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Operating on the brain in new, more precise ways

October 31, 2017 | UCI Health
neurosurgery 264

Craniotomy — removal of part of the bone from the skull to expose the brain — just might be the oldest form of surgery known to man. Scientists believe prehistoric man used crude tools to open the skull for magical, religious or initiation purposes.

Since its first medical use was documented by Hippocrates in the 5th century B.C., brain surgery has evolved to a point where doctors today routinely use highly complex methods to restore function and save lives.

Today, most surgeries still involve opening the skull and to expose an area of the brain. But through the years those cuts to the skull have gotten smaller and the instruments have become more sophisticated.

A burst of innovation over the past 10 to 15 years is allowing UCI Health neurosurgeons to reach delicate brain tissues through pinhole-sized openings in the skull using techniques that:

  • Increase precision
  • Reduce risk
  • Expedite recovery
  • Improve outcomes for patients

While these minimally invasive techniques are not for all conditions, they can be extremely effective for treatment of epilepsy and some types of brain tumors. Live Well spoke with neurosurgeons Dr. Gilbert Cadena and Dr. Sumeet Vadera, surgical specialists in brain tumors, epilepsy and other neurological conditions, about these leading-edge tools their predecessors could only dream about.

Brain navigation with BrainPath®

Neurosurgeons use a tool called BrainPath® to reach tumors that were once deemed inoperable.

BrainPath uses a GPS system based on a patient’s MRI to target small and deep-seated lesions and tumors. Images from a tiny camera inserted through a small incision in the skull are projected onto large screens in the operating room.

Using these images, surgeons are able to navigate between the natural folds and neural structures in the brain, much like a boat moving through water, without cutting or damaging anything else in its path.

Once they reach the targeted areas, they can obtain tissue samples for biopsies or remove tumors with extreme accuracy, eliminating the potential for damaging surrounding tissue or the paths that carry information throughout the brain.

Endonasal (nostril) skull base surgery

With this technique, a 4 mm endoscope with a camera and its own light source is laced through the natural corridor of the sinus into the brain, directly to the tumor.

This is helpful for hard-to-reach tumors in the front of the brain, and it eliminates the need to make large incisions or remove parts of the skull. Again, surgeons work from real-time images from the endoscopic camera that projected on a large screen. 

Laser ablation

Advances in MRI technology and lasers make it possible to cut out tumors with a thin laser that directs heat to kill them from the inside out, while minimizing damage to healthy tissue.

This thermal energy also is used to disrupt brain lesions that may be triggering certain types of epileptic seizures. These procedures are done through pinhole-sized openings in the skull and are directed precisely at the area of concern.

Robotics with ROSA

ROSA is a robot that assists neurosurgeons with a variety of minimally invasive procedures.

In 2015, UCI Health was the first hospital on the West Coast to acquire ROSA. It’s used for biopsy and laser ablation of tumors and lesions. It has also replaced the formerly invasive stereoelectroencephalography (SEEG) procedure, in which doctors placed electrodes in the brain to identify areas where epileptic seizures originate.

Today, using ROSA, surgeons can implant electrodes through a pinhole-sized opening to locate the source of seizures. UCI Health Comprehensive Epilepsy Program has the highest level of designation — Level 4 — and is one of the few in the country to use this robot for neurosurgery.

“Our premiere center is one of the busiest places on the West Coast for epilepsy surgery,” says Vadera. “We naturally aim to reduce the number and severity of seizures, but our goal is to cure epilepsy. For certain surgeries, 60 percent to 80 percent are completely cured.”

Adds Cadena: “This is an amazing time to be a neurosurgeon. Every day there’s something new. Being in this environment at UC Irvine, where the collaborations are so easy and there are so many bright minds, allows us to continue to push the envelope.”

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