Image: A pathology lab on wheels aims to revolutionize brain surgery (Photo courtesy of NYU Langone)
The conjecture defines a central challenge of brain surgery. Cut too little and residual tumor cells will restart and kill the patient. Cut too much and critical brain functions could be irreversibly damaged. Studies show that in up to three-quarters of brain cancer patients, parts of the tumor that could be safely removed are left behind, simply because the surgeon cannot see them. Without visual certainty, the risk of removing valuable healthy tissue that might be involved in speech, memory, movement, or virtually any other important brain function is simply too high to exceed known limits. Today, a radically new imaging system is helping brain surgeons cut with more confidence.
The new imaging system, now employed at NYU Langone’s Perlmutter Cancer Center’s Brain and Spine Tumor Center at NYU Langone (New York, NY, USA), is called stimulated Raman histology, or SRH, a method that distinguishes tumor regions , high in protein and DNA, from normal, lipid-rich brain tissue, creating high-contrast images similar to conventional histology slides. The technology is based on an ancient technique, Raman spectroscopy, used in chemistry since the 1920s, which involves shining a laser beam onto a sample. The unique vibrational properties of different molecules alter the optical properties of the laser, helping to image the structure of the sample.
Pathologists can distinguish cancerous tissue from healthy tissue just as well using SRH images made in the operating room as compared to conventional images created in the laboratory. The system works in concert with a powerful new diagnostic technique that leverages AI to distinguish between tumor types in less than two minutes, compared to the 20-30 minutes it typically takes human pathologists. The speed of diagnosis is a game-changer, eliminating the time a patient sits on the operating table while surgeons wait for lab results – a dangerous gap that increases the risk of infection or complications. Housed in a metal box the size of a mini-fridge and mounted on wheels, the technology, which is now available to all NYU Langone Health brain tumor patients, can be deployed in any room. operation to provide a surgeon with a near real-life experience. temporal analysis of a tissue sample.
“If we have a patient with a tumor of unknown etiology, for example, we might not know if it is glioblastoma or lymphoma – two tumors with very different treatments. Making the distinction in the operating room is extremely important,” said Daniel A. Orringer, MD. “Surgical decision-making is like operating the brake and accelerator pedals. We take the guesswork out by allowing the surgeon to interrogate tissue at the microscopic level and use imaging data to inform surgical strategy.