New Brunswick, NJ – A leading neurosurgeon has performed the nation’s first laser-assisted brain surgery for a specific type of resistant brain tumor using technology so advanced that the patient went home the next day.

Shabbar F. Danish, M.D., Director, Stereotactic and Functional Neurosurgery and Assistant Professor at UMDNJ-Robert Wood Johnson Medical School (RWJMS) and Robert Wood Johnson University Hospital (RWJUH), used the Visualase, Inc., laser-assisted thermal ablation technique to operate on a patient with a recurring brain tumor after two previous surgeries and radiation did not permanently destroy the growth.

The technology is the latest addition to RWJUH and RWJMS’s growing expertise in the division of neuroscience. Dr. Danish specializes in the latest in stereotactic neurosurgery, which involves targeting small areas in the brain with techniques used to treat everything from Parkinson’s disease to brain tumors.

Susanna Denude of Riverdale, N.J., was diagnosed with an intracranial ependymoma, a tumor that grows from the cells that line the ventricles in the brain. While only six hospitals in the country offer laser-assisted thermal ablation, this is the first time in the nation that the treatment was used for an intracranial ependymoma, explains Dr. Danish.

“This is a tool for patients with tumors who have been told they do not have other options,” Dr. Danish says about laser-assisted thermal ablation. “This is also a viable option for patients who do not want radiation therapy or general anesthesia. Additionally, we can take their hospital stay from four to seven days down to 24 hours.”

The technique involves placing a laser directly into the tumor and then guiding the laser to perform thermal ablation, or killing it with heat, while leaving the surrounding areas of the brain untouched. The entry hole that is made through the skull is about the size of the end of a pen and requires just one stitch and a small bandage following the procedure.

“In order to find the exact spot where the tumor is located, we use a GPS system for the brain so that we can identify the exact target location during laser placement, load and then map out a path in the operating room,” says Dr. Danish.

After the laser is placed in the brain, the patient is moved to an MRI unit, where the operating team can observe in real time how the brain changes temperature with respect to the laser. “It uses a light energy in order to deliver the thermal therapy,” adds Dr. Danish. Only local anesthesia is used and the patient is able to go home the day after surgery.

“What we hope for Ms. Denude is that she goes on now to live a full life,” Dr. Danish says. “She’s a very active woman.”

To learn more about RWJUH, please visit www.rwjuh.edu. For a referral to a physician affiliated with RWJUH, please call 1-888-MD-RWJUH. Follow us on Twitter at www.rwjuh.edu/twitter and Facebook at www.rwjuh.edu/facebook.

To learn more about UMDNJ-Robert Wood Johnson Medical School, visit rwjms.umdnj.edu. Find our fan page on Facebook and follow us on Twitter @UMDNJ_RWJMS.

- 1917: Einstein proposes the theory of “stimulated emission,” by which a photon, or light particle, induces an atom to emit an identical photon.

- 1953: American physicist Charles Townes builds forerunner of the laser, a “maser,” for Microwave Amplification by Stimulated Emission of Radiation

- 1957: Gordon Gould, a doctoral student under Townes, coins the term “laser,” theorizing that light could be used to excite atoms into making a coherent beam of light. Later files a patent; legal dispute lasts nearly three decades.

- 1960: First laser, built by Theodore Maiman of Hughes Research Laboratories in California, becomes operational.

- 1961: Laser used for first time in surgery, to destroy retinal tumor.

- 1962: Invention of the semi-conducting diode laser, the mainstay of small commercial lasers today.

- 1969: Laser’s use in telemetry makes headlines. A beam bounced back by a mirror deployed by the Apollo 11 crew measures the distance between Earth and the Moon to within a few yards.

- 1971: Lasers enter the arts, with light shows and the awarding of the Nobel Prize to Dennis Gabor, a British-Hungarian, for holography.

- 1982: First Compact Disc player. First CD to be pressed is “52nd Street” by Billy Joel.

- 1991: First laser surgery to correct short-sightedness. Gulf War sees first use of laser-guided munitions.

- 1996: Toshiba sells first digital versatile disc (DVD) player.

- 2008: French neurosurgeons use fiberoptic laser and keyhole surgery to destroy brain cancer.

More on Dr. Alexandre Carpentier

Source:
http://www.independent.co.uk/life-style/house-and-home/laser-a-timeline-1973907.html

Revolutionary Techniques in Neurosurgery:
A Q&A with Ravish Patwardhan, MD

Published Online: April 15, 2010 – 3:03:03 PM (CDT)
Ravish Patwardhan, MD, is the founder and director of the Comprehensive Neurosurgery Network (www.brainandspinecare.com), which “specializes in minimally invasive techniques for treating brain and spine problems.” Patwardhan has more than 12 years of experience in the neurosurgery industry and has published several peer reviewed studies on brain trauma, tumors, epilepsy, and spinal procedures. He is also a frequent speaker on the latest treatments and advances in brain and spinal surgeries.

