Image Guidance for Minimally Invasive Brain Surgery

The following was written by Alastair J. Martin, Ph.D., Adjunct Professor of Radiology in the Department of Radiology and Biomedical Imaging at UCSF.

Here at UCSF, we are currently working on intra-operative image guidance for the next generation of surgical therapies.  The ability to perform surgical procedures less invasively is very appealing as patients suffer less morbidity and recover more quickly than with standard procedures.  Such approaches, however, must assure that the surgeon is still provided with the feedback necessary to guarantee they have achieved their surgical goals.  Intra-operative imaging can play a crucial role in assuring technical efficacy when employing minimally invasive approaches and this is particularly true in the brain.  Magnetic resonance (MR) imaging is extremely adept at delineating brain anatomy and is routinely used to diagnose a wide range of conditions.  Thus, the use of intra-operative MR imaging holds great appeal for guiding minimally invasive brain surgery.

We have developed a new implantation system for precisely localizing brain structures within an MR magnet.  The system has been employed to implant deep brain stimulators, which are devices that suppress the symptoms of Parkinson’s disease and other movement disorders.  Additional applications for deep brain stimulation, including the treatment of depression and epilepsy, are emerging and intra-operative MR guidance has significant advantages.  The high precision that it affords means that patients need not be awake during surgery so that “test electrodes” can be inserted to determine whether the surgeon has accessed the correct brain structure.  This conventional approach is slow and arduous for patients.  The image guided approach, in contrast, allows the surgery to be performed more quickly and for patients to be anesthetized throughout the procedure.  It also minimizes the number of instruments that are introduced into the brain and permits confirmation of technical efficacy and complication detection during the course of the procedure.

This image guided platform also has great potential for emerging therapies that require localized deposition of drugs or gene constructs.  MR imaging can be used to precisely localize infusion catheters and monitor the infusion of agents into brain structures.  This approach has already been applied to the delivery of viral cocktails for treating brain tumors and soon will be applied to administer investigational gene therapies for Parkinson’s disease.

To learn more, please see this video: