Neurosurgeons develop new technologies to perform highly complex brain surgery

In a milestone procedure, neurosurgeons at UC San Diego Health System have integrated advanced 3D imaging, computer simulation and next-generation surgical tools to perform a highly complex brain surgery through a small incision to remove deep-seated tumors. This is the first time this complex choreography of technologies has been brought together in an operating room in California.

"Tumors located at the base of the skull are particularly challenging to treat due to the location of delicate anatomic structures and critical blood vessels," said neurosurgeon Clark C. Chen, MD, PhD, UC San Diego Health System. "The conventional approach to excising these tumors involves long skin incisions and removal of a large piece of skull. This new minimally invasive approach is far less radical. It decreases the risk of the surgery and shortens the patient's hospital stay."

"A critical part of this surgery involves identifying the neural fibers in the brain, the connections that allow the brain to perform its essential functions. The orientation of these fibers determines the trajectory to the tumor," said Chen, vice-chairman of Academic Affairs for the Division of Neurosurgery at UC San Diego School of Medicine. "We visualized these fibers with restriction spectrum imaging, a proprietary technology developed at UC San Diego. Color-coded visualization of the tracts allows us to plot the safest path to the tumor."

After surgery planning, a 2-inch incision was made near the patient's hairline, followed by a quarter-sized hole in the skull. The surgery was carried out through a thin tube-like retractor that created a narrow path to the tumor. Aided by a robotic arm and high-resolution cameras, the team was able to safely remove two tumors within millimeter precision.

"What we are seeing is a new wave of advances in minimally invasive surgery for patients with brain cancer," said Bob Carter, MD, PhD, professor and chief of Neurosurgery, UC San Diego School of Medicine. "These minimally invasive approaches permit smaller incisions and a shorter recovery. In this case, the patient was able to go home the day after the successful removal of multiple brain tumors."

UC San Diego Health System is an internationally recognized leader in minimally invasive neurosurgery. Chen is a pioneer in tractography-guided procedures and an expert in endoscopic surgery. He was among the first surgeons in the U.S. to perform magnetic resonance imaging-guided laser and gene therapy to treat brain cancers such as glioblastoma.