What are the benefits of the Visualase laser probe technique, and do you believe it will become the standard for brain tumor eradication?

The best way to understand the Visualase laser system is to understand what it simplifies. Say a patient comes in with a brain tumor that is less than 2cm in diameter. While he or she is awake, a small area of the scalp is locally anesthetized, and a stab incision is made, with a small hole drilled in the precise trajectory to enter the middle of the tumor and run its length. The operating room portion ends here. The patient is transferred to the MRI suite, where the precise position is verified on MRI scan. Subsequently, the tumor is ablated in the MRI scanner, leaving a black hole where the tumor used to be. The probe is removed in the MRI scanner, and a previously placed stitch is tied, all while the patient is awake and responding, to ensure that no new problem has occurred. The entire procedure takes about an hour (5 minutes in the operating room and 45 minutes in the MRI suite).

The length of time of the procedure, avoidance of general anesthesia, shortened length of stay in the hospital (patients may go home the same day versus three days or more, following a typical craniotomy for tumor resection), reduced blood loss (a few drops), smaller incision size (stab incision), and subsequently less pain all result in a quicker recovery. Because this technology is so new, we’re learning more about it with each case. We learn about which tumors in which locations may or may not be amenable to treatment with laser ablation. Presently, though, laser ablation’s advantages appear to be its ability to treat deep brain tumors—which would destroy the brain if approached openly surgically—and to produce relatively instant results. This is opposed to waiting several weeks to see an MRI change for techniques like Gamma Knife.

The laser is compatible with the Visualase Thermal Therapy System, which incorporates advanced MRI-thermal image guidance and novel cooled laser applicator technology for real-time monitoring and control of the ablation process.  The new PhoTex30 Diode Laser and Visualase cooled laser applicators allow creation of large ablation zones (up to 3cm in diameter) from a single probe in approximately 2 minutes.  Multiple probes can be used simultaneously to cover larger areas of tissue in the same short exposure time.  .

Visualase uses light energy to destroy unwanted tissue through a process called Laser-induced interstitial thermotherapy (LITT). In this treatment, laser fibers are directed to targeted areas in the body, often tumor tissue. Laser light is delivered through the probe which raises the temperature to lethal levels in the targeted tissue.  As more physicians become trained on the Visualase technology, lasers may have an increased impact on many types of tumor therapy.  Doctors are currently using the system for ablation of brain, prostate, liver, bone, and other solid tumors.

PhoTex30 Diode Laser System

For more information about the PhoTex30 Diode Laser Series and Visualase Inc., visit http://www.visualaseinc.com.
For news and events about Visualase Inc., visit http://www.visualaseinc.com/news/

Contact

Andres Schulz
Media and Marketing

Visualase Inc.
8058 El Rio Street
Houston, Texas 77054

New surgical technique uses laser energy to destroy brain tumors

Novel approach is minimally invasive and precise
04:20 PM CDT on Wednesday, October 7, 2009
Wendy Rigby / KENS 5

Perez has had one surgery to remove the tumor, but now the cancer has returned. This time, Dr. John Floyd, a U.T. Health Science Center neurosurgeon, is trying something different.

In an operating room at St. Luke’s Baptist Hospital, the doctor secured an anchor in the outside of the skull. Then, using what’s called neuro-navigation for precision, he slid a catheter several inches inside the head. That catheter houses a laser that can zap the cells growing out of control and threatening Perez’ life.

After the catheter was in place, the patient was moved to an MRI suite, where real-time images showed the doctors the area they were treating.

“Now we have another surgical technique which is minimally invasive and excellent for recurrences,” Floyd said.

While the two-step procedure took several hours, the heating and killing of the tumor took less than five minutes.

“In fighting brain cancer and brain tumors, we need everything that’s available at our disposal to be able to win the battle,” commented Dr. David Jimenez, head of the neurosurgery department at UTHSC.

Full article and video at News5

Visualase will be holding a seminar for physicians interested in the Visualase technology. Neurosurgeons that have used Visualase will present case studies and will be available for QnA. Please RSVP if you like to attend. There is limited capacity for this event.

Ray Turner, 33, a Medical University of South Carolina neurosurgeon, performed the first laser brain surgery in the hospital’s history, only the 10th performed in the United States and the 30th in the world. “It’s exhilarating,” he said Thursday. “This is what we want to do in medicine, stay on the cutting edge.”

