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Can a new technique stop bleeding during brain surgery?

Brain surgeons in Australia tested the accuracy of a specialized imaging needle to detect blood vessels during brain surgery.

Surgeons perform brain biopsies on approximately 80,000 patients a year in the United States. Biopsies are usually carried out for the diagnosis of brain tumours, which would then be removed by brain surgery. Bleeding into the brain following the biopsy is the most common complication and unfortunately the most serious. It can lead to permanent disability and death in a small percentage of patients.

Researchers in Australia have borrowed a fibre-optic technology used by cardiologists and ophthalmologists to detect small blood vessels that are not easily seen. The technology is proposed to replace the current practice of using MRI or CT to localize blood vessels prior to surgery. Difficulties with the current approach include a lack of real-time accuracy. That is, due to the growing nature of the brain tumor the blood vessels may have changed size and location in the time that occurs between the MRI or CT and the brain biopsy procedure.

Using the new technology, the presence of blood vessels is detected during the same procedure as the biopsy is taken. The tiny fibre-optic probe is inserted inside a standard brain biopsy needle. Once inside the brain tissue, it can detect blood vessels with a diameter as a small as that of a thread of hair. The surgeon uses the probe to determine a safe place within the tumour to take a biopsy. The probe is then removed from the inner part of the needle and replaced with the cutting device that actually takes the biopsy.

Surgeons tested the new technology in 11 patients who were undergoing brain surgery and consented to participate in the study. The needle was not used as a part of the surgery but was used on the surface of the brain to detect vessels. The results it provided were then compared with the high-quality photograph taken with a scale for measuring blood vessel diameter to determine accuracy. The results were published in Neuroscience.

The accuracy of the fibre-optic technology for detecting vessels was over 90%. The surgeons discuss that the results suggest that imaging needles may be valuable to use in a range of different brain surgery situations.

Written by Nicola Cribb, VetMB DVSc Dip.ACVS

References:

  1. Ramakonar H, Quirk B, Kirk R, et al. Intraoperative detection of blood vessels with an imaging needle during neurosurgery in humans. Sci Adv. 2018;4(12):eaav4992. doi:10.1126/sciadv.aav4992.
  2. Eurekalert. The Global Source for Science News. https://www.eurekalert.org/pub_releases/2018-12/uoa-hmb121718.php . Last accessed January 11, 2019.
Nicola Cribb
Nicola Cribb
Nicola obtained her Veterinary and Master’s degrees from the University of Cambridge, UK, and Doctor of Veterinary Science from the University of Guelph, Canada. She is board-certified in surgery and has research interests in minimally-invasive surgery. She has worked in a clinical setting, as well as research and teaching disciplines for the past 16 years at the University of Guelph, where she is currently Adjunct Faculty. She is a freelance medical writer and reviews, authors, and co-authors publications and reviews in scientific journals and books.
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