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.

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

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

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Watching Tumors Die

Thursday, April 2, 2009
By Sarah Petrie

Above, from left: Kamran Ahrar, M.D., and R. Jason Stafford, Ph.D., discuss an upcoming spinal surgery that will use the Visualase technology. They’ll be able to watch the tumor fully die in near real time during the procedure. Depending on where the tumor is located, the patient may or may not be awake during the procedure.

History books show that surgeons began removing cancerous tumors as early as the second century. Zoom ahead to 2009, take away the scalpels, scars and side effects that typically accompany surgery, and trade them for a tiny laser beam that zaps cancer dead on the spot. It sounds like science fiction, but our researchers and clinicians are among the first in the nation to investigate a new procedure that does just this … and more.

“It’s called laser-induced thermal therapy, and the basic theory is that the laser heats the tumor to a certain temperature to kill it,” explains Jeffrey Weinberg, M.D., associate professor in Neurosurgery, who’s conducting a clinical trial to test the effectiveness of this procedure on patients with metastatic brain tumors.
How hot is too hot for a cancerous tumor? Sixty degrees Celsius, in most cases.

“The clinical trial targets patients with otherwise inoperable tumors or those for whom other treatments failed,” Weinberg says. “This is possible because tissues surrounding the tumor aren’t harmed or affected with this procedure — an advantage over other types of brain surgeries for cancer, including radiosurgery.”

Delivering laser energy using a device only millimeters in diameter, the procedure leaves a scar no bigger than your thumb. Plus, there should be no side effects for this less-invasive surgery, which takes only a few hours from start to finish. “The laser portion should only take a few minutes, and patients will experience no swelling and little pain,” Weinberg adds.

Other forms of what also is known as ablation therapy already are in practice, killing tumors using heat, cold or electricity. So what makes this particular procedure so revolutionary? The physician actually watches the tumor die in real time, according to Kamran Ahrar, M.D., associate professor in Interventional Radiology, who has performed the procedure on a few patients with bone and spinal tumors as part of a similar clinical trial.

Weinberg agrees this is the biggest advantage of this method over other forms of treatment. “Patients don’t have to wait weeks or months for tests to confirm if the entire tumor is gone, as is the case with most surgeries. Instead, using this technology, we can convert magnetic resonance imaging into a color picture that indicates the temperature of the tissue,” he says. “This allows us to know exactly when the tumor is hot enough to fully die.”

How does it work?

Houston-based company Visualase Inc., which sells the technology, approached M. D. Anderson in 2000 for help with developing the tool. “For this procedure to be successful, the doctors must know the precise location and distribution of temperature in the tumor and that’s where the physicists come in the picture,” explains R. Jason Stafford, Ph.D., assistant professor in Imaging Physics, and lead consultant on the Visualase technology development for M. D. Anderson.

In other words, a stereotactic navigation system, “like a GPS for your brain” as Weinberg puts it, pinpoints the exact location and size of the tumor. After the surgeon drills a hole and sends the specially designed fiber directly to the tumor, the laser is activated, thus heating the tumor. Doing it in the MRI allows clinicians to monitor temperatures within the tissue. “Temperature as well as predicted regions of complete treatment are color-coded on a screen, giving us the ability to adjust or retreat a certain area, as needed,” Stafford adds.

And at M. D. Anderson, this entire procedure can be performed in one room, unlike at other institutions that also are researching the procedure. We have a dedicated intra-operative MRI suite, which is safer for patients than moving them to different locations to complete the procedure.