Three-minute surgery

By JEFF WEBER • GANNETT NJ • August 3, 2010

Dr. Shabbar Danish, the director of stereotactic and functional neurosurgery and an assistant professor at Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital, and his team perform laser-assisted thermal ablation surgery on Susanna Denude’s rare brain tumor on July 6.

Robert Wood Johnson University Hospital in New Brunswick has become the first hospital in the country to perform laser-assisted surgery on an intracranial ependymoma, a tumor that grows from the cells that line the ventricles in the brain.

Dr. Shabbar F. Danish and his neuroscience team successfully completed this surgery on Susanna Denude of Riverdale on July 6 in just three minutes — and Denude was awake the entire time. She even was in and out of the hospital in 24 hours.

“This is a tool for patients with tumors who have been told they do not have other options,” said Danish, the director of stereotactic and functional neurosurgery and an assistant professor at Robert Wood Johnson Medical School and Robert Wood Johnson University Hospital. “I felt that she was a good candidate for this based on what her tumor looked like.”

Denude’s tumor had been around since 2003, when she underwent the first of two open craniotomies (the second was in September 2009) and endured a full dose of radiation. But those conventional methods did not stop the tumor’s growth.

Denude came to Danish in early June for a screening MRI, and once Danish saw what was going on, he approached the Denude and her husband, John, about the laser surgery, known as a complete thermal ablation.

“Thirty seconds into his presentation, we decided this is what we were doing,” John said. “We understood what was going to take place, and we knew this was right.”

How it works

The technique involves placing the laser directly into the tumor and then guiding the laser to perform the thermal ablation, which kills the tumor 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. Denude was alert, talking and free of pain throughout the operation.

“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,” said Danish, who estimates that only 5 percent to 8 percent of brain tumors are intracranial ependymomas.

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,” Danish said. “During the surgery, we could watch everything that was going on, and I was able to talk to her. She’s been under close observation to see what happens with the tumor over time, and so far, everything looks perfect.”

Not available to everyone

Many brain surgery patients are terrified of their pending operations. Denude handled it with relative ease.

“At first I was a little skeptical, but after listening to Dr. Danish, I felt that it was right for me to do this,” said Denude, a schoolteacher. “I don’t remember anything bad about it. There was no pain at all.”

Denude is just glad she had this option available to her. Not everyone does. Only six locations in the country — Hackensack; Manhasset, N.Y.; New Haven, Conn.; Baylor, Texas; and Denver — have this kind of technology, a fact from which Danish and his team derive much pride.

“These options don’t exist where you think they would exist, in Manhattan or Philadelphia. They exist here,” Danish said. “We get offered the ability to use new toys all the time . . .

“What I saw was an opportunity to use this as a tool for patients who had run out of options,” he continued. “Mrs. Denude had a tumor that was growing — we were watching it grow — and we thought this would be a good option for her.”

Print copy of this article (PDF)
Source – CourierPostOnline.com

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.

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.