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Biotech Technology

Using Sound Waves For Outpatient Neurosurgery 152

Posted by Soulskill
from the so-that's-what-dr-mccoy-used-in-star-trek-4 dept.
eldavojohn writes "Got a piece of malfunctioning brain tissue in your head? Want to avoid messy lobotomies and skull saws? Well, you're in luck; a study shows that acoustic waves can do the trick and will hopefully treat patients with disorders like Parkinson's disease. A specialist said, 'The groundbreaking finding here is that you can make lesions deep in the brain — through the intact skull and skin — with extreme precision and accuracy and safety.' They focus beams on the part of the brain needing treatment and it absorbs the energy, which turns to heat. The temperature hits about 130 F, and they can burn 10 cubic millimeters at a time. Using an MRI to see areas of heat, they can watch the whole time and target only what needs to be burned. The study consisted of nine subjects suffering from chronic pain that did not subside with medication (normally they need to go in and destroy a small part of the thalamus on these patients). After the outpatient procedure, all nine reported immediate pain relief and none experienced neurological problems or other side effects after surgery."
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Using Sound Waves For Outpatient Neurosurgery

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  • High-intensity focused ultrasound (HIFU) is different from the ultrasound used for diagnostic purposes, such as prenatal screening. Using a specialized device, high-intensity ultrasound beams are focused onto a small piece of diseased tissue, heating it up and destroying it.

    this sounds like it could be a good video game!
  • by Muad'Dave (255648) on Tuesday July 21, 2009 @01:06PM (#28771769) Homepage
    130 F is right between rare and medium rare. I wonder what well done feels like.
    • by mcgrew (92797)

      I'm sure it's more pleasant than having a metal probe supercoooled with liquid nitrogen held on my eyeball for five minutes, let alone needles stuck in my eyeball [slashdot.org]. "If I'd been strapped to a chair at Guantanimo when they did that I'd have confessed to anything."

      If I had a brain cancer or a leaking blood vessel in my brain, I'd rather have this proceure done than have them saw my skull open, let alone die or become crippled.

      • by Abreu (173023)

        McGrew, that's the second time I read that journal entry

        Thats the second time I have been freaked out of my friggin' mind

        Please post a warning when you link to that story!

        • by mcgrew (92797)

          Will do. You think you're freaked out reading it, how do you think I felt living it? I wouldn't wish a vitrectomy on my worst enemy, let alone the nitrogen probe.

          • by Abreu (173023)

            I mean, I got Lasik surgery done like 6 years ago (and I'm still wearing glasses, thanks for asking) and I was freaked out of my mind the whole time...

            Reading about your experience makes me glad I didn't get anything more invasive

    • "I do wish we could chat longer, but... I'm having an old friend for dinner. Bye. "

      Hannibal would like this new tool.

  • Um (Score:1, Redundant)

    The groundbreaking finding here is that you can make lesions deep in the brain—through the intact skull and skin—with extreme precision and accuracy and safety.

    Ah, the miracle of modern medicine.

  • by Stu1706 (1392693) on Tuesday July 21, 2009 @01:14PM (#28771887)
    Could this be used on other parts of the body for cancer and such? Since the brain does not feel pain, you would have to use some kind anesthetic on other parts of the body.
    • Re: (Score:3, Insightful)

      by jd (1658)

      There's probably quite a bit of the body that has no pain receptors. You don't really need pain receptors on a lymph node, for example, so I would imagine there would be rather fewer of them.

      I don't see why this couldn't be used elsewhere in the body, and I imagine as the technique improves, people will find all kinds of uses for it beyond killing cells. (For example, being able to selectively warm internal tissue might be quite valuable when treating hypothermia.)

    • RTFA (Score:3, Informative)

      by Anonymous Coward

      They already use it on some other tumors--I think some uterine tumors, for example. This version is for the brain and has some particular tricky problems associated with it, notably that the skull can absorb sound waves and its density varies--kind of like how when you build a nuke you need to focus the shock waves right, through solid materials of different densities.

