this? To be able to tell from the outside, where your instruments are on the inside of the head. All the surgical tools that the surgeon uses are also equipped with reflective positioning balls that get picked up by the cameras surrounding the operation table. On the screens the surgeon can see exactly where the probes, scalpels and what not are located inside of the head of the patient. That thy don’t have to cut open a whole section of the skull to be able to see what they’re doing.
This technique is also being used to treat parkinson patients with deep brain stimulation surgery, where an electrode is placed into the motor centre of the patients brain. There, this electrode gives off weak pulses to suppress the tremors. These electrodes have to be placed extremely carefully and aligned correctly to stimulate the right areas. And because the insertion of the electrodes is also guided by this whole navigation system, that’s now possible. Without these neuro navigation systems, it probably would be a lot more difficult to position them correctly in the first attempt.
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