Rare laser brain surgery a first at MUSC – The Post And Courier Charleston, SC

30 Minute Brain Surgery – WCIV ABC News 4 Charleston, SC

1. GBM Guide – MGH Brain Tumor Center

   Dec 2, 2005 … A patient guide. by John W. Henson, M.D., MGH Brain Tumor Center … The exact name and grade of the tumor determine treatment options, …
   brain.mgh.harvard.edu/patientguide.htm – Cached – Similar

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   Brain Tumor Guide for the Newly Diagnosed

   File Format: PDF/Adobe Acrobat – Quick View
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   The Essential Guide to Brain Tumors

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   40 THE ESSENTIAL GUIDE TO BRAIN TUMORS. National Brain Tumor Society | 800 934 2873 | www.braintumor.org. There are some cases where chemotherapy treatment …
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Burning out brain tumors: new procedure shows promise

Posted: Apr 20, 2009 5:59 PM CDT Updated: Apr 28, 2009 11:51 AM CDT
By Carolyn Roy, KSLA News 12

SHREVEPORT, LA (KSLA) – A Shreveport neurosurgeon has taken brain surgery for the removal of tumors to a whole new level, finding a way to obliterate a tumors, with much less risk.  A Many, Louisiana woman was the first patient in the U.S. to have the procedure done.

Karen Mowad … has been through surgery, chemotherapy and radiation…, but when the cancer spread to her brain, she came to Dr. Ravish Patwardhan of the Comprehensive Neurosurgery Network.

The Shreveport neurosurgeon had to open her skull to remove that tumor.  It’s the kind of surgery that leaves a big scar and comes with serious risks and a longer recovery time.  But by the time another tumor appeared last fall, Dr. Patwardhan had a new tool to try: a laser probe, and he was looking for a patient willing to be the first.  “We offered her both options,” says Dr. Patwardhan. “We said, ‘Look, you’ll be the first one in, really, North America to have this tumor re-sected for a metastatic brain tumor.  If you’re interested in it, we can do this. It involves making a small opening and going in and burning it.”  The alternative was another open operation.  Mowad was in.

The procedure, marries the precision of navigation tools … with an MRI-guided laser probe developed by Visualase out of Houston. “What this does is you just have to make a hole that will take you to the middle of the tumor, burn the tumor and then the tumor will essentially evaporate.  It’s actually done in the MRI suite, so when the probe is confirmed to be in the correct position in the MRI suite what you do then is heat it and you can watch it directly on the MRI scanner what area is being heated using the program.  After that you can do another MRI scan, since the patient is already there to show the tumor is gone.  So you have instant gratification.”

The procedure leaves behind a small pinpoint incision, comparable to that size of the tip of a pencil.  Karen Mowad was able to stay awake through the procedure, and felt no significant discomfort.  In addition to avoiding the risks related to anesthesia, the laser ablation probe is thin and slides through the brain with much less disturbance.  It allows the surgeon to reach even deep tumors with far less risk, like the brain swelling that comes with conventional procedures.

“It’s so much simpler and easier on the patient than a conventional procedure,” says Dr. Patwardhan.   It’s also faster, and it appears to be just as effective, if not more so.  Mowad’s surgery came at the end of one week.  She was back at work by the beginning of the next.  (Please note Visualase is effective in ablating tumors. It is not a cure for cancer.) Six months later, there is still no sign of the tumor.  “The number of people who make it out one year with a metastatic brain tumor is very low,” explains Dr. Patwardhan.  “She’s actually functioning and working, which is incredible.”

“It’s because of a lot of what I’ve been through, you know, I want other people not to be afraid of this.”

Since Mowad became the first patient in North America to undergo the procedure, several others have followed.  For now, Dr. Patwardhan says they’re reserving the laser treatment for brain tumors as a last resort, as long as patients’ conditions meet certain criteria.  “It’s restricted for tumors where you can go into them, which are tumors that are not extraordinarily hard, but there are quite a few tumors that are amenable to this treatment, so that’s nice.”

Click here to view the embedded video.

Click here to view the embedded video.

“Lasers used in keyhole surgery for brain cancer” – Agence France-Presse

Paris, France August 29th, 2008 – Visualase technology used to successfully treat brain tumors, as reported by AFP and the Telegraph (UK).

Read: AFP article | Telegraph article

Paris hospital hosts pioneering laser brain surgery

Saturday 30 August 2008 – A French team of neurosurgeons claims top have successfully tested a combination of new techniques, including fibre-optic lasers, in treating brain cancer through ultra-keyhole surgery.

Read: France24

Laser Ablation of Liver Metastases from Colorectal Cancer with MR Thermometry: 5-Year Survival

Purpose

To determine technical success, technique effectiveness, complications, and survival after laser ablation of liver metastases from colorectal cancer.

