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News Americas

Drs. G. Michael Lemole Jr., left, and Travis Dumont perform brain surgery at Banner-University Medical Center Tucson. (Photograph: Nikolay Martirosyan)
0 Comments Nov 23, 2015 | News Americas

New microscopy technology may help neurosurgeons save more lives

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TUCSON, Ariz., USA: Researchers at the University of Arizona (UA) have invented a device that, for the first time, allows neurosurgeons, who use microscopes extensively while operating, to see blood flowing inside vessels and more clearly distinguish cancerous from healthy tissue under the microscope. This augmented microscopy technology will help surgeons operate with more precision without having to learn new technical skills or adapt to changes in the operating room.

The technology gives surgeons a much more detailed picture in real time and helps them stay on course in surgeries where being off by 2 mm could cause paralysis, blindness and even death. "When we started developing this technology, we thought of it like a Google map of a surgical view, providing layers of pertinent information in real time," said Dr. Marek Romanowski, Associate Professor of Biomedical Engineering at UA. "Our augmented technology provides diagnostic information under the microscope on demand and in color, appearing directly over tissue a surgeon is operating on—as if the tissue was painted to help direct the surgeon's work."

Romanowski describes the invention with lead author Jeffrey Watson, a biomedical engineering doctoral student at UA, Dr. G. Michael Lemole Jr., Chief of the Division of Neurosurgery in the Department of Surgery at the UA College of Medicine, and UA neurosurgery resident Dr. Nikolay Martirosyan in an article published recently in the Journal of Biomedical Optics.

The new technology overlays the actual image a surgeon sees under a microscope with an electronically processed image using near-infrared (NIR) fluorescence. Most neurosurgeons must look up from a surgical microscope, or stereomicroscope, to view fluorescence on a display monitor. However, this fluorescence shows only contrast in black and white, not anatomical structures or their spatial relationships. Thus, surgeons must visualize how fluorescence lines up with the anatomical structures they see under the microscope. The new add-on technology developed at the UA removes such interruptions or guesswork by showing surgeons real and fluorescence images simultaneously and in one location. The microscope adapted to project fluorescence switches back and forth between the real and electronic views, with the surgeon’s field of vision shortly fading to black in between.

"Surgeons need more information than can be provided by stereomicroscopes alone," said Dr. Jennifer Barton, Professor of Biomedical Engineering at UA and interim Director of the UA BIO5 Institute, who specializes in cancer imaging. "Dr. Romanowski's augmented microscopy technology provides critical functional information that can improve surgical accuracy and efficiency."

The new device, a small box fitted inside a surgical microscope, combines electronic circuitry and optical technologies to superimpose the fluorescence image on the real one and send the augmented view up through the microscope's right eyepiece to the surgeon.

Perhaps the most valuable application of augmented microscopy is treating brain cancer, Romanowski pointed out. More than 20,000 new cases of primary brain cancer are diagnosed in the U.S. each year, and each year nearly 16,000 patients die from the disease, he said. Of the half-million patients who die of any other cancer, up to a third have some form of cancer spreading to the brain. "Brain cancer is especially difficult to remove," he explained. "Current surgical microscopes limit how much of the cancer tissue surgeons can see and how precisely they can determine its boundaries."

Lemole, a skull base neurosurgeon, routinely operates on brain cancer patients, manipulating vessels the width of a pin to remove malignant tumors. "Aggressive resection is associated with the risk of removing normal brain tissue and impairing functions of the patient," he and his co-authors write in the journal. "On the other hand, incomplete resection of a tumor results in its immediate relapse in 90 percent of patients. Intraoperative NIR imaging may aid in resection of these challenging tumors."

Augmented microscopy also holds promise for treating aneurysms. Neurosurgeons treat an aneurysm by sealing it off from connecting vessels to prevent a rupture. Nearly half of patients with ruptured aneurysms die, Lemole said, and at least half of the survivors have major mobility and other problems. Augmented technology could improve the prognosis of aneurysm patients, by giving surgeons real-time feedback on every delicate and potentially deadly surgical maneuver they make.

The article, titled "Augmented microscopy: real-time overlay of bright-field and near-infrared fluorescence images," was published in the October edition of the Journal of Biomedical Optics.

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