      (Only on Slashdot could you simplify something by comparing it to building a nuke)

    • by sjames (1099)

      Possibly, but it might need to be made hotter. Neurons are one of the more sensitive cells in the body.

    • by ianmkz (1533955)
      I think I read somewhere that the technology is currently used to ablate uterine fibroids--small benign tumors in the uterus--and it's in clinical testing for removing tumors from breast and other cancers... Oh yes, TFA
    • Re: (Score:3, Interesting)

      by smellsofbikes (890263)
      My then-gf made an ultrasound transducer -- as in physically assembled, as well as partly designing -- that was about 11mm long by 2mm in diameter. It was designed to be inserted into a (conscious) person's femoral artery, and run up inside the heart, through the valve into the atrium or ventricle. It could simultaneously image the inside of the heart and use ultrasound to locally fry parts of the heart that were contributing to fibrillations. Apparently after a heart attack sometimes there are sections
    • Yes, MR guided focused ultrasound is currently approved by the FDA in the US to treat uterine fibroids (which affect 20-30% of all women), and in clinical trials in the US to treat the pain caused by bone cancer (it's approved for use in Europe).

      There's also several clinical trials for using the technology on treating prostate cancer, breast cancer, liver cancer, and many other forms of soft tissue tumors. There's also studies being done to use focused ultrasound to break up clots within the brain that
  • by Anonymous Coward on Tuesday July 21, 2009 @01:17PM (#28771933)

    Actually I find the fact that we just go in there and destroy a relatively large part of the brain as the leading edge technology kind of amazing. The fact that it seems to work is even more amazing. But essentially this is a hammer, made to work on the opposite side of the wall. You still go in there and destroy whatever is there. Just weird to me that this is the cutting edge so far in brain surgery is all. Just goes to show how far we still have to go.

    • Re: (Score:1, Informative)

      by Anonymous Coward
      >> a relatively large part of the brain

      You do realize, right, that ten cubic millimeters is not large? It's 2.15443469mm (yes, I used a calculator) on each side. Granted, most procedures will likely require more than one ... shot? ... with the device, but such a small amount leaves a lot left untouched.
      • You do realize, right, that ten cubic millimeters is not large? It's 2.15443469mm (yes, I used a calculator) on each side. Granted, most procedures will likely require more than one ... shot? ... with the device, but such a small amount leaves a lot left untouched.

        I don't understand how you arrived at that number.

        when i did the math, my answer was that 10 cubic millimeters is 1 cubic centimeter.

    • Just weird to me that this is the cutting edge so far in brain surgery is all. Just goes to show how far we still have to go.

      But that's not quite right.

      This is not the cutting edge of brain surgery. This is better than the cutting edge, it's the burning acoustic probe of brain surgery.

      I think it's pretty damn cool that we can operate on a brain without having to open up the skull or damage surrounding tissue to get at the target tissue.

      And FWIW, there are plenty of other areas where brain surgery is a

  • that I needed to keep the volume down on my headphones and not blast that garbage into my head. I guess one day they'll look around in my skull and find tissue cooked into a rude shape.
  • by FatRichie (1456467) on Tuesday July 21, 2009 @01:20PM (#28771975)
    I'm curious to know how they control the heat disippation. In fact, there are probably other invasive procedures involving burning away tissue with lasers as well, where I wonder how they protect surrounding tissue from the heat. It seems that in the brain in particular, some tissue would be susceptible to damage by high temperatures, even if that temp doesn't actually burn anything away.

    Any ideas, Dr. Slashdot?
    • by amateur6 (1597289) *

      Yeah, I was thinking along these lines -- and a cubic centimeter isn't really what I'd call a "precision operation".

      On the other hand, TFA says that it's more precise than radiation, so...

      • Re: (Score:1, Informative)

        by Anonymous Coward

        a cubic centimeter isn't really what I'd call a "precision operation".

