Surgical Theater: Exploring the brain in 3D

The technology is capable of combining CT, MRI, fMRI and PET imaging into a single 360-degree, 3D color picture in virtual reality.

A powerful new technology gives neurosurgeons at Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine, an incredible tool for planning complex surgeries and then sharing that information with patients and families in virtual reality (VR).

The technology, called Surgical Theater, is capable of combining CT, MRI, fMRI and PET imaging into a single 360-degree, 3D color picture in VR. The result is a robust and intuitive model combining all the images with high precision.

With Surgical Theater’s VR, we can simulate a procedure and practice before we ever step into the operating room. This tool uses research-grade technologies and allows us to integrate them for clinical use. Norton Children’s Hospital is the first hospital in the region to use this cutting-edge technology.

For epilepsy, it’s a game changer. With the virtual 3D model, laser ablation can be targeted as never before. Precision makes all the difference. If the laser is off by 1 centimeter in one direction, the patient may permanently lose function. A centimeter off in the other direction, and the surgery fails to stop seizures. For epilepsy and some tumors, Surgical Theater technology is integrated with highly precise surgical procedures for planning and navigation. VR images from before and during surgery can be compared and shared with patients and families to help them understand what is going on.

Surgical Theater can be used with complex brain tumors, offering surgeons a chance to explore different surgical exposures and routes to the tumor. The 3D VR environment offers a more intuitive understanding of the anatomy. Instead of just seeing a tumor, we can see tumor, vessels and functional areas of the brain. VR interaction might help the surgeons know where to put the craniotomy (opening in the skull) and might lead to picking a different route to the tumor than previously considered.

Surgical Theater is far superior to the traditional way of preparing for surgery — by looking at multiple black-and-white, 2D images from different sources. Now, we can move through all the scans at once, in three dimensions.

Surgical Theater is a helpful tool for children and their families, too. Surgeons are able to move patients and families through vivid VR images of the brain, showing the precise locations of the tumors, lesions and other anomalies. This can help families understand risks and benefits of particular surgeries in a much more understandable way. Surgical Theater is used during the informed consent process. It’s much easier for patients and their families to understand and relate to information when they can virtually fly though images of their own brain, and see exactly what the challenges are.

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To take advantage of this revolutionary technology requires work. Norton Children’s Neuroscience Institute has a full-time, dedicated project leader who not only collects and organizes these images, but also is actively involved in creating new processes for the epilepsy program.

“We are using Surgical Theater in unique ways here in Louisville,” said Andrew Carlson, B.S., project leader for Surgical Theater, Norton Children’s Neuroscience Institute. “We are developing image analysis processes here that will be used all over the country, potentially.”

We are only at the beginning of this VR revolution. In the not-too-distant future, we will collect gray matter volumetry and white matter diffusivity data that can provide useful information about the whole brain. This data can be generated by the Surgical Theater system, which may one day give us new biomarkers for such conditions as epilepsy, dementia or multiple sclerosis.

On a more novel note: The technology also may be able to extract bony detail from MRI images, eliminating the need for CT scans of the head in children and adults. CT scans use radiation, increasing the risk of cancer in patients.

“I looking forward to seeing — and helping to create — where virtual reality takes us,” said Ian S. Mutchnick, M.D., director, pediatric restorative neuroscience, Norton Children’s Neuroscience Institute, and assistant professor, pediatric neurosurgery, University of Louisville School of Medicine Department of Neurosurgery.

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