Using Sound Waves For Outpatient Neurosurgery 152
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."
Re:Awesome (Score:2, Informative)
blood carries away heat, but not instantly.
if you can add the heat in 1/100 of a second, and it takes the blood a second to get rid of this heat...
RTFA (Score:3, Informative)
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)
Re:How brain surgery is done these days. (Score:1, Informative)
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
Re:ow, my aching hot spot... (Score:1, Informative)
10 cubic millimeters is only 1/100th of a cubic centimeter.
Re:Very cool, but... (Score:5, Informative)
Actually, as a researcher in the field, controlling cost is one of the motivations behind this method.
Do you have any idea how much open brain surgery costs? It's several days in the hospital, plus a team of surgeons, plus an operating room. All in all, from $50,000 to $200,000. High intensity focused ultrasound (HIFU) doesn't need any of that. There are hopes this could almost be an outpatient type of procedure.
One my childhood friends suffered from epilepsy for many years until as a teenager, he had exploratory brain surgery (in 1988) where they removed a cubic centimeter of diseased tissue. He was in the hospital for a week.
Not every new idea in medicine costs more money.
Re:Very cool, but... (Score:2, Informative)
Well, it'll get cheaper until we finally hit that impending shortage of helium (http://www.wired.com/wired/archive/8.08/helium.html) - you know, that situation where virtually all of the helium in the world comes from one deposit in Texas, and the well's running dry. It's also, at the moment, completely unrecoverable, as when it gasifies and escapes, it simply floats to the farthest reaches of the atmosphere.
When that happens, the price of performing MRI will skyrocket. MRI needs superconducting electromagnets, and when helium (and thus liquid helium) goes, superconductors go too.
So, until we get metallic, or at least, non-ceramic, high-k superconductors, or find a way to recover or synthesize helium (Hi, hydrogen fusion!) ... this, and most other NMR-based technologies, are just going to get more expensive.
Bull (Score:3, Informative)
I don`t get where this meme is coming from. Ive seen it mentioned lots of places...the kooky idea that robots and computer software will soon be doing SURGERY.
Out of all the jobs on this planet, surgery is going to be one of the last ones replaced by automation. Nearly every other form of employment is easier to automate. Surgery is a series of delicate, deliberately chosen steps that requires an enormous pool of knowledge and experience to do successfully. Surgeons go through more years of training than any other job on the planet. The actual physical motions and dexterity have little to do with what makes it difficult : as the Dean of my medical school said, surgery is about knowing when to operate, not doing the procedure itself.
Yes, telepresence bots are used to hold some of the instruments...but that in no way even slightly reduces the need for an educated professional at the controls of the robot.
Oh HEYALL No (Score:3, Informative)
"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.