        10 cubic millimeters is only 1/100th of a cubic centimeter.

    • AFAICS the best you can do is make the pulse as short as possible ... with lasers and surface tissue you can use ablation to avoid heating the rest of the tissue, but that's not going to work internally.

    • Re: (Score:3, Funny)

      by NotQuiteReal (608241)
      how they control the heat disippation

      Pierce the skin with a fork a few times before you apply the heat.
    • by mcgrew (92797)

      See this comment [slashdot.org], be careful following the link to the journal about lasers to the retina, supercooled metal probes to the white of the eye, and needles stuck in the eye, it's graphic and may cause nightmares (I promised someone I'd freaked out with that journal that I'd post a warning).

    • by sumdumass (711423)

      there used to be a similar procedure called a gama knife which was used on cancers in certain locations as non-evasive treatment. The bursts and focus is so small that there really isn't any heat dissipation to be concerned with.

      This apparatus should work in a similar method in which they direct the energy in non-damaging doses from several angles and where the point of intersection happens, they can slightly increase the strength giving the desired action without threatening any other part of the body. I i

  • McCoy and Crusher and Bashir never cut anybody open, they use... er, it looks like the technique from TFA. Communicators, flat screen computers, self-opening doors, etc. Now this.

    Amazing. When do I get my matter replicator?

  • Darn, the tin foil in my hat won't work against this! I'm going to have to add some sound-absorbing cotton wool too in order to keep the CIA out of my head!

  • Could this technique be used for people who are super morbidly obese to kill of the section of their brain than gives them an appetite? I mean they would still have to eat, but they would have to make eating a routine like brushing your teeth, etc...

    Or would there be issues getting them to FIT into a MRI to do the procedure in the first place. I see a future where fatties are put into the MRI for 30 minutes until parts of their brains reach 130 degrees and they loose their appetites.

    Of course me being a

    • Re: (Score:3, Insightful)

      I think this would mean that you would have to carefully plan your meals -- times, portions, specific foods -- for the rest of your life. Or die of starvation and never even be aware of it.

      It would work, sure, but it really strikes me as a case of the cure being worse than the disease. And if you are capable of putting that kind of care into your diet, you can probably lose weight without burning out a part of your brain.

      • Just make them monitor blood sugar levels after the procedure like the diabetics do. You only need to plan you meals with an accuracy of +- 30 days to not die anyway. Also, if you faint or are very weak, then it is probably wise to eat something. There is plenty of other signals to inform you of not eating enough well before death.

    • Re: (Score:2, Funny)

      by Vandilizer (201798)
      Maybe, but unfortunately most morbidly obese people cannot fit into or be supported by the MRI machines that hospitals have. It is quite the reality check when these people have to be sent to the Zoo to make use of the same equipment they use for large animals.
    • by QuoteMstr (55051)

      Could this technique be used for people who are super morbidly obese to kill of the section of their brain than gives them an appetite?

      I believe there are drugs that do the same thing chemically and non-destructively. I've met a few people who've used them to great effect. Granted, they have side effects, but wouldn't overwriting part of your brain with NOPs also have some side effects?

  • by 2names (531755) on Tuesday July 21, 2009 @01:28PM (#28772081)
    and now my ice cream thinks trees are precisely why shoe laces bark the 1812 overture spatula rice mommy.
    • They used you as a scratch monkey!

    • Re: (Score:3, Funny)

      by igloonaut (1376833)

      and now my ice cream thinks trees are precisely why shoe laces bark the 1812 overture spatula rice mommy.

      Now you'll be able to write "The Family Guy" episodes with the best of them.

      • and now my ice cream thinks trees are precisely why shoe laces bark the 1812 overture spatula rice mommy.

        Now you'll be able to write "The Family Guy" episodes with the best of them.

        Well, at least it's better than the time that...

