Brain Surgery with Light and Sound

Technology is the linchpin in advanced medical procedures.  One of the most important inventions in medicine was Magnetic Resonance Imaging (MRI).  The concept of using magnetic fields to image various parts of the body was developed in the 1970’s and practical use started in the mid 1980’s. The inventors were awarded the Nobel Prize in physiology and medicine in 2003, underscoring the importance of MRI.  We now use MRI routinely to diagnose tumors, strokes, heart attacks and other maladies.  But wait, there’s more. MRI is now being used to guide and actually help direct surgical intervention.  An MRI machine, using sophisticated equations, can measure the temperature at very precise locations in the brain in real-time. Leveraging this Magnetic Resonance Thermography, we can perform sophisticated brain surgery in the MRI scanner using only laser light or ultrasound waves as “scalpels!” 

Laser Interstitial Thermal Therapy or, LITT, uses precisely placed glass fibers to treat patients with epilepsy and to destroy brain tumors.  The glass fibers allow laser light to be delivered to a specific location without cutting through the brain.  Once the fiber is introduced to the target, and the location is confirmed in the MRI scanner – the laser is activated.  In real-time we observe the temperature rise and watch the seizure focus or brain tumor “melt away.”  The whole surgery is done through a 2mm hole in the skull and uses one stitch to close the skin! Unlike conventional surgery which requires large openings and a surgical microscope looking only at the area of interest, we can see what is happening at the target and all over the brain in three dimensions with nothing more than a 2mm hole in the skull. The MRI provides visual and thermal feedback, helping the surgeon compete the operation accurately. This minimally invasive approach leads to fewer days in the hospital and a quicker recovery.

Magnetic Resonance Guided Focused Ultrasound (MRgFUS) uses sound waves instead of laser light to treat essential tremor and tremors associated with Parkinson’s Disease.  Instead of implanting a fiber to the target, MRgFUS uses multiple sources of ultrasound 
waves and transmits them through the skin and skull to the target where the tremors originate. The cells causing the tremor are heated and destroyed.  The patient gets immediate relief.  Again, doing this in the MRI scanner, we can see the small area (2-3mm in diameter) that is treated and all the surrounding areas of the brain as well.  Because sound travels faster through solids and liquids than air – we penetrate through the skin, skull, and brain tissue quickly and accurately.  Each individual source is not strong enough to destroy or heat tissue on its own, but when the multiple sources all intersect at the target, we can treat the cells that cause the tremor. This is all done without any incision and the patient is discharged home after the procedure. 

As technology advances, physicians and surgeons need to understand it and embrace it.  Often the advances are small and need time to make impact.  LITT and MRgFUS are not small advances. These technologies are enabling us to perform sophisticated neurosurgery with fewer complications, shorter hospital stays and quicker recovery.  The Washington Brain & Spine Institute is the only adult neurosurgery practice in the Metro DC area offering these innovative treatments.