Materials and Methods

Eighty-seven consecutive patients (65 men and 22 women; mean age, 62.8 years) with 180 liver metastases from colorectal carcinoma were included between 1998 and 2005. They underwent laser ablation with magnetic resonance (MR) thermometry in 170 sessions. Indications for laser ablation were locally unresectable tumors (16.1%), metastases in both liver lobes (34.5%), and refusal of surgery and/or general contraindications to surgery (49.4%). Technical success, technique effectiveness, and complication and survival rates were evaluated retrospectively.

Results

Technical success was achieved in 178 of 180 sessions (99%). Follow-up after 24–48 hours demonstrated an effectiveness rate of 85.6%. Local tumor progression rate was 10% after 6 months. Major complications included large pleural effusion, large subcapsular hematoma, abscess, large pneumothorax, pleuritis with fever, intrahepatic hemorrhage, and biloma. Mean survival from the time of diagnosis of the primary tumor was 50.6 months for all patients treated (95% CI, 44.9–56.3 months). Median survival time was 54 months and survival rates were 95.7% at 1 year, 86.2% at 2 years, 72.4% at 3 years, 50.1% at 4 years, and 33.4% at 5 years. The mean survival time after the first treatment was 31.1 months (95% CI, 26.9–35.3 months).

Conclusions

Laser ablation of liver metastases of colorectal cancer with MR thermometry appears safe and efficacious. Although the results are encouraging, direct comparison with other ablative modalities in a prospective clinical trial would be necessary to definitely show one modality is superior.

Source:
Journal of Vascular and Interventional Radiology, Volume 20, Issue 2, Pages 225-234 (February 2009)

Houston, Texas March 1st, 2006 The U.S. FDA granted 510(k) clearance (K053087) for the Visualase Cooled Laser Applicator System. The Visualase Cooled Laser Applicator System, manufactured by BioTex, Inc. and to be distributed by Visualase, Inc. received clearance for marketing with broad use in a number of medical specialties. “This family of products consists of a number of novel advancements in laser applicator systems,” stated Dr. Ashok Gowda, President and CEO of Visualase. “The laser diffusing fiber and cooling catheter system can be used together to allow use of higher laser powers and faster ablation times, while minimizing risk of applicator damage and tissue carbonization,” he added.

Liver tumours treated effectively by MR-guided laser ablation

20 December 2005

Destruction of cancerous liver tissue by laser light guided by magnetic resonance (MR) imaging was found to be as effective as traditional surgery for some patients, in a large-scale, 12-year study in Germany.

In the largest study of its type with the longest follow-up, 839 patients at the University of Frankfurt in Germany received MR-guided laser-induced thermotherapy (LITT) for the treatment of liver tumours resulting from colorectal cancer. Between 1993 and 2005, the researchers treated 2,506 liver tumours and tracked survival rates to evaluate the long-term results of the procedure. The average survival rate from the date of diagnosis was 3.8 years, which compares favourably to survival rates after traditional surgery (approximately 1.5 to 5.0 years). The study was presented at the annual meeting of the Radiological Society of North America (RSNA).

In LITT, also known as laser ablation, laser light is used to destroy tumour tissue. According to the study’s lead author, Martin Mack, M.D., laser ablation has many advantages over other treatment methods.

“Traditional surgical resection has higher morbidity and mortality rates than laser ablation,” said Dr. Mack, an associate professor in the department of diagnostic and interventional radiology at the University of Frankfurt. “Laser treatment can be done on an outpatient basis under local anaesthesia. Typically, the patient stays only a couple of hours, instead of a couple of weeks in the hospital after surgical liver resection,” he said.

Laser ablation can be used to treat tumours that occur in both halves of the liver — often during the same treatment — which is practically impossible in a traditional surgery where typically only the left or right lobe is resected. If new tumours are found during follow-up exams, it is much easier to repeat laser treatment than to subject the patient to another open surgery.

Laser ablation also holds advantages over radiofrequency ablation, another minimally invasive method of treating liver tumours, because it can be applied to different parts of the liver simultaneously and can be used with MR guidance to provide the radiologist with an accurate image of the tumour for precise targeting throughout the procedure. Radiofrequency ablation can only treat one tumour at a time and cannot be used with continuous MR monitoring.

Dr. Mack believes that laser combined with MR guidance will have wide-ranging impact on the treatment of tumours throughout the body, and may one day replace traditional surgery as the gold standard of treatment.

“Many surgeons are already performing local ablation instead of resection, because they have already recognized the positive effect of local ablation,” he said. “I believe that minimally invasive tumour ablation together with chemotherapy will play the most important role in the treatment of tumours in the years to come.”

Source: MTB Europe – Technology For Healthcare