    • by shiftless (410350)

      So YOU'RE the one responsible for all those spam emails!

  • Now they won't laugh anymore when I tell them I have noises in my head

  • by jez9999 (618189)

    ... is about 54 degrees Celsius, by the way.

    C'mon, America. Catch up with the world's weights and measures. ;-D

    • by tholomyes (610627)

      But in America, bigger is better, and 130 is clearly bigger than 54...

    • Re: (Score:1, Funny)

      by Anonymous Coward

      It's not our fault that you have no respect for history! Why, every American learns the maximum temperature in Farenheit's lab by heart. Even the ones who can't spell know what 100 degrees are!

      See, we have a secret plan to memorize all trivia by using weird units.

    • by mcgrew (92797)

      C'mon, America. Catch up with the world's weights and measures. ;-D

      Well, we may be behind in measures, but our fatasses have your weights beat by a mile!

  • 'The groundbreaking finding here is that you can make lesions deep in the brain â" through the intact skull and skin â" with extreme precision and accuracy and safety.'

    Something about the word "lesions" doesn't quite make me think "safety". Reminds me of Eternal Sunshine of the Spotless Mind where Jim Carey's character asks if there is any risk of brain damage and the guy tells him that "technically, it is brain damage".

    • Re:Safety? (Score:5, Interesting)

      by sjames (1099) on Tuesday July 21, 2009 @02:36PM (#28772967) Homepage

      Currently, all brain surgery consists of excising something, implanting something, or making a lesion in something. We do not have the ability to make a repair on anything in the brain. The best we can do is find the part that is malfunctioning and kill it off so it at least won't interfere with the rest.

      What this does is avoid the whole drilling holes in the skull part and the infection risk that goes with it.

  • Want to avoid messy lobotomies and skull saws?

    Not everyone that has brain surgery needs half of their brain removed. Lobectomies remove smaller portions of the brain. The portion of the skull that was opened is resealed using wire and the original skull piece.

  • Epilepsy (Score:4, Interesting)

    by notarockstar1979 (1521239) on Tuesday July 21, 2009 @02:18PM (#28772747) Journal
    Would be nice if they could use this to destroy the two pinpoint spots of brain damage my girlfriend has that cause her epilepsy. She's afraid of surgery (doesn't want her skull opened up, and who can really blame her?) but she would be one to try something like this in a heartbeat.
    • Re:Epilepsy (Score:4, Insightful)

      by QuoteMstr (55051) <dan.colascione@gmail.com> on Tuesday July 21, 2009 @02:45PM (#28773081)

      Neurosurgery (along with other kinds of brain damage) frightens me like few other phenomena. It's a little bit like saying: "okay, this piece of code in the kernel is crashing. Let's overwrite it with NOPs and see what happens." What if you need that part of your brain? Are you really the same person after the procedure?

      • Perhaps you could followup with those who are undergoing the procedure? Besides, if you change: will you know and care?
      • That is one of the best ways I've ever heard it explained. I wish I had mod points.
      • Re: (Score:3, Interesting)

        by DoofusOfDeath (636671)

        Neurosurgery (along with other kinds of brain damage) frightens me like few other phenomena. It's a little bit like saying: "okay, this piece of code in the kernel is crashing. Let's overwrite it with NOPs and see what happens." What if you need that part of your brain? Are you really the same person after the procedure?

        In that sense, you're a different person every time your brain undergoes any change, including learning, forgetting, being short on sleep or having extra sleep, etc. I think the notion of "identity" can be disturbingly slippery.

  • Abuse (Score:2, Interesting)

    by Rowanyote (980640)

    What springs to mind first is the terrible potential to abuse this technology on political prisoners, criminals, etc.

    Depending on how well you pinpoint certain areas of the brain, but I wonder if you can permanently destroy a person's effectiveness at whatever skills the government doesn't want them pursuing. It sounds like this procedure doesn't leave any external evidence, and the internal lesion may not be readily identifiable without biopsy.

