Name: Insights: VR is Making Surgery Safer and Smarter
Uploaded: 2020-08-12
Duration: 5 min 20 s
Description: Neurologists are now using VR technology to better prepare for surgery.

 SPEAKER 1: The advent of virtual reality recently is part of this revolution in technology that has allowed us to advance the field, and make surgery much safer for patients. The work I do is very delicate and requires attention to detail. Operating on the blood vessels in the brain, and those leading to the brain, is some of the most challenging kind of surgery that we face. In part because of the very intricate and delicate nature of the blood vessels, and in part because the blood vessels are supplying the brain. Which, of course, is what makes us human. One of the advantages that virtual reality provides is the ability to see and appreciate a three dimensional view of the patient's brain, anatomy, and pathology. The image that we use for the 3D virtual reality is taken from a radiologic image-- that can be either a CT scan with a CT angiogram, an MR scan, or a digital subtraction angiography. So we have the ability to take the data from these three different modalities and fuse them into one single unique image exactly. And then we can look at the relationship between whatever pathology we're dealing with-- an arterial venous malformation, an aneurysm, a tumor-- and see its relation both to the blood vessels and to the brain substance itself. And so for planning surgery, we can actually rotate this in three dimensions. We can wear goggles like a video game. We can look around the entire brain. We can see the blood vessels. We can see the surrounding brain tissue. We can see the bone. And so, in a sense, we can simulate or rehearse the entire surgical procedure beforehand. So that when we get to surgery, it's not a surprise. It's as if we've actually performed the surgery before. Very good to see you again. KEITH HOLLEMAN: Nice to see you again, doctor. SPEAKER 1: Good to see you. Hi, nice to see you. KEITH HOLLEMAN: Last month, just before Thanksgiving, I was in Spain. And I woke up and realized that I had a dislocated shoulder, and put together the facts and realized that I had probably had a seizure. And after visiting my primary care physician, had a couple of tests, and they found out that I was diagnosed with an AVM-- which is an arteriovenous malformation in the brain. The malformation is that, typically, you have arteries that carry blood-- and oxygen-rich blood-- and they connect to capillaries in your brain that distribute the oxygen into the brain tissue. And sometimes, some people, they don't form quite right. So the high-pressure blood flow from the artery goes right into the vein. And veins aren't typically meant to handle high-pressure blood flow. So a lot of times, what can happen is there'll be scar tissue, you can get pressure, or the veins will actually break. Or you can have a brain hemorrhage, basically. It's the way a lot of people find out about AVMs. SPEAKER 1: So you'll be coming in the morning of surgery. And then you're going to be put to sleep, obviously, for the surgery. My part will probably be about two hours. And then I'm planning on doing a quick angiogram in the operating room with you asleep to make sure we've got the whole thing out. Keith's AVM is located in his temporal lobe. And it's in one of the safer areas in the brain, but it had a very high vascular flow and supply. And so what we did was to cut down the vascular supply with two sessions of what we call "embolization." And that will set the stage for me to be able to operate more safely. And what I will do then is, through a small incision on the side of his head, I will take off a piece of bone. I'll magnify everything 20 times. And I'll use very fine instruments to clot off the remaining vessels leading to the AVM, and draining it, and actually take it out of his brain. KEITH HOLLEMAN: Now he can take and show what is a tangle of veins in your brain, and walk around where there's a supply, and you can start to see how he's going to do the surgery. And it's nice to know that he has a map. Even though he knows what's in his mind, he knows that he can refer back to this at some point and see it from multiple angles. SPEAKER 1: Because of these advances in computer technology and imaging, we can operate deep in the brain stem through safe trajectories, magnifying everything with the microscope 20 times, and actually take out abnormalities through an opening one to two millimeters in diameter. My vision of the future of VR in surgery would be for us to use robotic instrumentation, initially at the same site with the patient, but ultimately being able to operate remotely with VR and robotics. 

Neurologists are now using VR technology to better prepare for surgery.

Insights: VR is Making Surgery Safer and Smarter

VR is used by Neurologists to prepare for surgery.