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Rare Device Aids N.Y. Brain Surgeons

Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)


Posted on: 08/11/2008

Rare Device Aids N.Y. Brain Surgeons

By E.B. SOLOMONT, Staff Reporter of the Sun | August 11, 2008

Inside the operating room, three screens projected the magnified image of the patient's brain as surgeons prepared to remove a tumor. But all eyes were trained on one screen in particular: the one offering a three-dimensional view.

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Ben Parker

Dr. Theodore Schwartz (L) performs a new type of brain surgery in which surgeons use a 3-D camera to operate on the patient through the nostril. The surgery was performed at New York Presbyterian Hospital


"Kill the lights," someone said, shortly after the surgeon, Dr. Theodore Schwartz, entered the operating theater. With an egg-size tumor resting on the patient's skull, Dr. Schwartz had planned a minimally invasive procedure using a three-dimensional endoscope, a device currently used only by a handful of surgeons.

Featuring a 3.4-millimeter microchip on the tip of an endoscope, or tube used to view the interior of a patient's body, the device mimics the vision of an insect: After the tube is inserted into the patient's nose, a matrix of hundreds of "eyes" captures the image inside the brain. A computer then reconstructs the picture in stereo to provide a high-definition image to the surgeon.

"You feel like you're sitting inside the patient's head doing the surgery," Dr. Schwartz, an associate professor in the department of neurological surgery at Weill Cornell Medical College, said. "If the screen were bigger, it would be like an IMAX experience."

In recent years, surgeons and patients increasingly have opted for minimally invasive, or laparoscopic, surgery. The practice has taken off in certain fields, such as orthopedics and gynecology, and it has become popular among surgeons who do prostate surgery, where devices like the da Vinci robot have further changed the way some surgeons operate.

More recently, some neurosurgeons have begun testing minimally invasive techniques for some brain surgeries to avoid traditional craniotomies, which require breaking open a patient's skull to reach the brain.

"You'd make an incision around and behind the ear, take off bone from the skull and spine, dissect around the spinal cord, brain stem, and through the cranial nerves to get this tumor," Dr. Schwartz said, tracing a line around his own head to describe the traditional procedure.

In this case, the three-dimensional endoscope, manufactured by an Israeli start-up company, Visionsense, received the approval of the Food and Drug Administration in March. But the concept was initiated more than 10 years ago, when Visionsense's founder, Avi Yaron, was hospitalized after a motorcycle accident. Doctors ordered an MRI to rule out brain injuries from the crash and found a tumor.

"He invented this technology to save his own life," the company's executive vice president, Joseph Rollero, said. Today, Mr. Yaron is "tumor-free and it's behind him," Mr. Rollero said.

The device, while not yet commercially available, is being used by a handful of surgeons around the country, including those at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, who have joined with Visionsense to refine the product. The company is not paying the doctors to do so, Mr. Rollero said.

So far, Weill Cornell surgeons have operated on about 20 patients using the three-dimensional endoscope. In the past five years, they operated on 250 patients using an older, two-dimensional endoscope that transmits a flat image that some surgeons said is not as good as the loupes and microscopes traditionally used during brain surgery.

Indeed, Dr. Schwartz said brain surgeons have been slower to adopt endoscopic techniques because many were trained using traditional methods. "Neurosurgeons are used to working with a microscope," he said. "It kind of required a paradigm shift in neurosurgeons' ability to see and be comfortable using an endoscope."

During a recent surgery, the patient — a 30-year-old auto mechanic, Nazeer Kahn — was set to undergo an operation to remove a chordoma, a rare type of tumor that grows on the spine or at the base of the skull. Reached several days before the operation, Mr. Kahn said he was painting a car when his vision became blurry and he started to see double. He said he was scared but also relieved to know doctors would not be cutting through his skull.

"I can't feel it. I look in the mirror, I can't see anything," he said of the tumor. "I'm just scared, to be truthful with you."

In his case, doctors said the mass, described as average to large in size, was wedged in a precarious spot near two branches of the carotid artery, the blood vessel that supplies the head and neck with blood.

Prior to Dr. Schwartz's arrival, a team of surgeons prepped Mr. Kahn for surgery. Passing through his nostrils, surgeons cut open the sinuses to create a cavity of space where Dr. Schwartz would work.

On the screen, the interior of the sinus cavity had the appearance of peaks and valleys. Using a diamond-studded drill, Dr. Schwartz bored deeper to reach the tumor, operating in a space the size of a coin.

"Make sure we're not anywhere near the carotid," Dr. Schwartz said to a team of gowned surgeons assisting him.

Later, Dr. Schwartz said his precision is not affected during endoscopic procedures. "The precision has to do with the instruments and the surgeon's hands," he said. "The advantage is that you can see better with the endoscope because you're going in directly to the barrel of the tumor."

Mr. Kahn, who was ready to leave the hospital two days after the surgery, "did great," Dr. Schwartz said. "Eventually, I think, it will become the standard of care throughout the country."

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