When it comes to brain surgery, neurosurgeons want to be as precise as possible, but sometimes it’s difficult to know exactly where healthy tissue stops and tumor tissue begins during brain surgery. However, we may soon be better able to view the brain in real time during surgery thanks to researchers at the Center for Ultrasound Brain Imaging at Erasmus Medical Center (CUBE).
Researchers managed to image live cerebral blood flow during awake brain surgery using a functional ultrasound system. This new technology could help neurosurgeons remove brain tumors without damaging functional tissue in the brain, and it can help spot the tissue during the operation.
The functional ultrasound system works by displaying tiny changes in blood flow in the brain. This may not mean much to the average person, but for a brain surgeon, it would allow them to view all the blood vessels that are feeding a brain tumor in the area. With this information, the surgeon can now chart a course for total and only essential tissue removal.
“Functional Ultrasound (fUS) displays very small changes in blood flow,” said Pieter Kruizinga and Sadaf Soloukey from CUBE. “For tumor tissue, this means that we can see feeding vessels of the tumor in extreme detail, allowing for tumor delineation. For healthy tissue, this technique gives us immediate access to brain activity. During awake brain surgeries we could also ask our patients to perform tasks such as speaking and moving. By identifying exactly those areas where the blood flow follows the pattern of the functional task, we can determine whether or not that brain area is involved. As such, we can image the eloquent areas of the brain and inform the surgeon which brain areas to avoid”.
The importance of removing only critical tissue during brain surgery cannot be understated. While taking a little extra skin from your shoulder during skin cancer removal may only leave you with a lightly larger scar, removing excess tissue during brain surgery can cause speech issues, motor skill impairment or worse. But with functional ultrasound, brain tumor removal may soon become even safer.
“For the first time, we now have access to a technique with which we can image the living brain directly and with an unprecedented level of precision,” the pair said.
The level of detail with the functional ultrasound is beyond compare. Kruizinga and Soloukey said the technology essentially allows them to view a thought in real time.
“We asked our patients to think about words, which we could then display live in our ultrasound images. This means we can now actually image the thought of language using ultrasound. This observation has an impact that reaches even further than just the neurosurgical domain.”
Their work isn’t done either, as their ultimate goal is to be able to get the same level of detail when imaging the brain without the need to remove a portion of the skull, which is required for their current setup.
“The true breakthrough will be when we manage to image the brain without the need for skull removal, as is now still necessary.”
This is truly a fascinating piece of technology, and hopefully we only continue to make brain tumor removal safer for patients all over the globe.