Digital imaging guides neurosurgery into the future

Diagnosis, imaging, and management of brain tumors have all improved in the century since the first successful brain tumor resection. Technological advances are largely responsible, and not the least of these is digital imaging.

Operating rooms for brain tumor surgery have correspondingly evolved in complexity, with multiple forms of equipment now considered necessary.

"Digital imaging modalities such as intraoperative MRI coupled with surgical navigation are standard essentials in an operating room for the surgical management of brain tumors," said Dr. Gene Barnett, chair of neurosurgical oncology at the Cleveland Clinic Taussig Cancer Center.

Large plasma displays of PACS radiology information are highly desirable, as is Internet and intranet access with wireless, encrypted capability, he said.

Other features of the neurosurgical operating suite include access to electronic medical records and tracking of inventory for automated billing of equipment.

Barnett expected that minimalism in combination with advanced image-guidance techniques and a cohort of sophisticated technologies like robotics and nanotechnology will drive changes in the OR environment for the foreseeable future. He documented the modern brain tumor OR from standard essentials to current state-of-the-art in a recent paper (J Neurooncol 2004;69(1-3):25-33.)

"In the future, robotic assistance including dexterity enhancement will extend operability of many lesions," he said.

Also on the horizon are tumor-specific fluorescent ligands and fluorophores that will enhance extent of resection. Computer simulation of drug distribution by convection-enhanced delivery (slow, continuous infusion of drug through the substance of the brain) and computer-generated site recommendations for catheter placement for this delivery are desirable as well.

"Multimodality stereoscopic displays of the surgical field in combination with image-derived data will need to be presented to the surgeon, perhaps through direct laser-retinal displays," he said.