    "We will release you to your family immediately, but only if y

  • by Anonymous Coward

    Wasn't this in an episode of The Prisoner? That show was way before its time.

  • by DoofusOfDeath (636671) on Tuesday July 21, 2009 @02:50PM (#28773133)

    I'm pretty sure this technique is already in daily use. From what I can tell, it involves rap, subwoofers, and the patient driving by my house at 11:30 p.m.

  • I bet (Score:2, Funny)

    by t_ban (875088)

    they're using Britney Spears waves to create the lesions.
    Also, we now know what makes the RIAA people brain dead.

  • Oh HEYALL No (Score:3, Informative)

    by DynaSoar (714234) on Tuesday July 21, 2009 @10:44PM (#28777789) Journal

    "During traditional surgery for Parkinson's, for example, the neurosurgeon stimulates the target area with the electrode to make sure he or she has identified the piece of the brain responsible for the patient's motor problems, and then kills that piece of tissue."

    I got my PhD in psychology, but the work was done in the Center for Parkinson's Research in the chemistry department. At NIH I worked for a guy that did lots of studies on Parky's, and he loaned me out to other labs doing Parky's work to help develop new data collection and analysis techniques. I did work for a review paper on Parky's research and treatment techniques when I was with the psychiatry department at Yale Medical School. I've worked in surgery doing intra-operative neural monitoring -- I don't hold a knife, but I do hold that probe, test the target areas, and tell the surgeon where he can and can't cut. I know my way around a brain and a good bit about Parky's. That's not to ring my own bell, but is a set up for my response to TFA.

    I've never heard of surgery for Parky's. If someone said they were going to have it I'd convince them not to. If a surgeon said they were going to do it, I'd offer to smack his hands. There are so many other things that can be done that it's foolish to kill off perfectly functioning brain tissue (motor area or thalamic circuitry feeding it) just because the circuitry that suppresses all but the desired actions (dopamine carrying inhibitory innervation) is running low on power because its source (substantia nigra) is itself dying off. Quite often the problem resolves itself because the various uninhibited signals wear themselves out fighting against each other, and some motor control can be retained. But if you kill the circuitry, it can't possibly be recovered.

    When motor activity must be brought down due to disinhibition allowing random activity to become harmful, you can always do cryo-ablation of the nerve trunk coming off the spinal cord, killing off a small portion of it temporarily. It lasts around 18 months. You can redo it then if the problem returns, or let it recover if not. This is done as outpatient treatment in clinics by anesthesiologists all over, for chronic pain and such. Doing it to motor nerves differs not one iota in principle.

    There's plenty of other alternatives, some approved by cross over for treatment of other symptoms, such as hydergine + nootropil conjunct (approved to delay or prevent dementia; helps sensitize the cortex to a lower level of dopamine), and high dose gabapentin to make those neurons that receive the dopamine signal and control cortical pyramidal cell circuitry to make them more effective.

    If I ever run across a surgeon that wants to ablate some cortex or otherwise kill off brain tissue to treat a chemically based control signal failure, I'm going to attempt to alter his consciousness on the subject with an experimental technique of my own: corrective phrenology.

    For the unlearned, phrenology is the discredited technique of reading the bumps in the various regions on one's head to determine the greater or lesser contributions from those areas to one's collective make up. Corrective phrenology is applying kinetic energy in the form of a good whack in order to change the size of the bumps and so the relative contributions of the areas this is applied to. The technique is discredited because nobody ever proved what areas do what, although we know that applies to the brain. So my technique would be experimental in that I'd have to give a good many whacks in various places to see what accomplishes the job. I'm thinking a Craftsman five pound ball peen cranial impact probe would be an appropriate tool.

  • I know this can be beneficial, but this is too close to ice pick lobotomies for comfort.

    And this seems like it is ripe for abuse by totalitarian states.

  • Creed and Linkin Park have been performing live lobotomies for years.

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