Advancing brain surgery through technology

The brain is the most complex organ in our body, and it takes a highly trained set of medical minds, specialised tools and equipment to take care of it if anything goes wrong. Luckily for patients at the RCH, the neurosurgery team and their operation suite is one of the best in the world thanks to the support of the community through the Good Friday Appeal.

When you walk into the neurosurgical operating theatre, the first thing you notice is the large warning signs alerting you to the presence of incredibly strong magnets, and a suite of tools, scopes, screens, and scanners adorning the walls and roof.

This suite of advanced equipment has been made possible thanks to the generous contribution the community has made to the Good Friday Appeal across the past 10 years, which has allowed the neurosurgical team to have the latest technology available.

In 2011, donated funds allowed the RCH to purchase an IMRIS making it the first paediatric hospital in Australia to have this advanced technology. The IMRIS is suspended from the ceiling and stored behind large doors in the theatre, and can be moved into surgery when needed. Having this technology on hand means surgeons can undertake scans before, during and after surgery, and patients don’t need to be taken out of theatre. This allows for a more efficient and accurate surgical operations.

Another exciting upgrade provided by Good Friday Appeal in 2019 was the comprehensive intraoperative craniospinal navigation, an inbuilt ceiling mounted system with mobile navigation and ultrasound attachment which allows for 3D imaging of a patient’s brain for precise brain mapping and operation planning.

This suite, in conjunction with skilled medical imaging scientists, neurosurgeons and their surgical teams has ensured precise and accurate brain surgery for thousands of children with complex brain disorders such as epilepsy, brain tumours or brain injuries.

Alison Wray is Director of Neurosurgery at the RCH and has a passion for helping patients and families through some of the most stressful and difficult times in their lives, which is often made easier thanks to the suite of advanced equipment she has at her fingertips.

“I always say that no family ever really wants to meet me because when they do, they are at a time of crisis. Despite that, I try to help them through it and it’s rewarding to be able to offer our clinical expertise complemented by the most advanced technology available,” said Alison.

Alison and her team aim to make a child’s number of surgeries as minimal as possible through extensive surgical pre-planning.

“The neuroimaging analysis pre-surgery and its integration with our operating technology means we try, in as many cases as possible, to provide a complete solution for the child at their first and definitive operation,” said Alison.

“Without the capable people behind the equipment, it would be good, not great. The role of neuroscientists who conduct advanced neuroimaging analysis make sure we fully utilise what the technology is capable of in surgery,” said Alison.

Dr Joseph Yang is the Clinical Research Fellow in Paediatric Neurosurgery and the lead scientist for the Neuroscience Advanced Clinical Imaging Service (NACIS) at the RCH. For the past 10 years, Joseph has been researching the integration of MRI techniques known as “tractography” into neurosurgical procedures.

Having dedicated research time and the opportunity to translate his work into the clinical space is thanks to the support of generous donors who funded his fellowship, including Di and Neville Bertalli and Evan Dwyer.

Joseph and his team at NACIS use sophisticated imaging modelling to produce a detailed map of a child’s brain arteries and nerve fibre tracts which control functions like language, vision and movement. This map is uploaded into the comprehensive intraoperative craniospinal navigation system pre-surgery so Alison and her team can precisely plan their operations.

“Using the model, we can pre-plan the surgery and see what path we can take to reach the abnormal area and remove it without disrupting any functions. The preoperative technology also allows us to view this map as a 3D model during surgery,” said Alison.

When a neurosurgery patient is in theatre and under anaesthesia, the IMRIS can be brought in to scan the brain and to match the virtual model with the real brain to create what Alison describes as “a GPS navigation system” to perform precise and accurate surgery. The additional ultrasound function also allows for another view of the brain, which provides live feedback into the system and updates the map.

Prior to this technology, if the brain abnormality could not be identified from the standard MRI, a patient would need to spend a week in hospital with electrodes on their brain for testing to find the source of the seizure.

“Without the confidence this technology and the accurate imaging techniques it provides, we would not operate until we knew we wouldn’t damage any critical functions,” said Alison.

No other paediatric hospital in Australia has the complete suite of neurosurgical equipment and therefore access to the most advanced technology available.

“We are grateful for government funding of the hospital, but it doesn’t allow us to take things to the next level, to integrate research into our practice so we make the most of the best technology available. This is all thanks to philanthropic support and the support of the community that allows us to perform as a team at the top tier.”