Neurosurgery, going into the brain with IGS (image guided surgery)

Wednesday was Dr. Dharmendra's OT day, we were lucky to have the chance to see the IGS performed on 3 patients. Moreover, three of them were using the different technique of IGS. Basically IGS is a image guided surgery, in which the computer helps the surgeon to identify and localize the lesion in the brain in order to perform some procedures such as biopsy, drainage etc.

Brain is the most vital organ in our body. Any small damage may cause serious impact on the patient function. Therefore, these modern technology help to localize the lesion to even less than 1 mm error, giving a much better operation outcome and reduce morbidity and mortality.

IGS uses the help from CT Scan and MRI, it can combine both images to produce the desire picture. 3 types of IGS are framed, frameless and making a preset pathway. The computer is from BrainLab, currently on trial period, and the technicians were there to explain and show the way to use the computer.

This is the first patient with frame. After CT scan immediate before surgery, the CT picture is transferred to the computer. After setting a preferred pathway to enter the brain for biopsy, the computer will calculate the angles for surgeons. You can see Dr. Dharmendra is setting the angles on the gadgets.

The top and bottom gadgets are set with the same angle to calibrate the accuracy. The needle touching right on the centre showing good accuracy.

After incise through the scalp, drilling is done to go through the skull.

One can see the drilled hole on the skull. Scary isnt it?

The second patient uses frameless technique, not as accurate as the framed one, but still has very high accuracy. Note that there are 'cameras' on the patient to identify the probe location.

The location of probe will be translate into the CT Scan of patient taken earlier. However, this technology doesnt show the insight view after procedure is performed eg. abscess drainage on this patient. Brain structure may change after drainage, thus the image is no longer accurate after that.

Third patient has a preset pathway to let the needle enter. A needle holder which looks like a robot hand, is set up based on the calculated angles. The biopsy needle will then enter the brain, and the computer will show on live of the needle entering.

Some gadgets of the 'robot' hands.

Aspirating the syringe to biopsy some tissue.

BrainLab computer

I'm in neurosurgery, plastic surgery and paediatric surgery for this 2 weeks. They are highly specialized surgical field, and I have no idea what's going on most of the time. But it's nice to have the chance to see how things work nowadays. I believe this opportunity is not available everywhere, as it requires a modern facilities, good technicians, suitable patients and skilled neurosurgeon (there are only very few neurosurgeon consultant in this country!)

Btw, we had lunch in OT (first time) with Dr. Dharmendra, he is very nice and we are glad to learn with him. Going for for MASUM (Majlis Sukan Universiti Malaysia) in UUM Kedah today, playing squash. Gonna back on next Wed or Thurs, will miss quite a few classes. Hopefully I will pick up.