New Brain Surgery Technique Makes Cancer Cells More Visible for Removal

New Brain Surgery Technique Compared to Having “Lights Turned On” Successfully Used at Canadian Hospital

The traditional approach to brain cancer surgery often comes with the challenge of clearly telling cancerous cells from noncancerous ones. A new method that tends to make the process easier for surgeons has been successfully used at a hospital in Canada.

Glioblastoma

The new technique is called fluorescence-guided surgery. It makes malignant cells more visible in the brain, improving the efficiency of surgeons when removing the tumors.

Apart from the clinical trials, the first of this type of surgery in Canada was successfully carried out at The Ottawa Hospital in September. It was performed by the neurosurgeon Dr. John Sinclair while the patient was awake but anesthetized.

The patient was given a drink containing aminolevulinic acid (5-ALA) some hours prior to the start of the procedure. This drug builds up in the cancerous cells making them more visible.

The cells become fluorescent orange and pink under blue light. This makes a surgeon’s job of distinguishing the tumors from neighboring tissue easier using an operating microscope. It improves the ability to remove more malignant cells with confidence.

“It’s like being in a room with the lights dimmed and having the lights turned on,” said Sinclair, who is the pioneer of the brain surgery technique in Canada. “That’s literally what it looks like.”

Current brain surgery methods involve working with a preoperative MRI scan and an operating microscope with standard white light for the identification of the tumor. The traditional approach often results in a problem with visualization at some point as the tumor blends with healthy brain tissue. The MRI scan becomes less reliable for detecting cancer cells, making surgeons rely more on their eyes and operating microscope.

This makes fluorescence-guided surgery even more interesting. Patients can have an improved prognosis as a result of a better ability to get rid of cancerous cells. The technique can help reduce the likelihood of the disorder recurring, as is commonly the case.

Sinclair performs nearly all his brain cancer surgeries with patients awake. Anesthesiologists at The Ottawa Hospital have perfected a technique that makes longer surgeries while having patients awake possible. This enables surgeons to interact with patients while stimulating the area around a tumor.

Surgeries can run for up to seven hours, with interaction taking place between patients and the professionals in charge of a procedure all the time.

Many of the patients Sinclair works on have glioblastoma multiforme. This deadly disorder is the most prevalent form of primary brain tumor among persons older than 50 years. The survival rate without treatment is mere weeks. The median survival rate even with treatment stands at only about 14 months or less.

Glioblastoma multiforme is deadly because surgeons find it difficult to completely get rid of malignant cells. The tumors have the shape of tentacles without clearly defined edges.

Sinclair hopes a combination of the new technique and “awake” surgery will improve the survival rates of patients with primary brain tumors. According to him, European surgeons have been using 5-ALA and fluorescence-guided surgery for over 10 years.