You don't need to be a brain surgeon to recognize the extremely complex nature of brain surgery, but a new device called the stimulated Raman scattering (SRS) microscope might take some of the uncertainty out of these highly intricate operations. To a certain extent neurosurgeons must rely upon their past experience and intuition to determine the edges of a tumor while removing it, but researchers believe SRS may help them distinguish between normal brain tissue and tumor tissue in real-time.

“There is a lot of ambiguity and judgment that goes on in the practice of brain tumor surgery,” Dr. Daniel Orringer, the University of Michigan Health System neurosurgeon piloting the technology, told HCB News. “The hope is that we will be able to eliminate some of that guesswork and make the process of taking out a tumor more of a quantitative process and a more data driven process, rather than something that relies on the physician’s own judgment.”

Orringer and his colleagues are currently working on a second-generation version of the device, which they hope to keep close to the operating table once complete. Surgeons can insert a fresh tissue sample into the device, which will immediately generate microscopic images to determine if more surgery is needed to remove the tumor, or if the entire lesion has been removed.
The team developing the SRS microscope intends to make it roughly the size of a microwave and more affordable than any of the current imaging technologies used for this purpose, such as intraoperative MR. Orringer believes that the technology will be of more interest to surgeons if the cost and space-capacity barriers are eliminated.

Traditionally, surgeons have to wait a half hour or more to get microscopic images. The tissue has to be frozen, sectioned, stained and interpreted by a pathologist who is trained to determine the difference between cancer cells and normal brain cells.

In addition to pathologists, Orringer believes that neurosurgeons will also interpret the SRS images in the future, just like they do with MR images. MR images are formally read by radiologists, but neurosurgeons use those images in the operating room to evaluate their progress.

“Much in the same way that neurosurgeons use radiology now, we expect they will use the microscopic pathology information in the future to make their decisions about what they are doing in the operating room,” said Orringer.

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