Listen to an interview with a neurosurgeon
Answers to common patient questions by an experienced neurosurgeon.
An Interview with Dr. Eric Leuthardt, neurosurgeon and user of NeuroBlate®.
So the NeuroBlate technology is really a seamless integration of a number of different modern technologies ranging from a laser to intraoperative robotics to intraoperative MRI. When you look at it, it looks like a crochet needle. Where basically it’s a small probe and, at the tip, there’s a laser. And we insert that laser into a very small incision in the scalp and a hole through the skull and we insert it into the center of the tumor. Then an intraoperative robot basically controls the position of that laser tip so that we can – when the patient’s in the intraoperative MRI – control the laser so that we can shape and mold the heating to kill that tumor in a very conformal fashion. And then, at the end of it, we pull that probe out and you have a single incision – that’s about the length of my fingernail – that we can close with a single stitch.
The location of a brain tumor plays an important role in how we decide on what the surgical strategy is for treating that tumor. If it’s superficial or not terribly close to any critical structures, open surgical procedures are commonly employed. This involves making a larger incisions in the scalp, a window into the skull, and making a small hole in the brain. Now, as the tumor becomes deeper in location – meaning closer to the center of the brain or close to critical locations such as motor and speech areas – then the risk profile of open surgical procedures increases and that’s where minimally invasive approaches – such as laser therapy – become an optimal approach to treating some of these types of tumors.
When we think about brain tumors, we often distinguish them into 2 broad categories. Primary brain tumors, which are tumors that are coming from the brain, and what I mean by that is that some cell in the brain it has become genetically altered and it has uncontrolled growth. So, again, it’s a tumor that has derived from some cell in the brain. That’s a primary brain tumor. The second category is a metastatic brain tumor and these are tumors such as lung cancer, breast cancer, colon cancer that have grown from some other part of the body outside the brain, but have metastasized or spread to the brain.
So the procedure itself often takes several hours under general anesthesia and patients will – to a degree – wake up groggy and that’s normal. Most patients go home around 1-2 days after surgery. The pain tends to be minimal. It’s usually a single stitch. They have to keep the incision dry for about a week, but otherwise they’re able to get back to normal activities by around 1-2 weeks.
It is a common question for me: What would I do if it was a family member of mine? And also, a lot of times, we are dealing with diagnoses that are not curable. These are sometimes malignant brain tumors that we cannot fully cure, but we can only slow down with all the therapies that we have. And that’s where quality of life becomes critical, because for the time that these people have left, we need to make sure that every moment is as good as it can be. That they can spend the time they want with their family, they can do the things that they enjoy, that really give them a high quality for the moments that they have. And so I think that’s where laser therapy plays a critical role, because oftentimes we can kick the can further down the road by treating the recurrence, by treating the tumor upfront, in a minimally invasive fashion that has minimal morbidity and allows them to return to their lifestyle as soon as possible versus open surgeries which could potentially take a lot longer to recover from.
So a craniotomy is a very classic surgical approach that we use to treat brain tumors. Typically this involves making an incision in the scalp, making a window in the bone – where we take a bone flap out – and exposing the surface of the brain to get access to the tumor that’s deeper in the brain. That often involves making some type of hole in the brain so that we can then take that tumor out. After the tumor’s been taken out, the bone is placed back, and then we close the scalp.
Interestingly, laser therapy is both a technology that’s been around, but that’s also new. It’s old in the sense that people have been using lasers to treat tumors for quite some time – close to 10-20 years. Where it’s new is its application in the brain, where we’re combining it with advanced imaging using the intraoperative MRI or a MRI scanner to image in real time so that we can do very precise therapy to kill the tumor cells in a very specific anatomic way, and do it in real time, so the surgeon has very specific control over this therapy while it’s happening.
Anytime we do surgery, I’m always going to give a standard list of complications that can happen anytime you cut the skin and penetrate the brain. Those risks include: bleeding (with any surgery), infection (with any surgery), the risk of something catastrophic happening with surgery (including coma, death, or paralysis). And that’s true whether it’s an open surgery or a laser surgery. Now when I think about laser surgery in particular, some of the things we can sometimes see with the laser is that we can have swelling after surgery that takes approximately 7-10 days to resolve and this tends to be self-limited and improves with steroids. And anytime we’re treating close to a functional area, sometimes there are always a risk that we could injure one of those areas, even though we’re using a minimally invasive approach that gives us a tailored treatment.
Progression free survival is a term that’s commonly used in the scientific and medical literature. What that is a measurement of is the time interval from the time of treatment to the time that the tumor comes back. So it’s an important measure to know how effective that therapy is in controlling the cancer disease.