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Practice Makes Perfect With Brain Surgery Simulator

by Brendon Nafziger, DOTmed News Associate Editor | September 07, 2009
Once more with feeling:
Researcher shows off the brain
surgery simulator
When David Clarke, MD, removed a benign tumor from a woman's brain last month, it was, in a way, the second time he had performed the surgery. Days earlier, the Halifax, Nova Scotia-based neurosurgeon had rehearsed the complex procedure on a state-of-the-art virtual-reality simulator, using a model created from the patient's own medical information. Dr. Clarke believes the operation was the first of its kind where a brain tumor surgery was practiced beforehand on a patient-specific simulator.

Known as NeuroTouch, the computer simulator is being developed by a National Research Council of Canada team of engineers, computer programmers and neuroscientists.

"We have flight simulators," says Ryan D'Arcy, PhD, a researcher at the NRC site in Halifax, and one of the "brains" behind the project, so he wanted to see "what would a simulator for neurosurgery be like."

But Dr. D'Arcy believes this machine one-ups flight simulators. "This is effectively as though your pilot would simulate the exact flight you're about to take before you get on the airplane," Dr. D'Arcy says. "They would simulate the air conditions, what is the best route or whatever."

To prepare simulations on NeuroTouch, surgeons feed MRI scans and other patient info into the computer, which then uses previously gathered data on tumor tissue types to create a three-dimensional model of the patient's condition -- all presented eerily realistic, high-resolution graphics.

The surgeon controls the virtual operation using a feedback-giving device that mimics the look and feel of the continuous ultrasonic aspirator. (Aspirators are surgical tools that vibrate at a high-frequency, pulverizing cancerous tissue, which they then clear with suction.)

"You can feel the vibration," says Dr. Clarke, "the tissue as it's being removed. It's like the actual thing."

For now, NeuroTouch can model three of the most common types of brain cancers, according to Dr. Clarke, including primary brain tumors, pituitary tumors and meningiomas. The tumor removed from the Nova Scotian woman was a meningioma, a benign tumor that afflicts about two percent of the population.

NeuroTouch will undergo trials at 5 sites across Canada, with 50 researchers from various disciplines involved in the project.

Robert DiRaddo, PhD, of the NRC site in Montreal, and the Scientific Lead of NeuroTouch, is in talks with companies to commercialize the device, but he cannot divulge who is interested. "We would like to have an agreement in place within the next one to two years," he said in a statement.

Dr. Clarke thinks the biggest impact of the simulator will be on the patients themselves. "How did my simulated surgery go?" was the first question his patient asked, he says, after he did a dress rehearsal on NeuroTouch. "It may be prophetic," he continues. "I think in the future, people and patients will want to know, how did it go? Were there problems encountered? Were you able to get around those problems? It obviously has implications for the risk of surgery, for consent of surgery. It represents [a change in] how the surgeons will interact with patients."