Brain cancer is a devastating disease with a relatively poor prognosis which accounts for about 1.5% of all cancers of the world population. Prior to the news release of this technological breakthrough, the traditional methods for obtaining a brain biopsy usually required painful and risky stereotactic techniques which involves the following steps:
A surgeon drills a small hole into the skull using coordinates that are calculated and guided by a computer. A needle is then inserted through the small perforation until it reaches the brain tumor after which a very small sample of tissue is collected using a brief vacuum suction action. Finally, the piece of brain tissue is collected, snap frozen in liquid nitrogen, sliced with a microtone by a trained pathologist and laid down in a glass slide in fixative solution overnight and stained for different markers or stains (H& E usually) that allows for the quick detection and classification of tumors. Finally, a well trained neuropathologist observes the tissue slice in order to determine the grade of a tumor.
Overall, brain biopsies are usually not recommended and only reserved for people with a serious brain cancer in which the tumor grade has to be determined in order to efficiently treat the patient.
How can traditional brain biopsies be streamlined in less steps and a more safe and efficient manner?
The traditional techniques for obtaining a brain biopsy may be substituted by a much improved and practical non-invasive approach using a novel confocal microscope in real-time. The procedure is an ingenuous innovation that uses confocal microscopy and a fluorescent dye contrast. This technique was first used by the neurosurgeons at Barrow Neurological Institute at St. Joseph's Hospital and Medical Center.
First, the patients ingest a small amount of a fluorescent dye that is very specific for tumors. Such dyes may include fluorescent albumin or others and are selective for the high metabolic state of tumors. The uptake and distribution of the fluorescent dye is analyzed by using a miniaturized hand-held confocal microscope. Without actually having to pry open the skull, the hand-held confocal microscope probes the brain by using a technique called optical coherence tomography which allows neurosurgeons to virtually analyze the brain.
Finally, the neurosurgeon can probe the entire tumor by scanning through different layers of the tumor in which individual vertical and horizontal slices can be analyzed and digitally recorded without the need to actually perform a brain biopsy. Once multiple digital slices of the tumor are acquired, a complete high resolution 3D reconstruction of the tumor can be generated by using sophisticated Open GL software that allows a neuropathologist to analyze the blood supplies feeding the brain tumor, the size and active areas of growth which are otherwise impossible to tell with a single slice of the tumor. All these steps can be performed in a matter of minutes as oppose to hours using the traditional methods.
After a diagnosis is performed on real time, the second step is to remove the tumor using endoscopy. Doctors can do this procedure on patients who undergo some kind of chemotherapy in order to shrink the size of the tumor first. The use of endoscopy to remove tumors can be used by accessing the brain through the nasal cavities . This technique was first employed by the by the University of Pittsburgh Medical Center in 2005. An advantage of this technique is that allows a surgeon to treat a tumor on site by sniping pieces of the tumor slowly via the use of a tiny surgical knives attached to the scope without actually having to pry open the skull. However, only 60% of brain tumors can be treated this way (frontal lobe tumors as oppose to the ones located on the back of the head).
The hand-held confocal microscope and neuro-endoscopy are two technological innovations that can allow the complete diagnosis and removal of brain tumors in real time without ever actually drilling through the skull or removing a single slice of tumor tissue.
As put in the words Marc Preul, M.D., lead investigator of this study which was published at the Journal of Neurosurgery this month, ""As neuropathologists become familiar with the new confocal microscopic appearance of various tumor types and grades, the traditional intraoperative diagnosis may be replaced by the real-time analysis of confocal images by the new microscope,"
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1. Original article reporting the use of a confocal microscope to analyze brain tumors in real time:
http://www.sciencedaily.com/releases/2009/11/091111153804.htm
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