The Brain Surgeon’s New Toolbox

Once upon a time, a neurosurgeon's best friends were a buzz saw and a knife. Now, robotic hands offer doctors the best chance of performing miracles
Sticking your head in an MRI scanner while robotic hands cut into your brain may sound like a terrifying proposition--but at least they won't accidentally nick your optic nerve. After five years and $27 million spent, the University of Calgary and the Calgary Health Region health-care system have unveiled the neuroArm, the first surgical robot that operates inside an MRI scanner, combining high-precision surgery with near real-time imaging. Most surgeons operate within one- or two-millimeter accuracy, says project leader Garnette Sutherland. The neuroArm can make incisions accurate to 50 microns--about half the diameter of a human hair. A surgeon using the neuroArm doesn't even need to be in the same room as the patient--a pair of high-definition cameras mounted on a microscope streams images to the doctor's control station. The controls filter out hand tremors, while a haptics system provides tactile feedback. The haptics can also help prevent accidental damage. "I can set a zone between the optic nerve and carotid artery, and the machine won't let me touch either of them," Sutherland says. Pending a successful debut surgery--most likely a brain-tumor operation this fall--and FDA approval, Sutherland says the robot will reduce surgical error and HMO bureaucracy in one office visit. Typically a patient will undergo an MRI, come back for a consultation, and finally return for a biopsy. "Now," Sutherland says, "if we see a lesion in MR imaging, we could biopsy it on the spot."--Michael Slenske Jason Stang/University of Calgary

The Ultimate Operating Room

If you happen to need brain surgery, the place to be is M.D. Anderson Cancer Center at the University of Texas in Houston. The center’s new $9.2-million operating room, called the BrainSUITE, features one of the most sophisticated neurosurgical setups on the planet (soon to be available in seven other U.S. hospitals). Ceiling-mounted cameras give surgeons a magnified view of the brain, giant “data billboards” display vital signs throughout the room, and an extra-wide MRI scanner can accommodate bodies in nearly any position, so patients lying on their side don’t need to be bandaged up and rolled onto their back to slide into the machine. A surgeon simply swivels the operating table into the scanner to inspect his handiwork. (Scalpels and other magnetic objects, however, must first be moved out of range of the magnet.)

All of this helps to eliminate the dangerous guesswork inherent to brain surgery. With brain tumors, for instance, a surgeon must remove 98 percent of the growth to give the patient a shot at surviving beyond one year. This creates a delicate balancing act. Take out too much tissue, and you increase the chance of damaging other parts of the brain. But leave behind more than two percent of the mass, and it might regenerate, shaving as many as four months off the patient’s lifespan. With the MRI-equipped BrainSUITE, a surgeon can determine in a matter of minutes whether there’s a need to go back in to finish the job-and can get the patient off the table as quickly and safely as possible.-Michael Rosenwald

For a look at laser scalpels, skull drills, and robotic arms on hand to aid today’s neurosurgeons, launch the gallery here.