Surgeons Cut a Giant Tumor Out of My Head. Is There a Better Way?

https://www.bloomberg.com/news/features/2024-08-14/a-neurosurgeon-who-operated-on-biden-wants-to-treat-disease-with-sound

by melling • 2 years ago

129 55 2 years ago

bloomberg.com

xyst• 2 years ago

https://archive.ph/3axkV

ChrisMarshallNY4• 2 years ago

Back in '96, I had a pretty serious craniotomy.

Took me a couple of months to learn to walk and chew gum at the same time, but I was pretty much 100% recovered, in five years.

One of best days of my life, was when my neurosurgeon said "I never want to see you again."

They did it the old-fashioned way. Scalpel and Black-and-Decker circular saw.

adin8mon• 2 years ago

A family member of mine had to go through something similar, the old-fashioned way. I've never felt more scared for someone else than on that day.

Loudergood• 2 years ago

Brain plasticity is amazing.

aborsy• 2 years ago

So long as they are young!

tomcam2• 2 years ago

Wow. Genuinely grateful you got through it so well.

ChrisMarshallNY4• 2 years ago

So am I. It was a ... tense ... time of my life.

blackeyeblitzar• 2 years ago

Is it actually a black and decker? It isn’t some sort of special FDA approved medical saw? Is that even a thing?

bluefirebrand• 2 years ago

What would the difference be in your mind?

As long as the blade is suitable for cutting bone and it's all sterilized, what would make it medical grade over carpenter grade?

My Dad was the manager of a tool store for decades. He has had a lot of knee problems and he has a funny story about his knee surgeon coming into the store looking for a drill bit to drill out a stripped screw. He jokingly asked if the stripped screw was in someone's knee, and sure enough it was.

rich_sasha• 2 years ago

A friend is a neurosurgeon and they use some special saw that stops as soon as there's no hard tissue providing resistance. So you press it hard into the skull, and when it's done chewing through the bone, it immediately stops.

Apparently the scariest bit for the junior doctors to learn to use, somehow.

ChrisMarshallNY4• 2 years ago

Nah… that was a joke.

But their tools look surprisingly like standard hardware.

Lot more pricey, though.

bearsnowstorm• 2 years ago

A counterpoint on focused ultrasound for essential tremor - just because you don’t penetrate the brain with a physical object doesn’t mean you don’t have side effects - as usual, benefits come with risks

https://jamanetwork.com/journals/jamaneurology/fullarticle/2...

vasco3• 2 years ago

This article isn't accessible so it's hard to see what you mean. Do you have a link to the full thing?

Found a similar previous one https://movementdisorders.onlinelibrary.wiley.com/doi/10.100... where out of 10 patients, 7 had issues:

Tremor significantly improved in all patients. Seven experienced mild adverse effects, including 2 with transient gait impairment and a fall, 1 with dysarthria and dysphagia, and 1 with mild dysphagia persisting at 3 months.

Also can't access the full pdf either though.

melling• 2 years ago

The FDA approved histotripsy mentioned in the article to treat liver tumors is available at NYU Langone.

https://nyulangone.org/news/nyu-langone-cancer-specialists-u...

yarg• 2 years ago

Either sonic or photonic attacks from every direction at once, resonating at the tumour site.

You'll also need to bolster the immune system to aid in recovery.

kuhewa2• 2 years ago

You'll also need to bolster the immune system to aid in recovery.

This eats the brain

tomcam2• 2 years ago

How?

atlas_hugged• 2 years ago

Wait, what???

Where on earth did you hear that?

Source?

rishabhjain• 2 years ago

I wonder how is it different than radiosurgery? Machines like Cyberknife, Gammaknife also treat brain tumours in non invasive way

suddenseizure• 2 years ago

I wouldn't call radiation non invasive, it ages the surrounding brain tissue a lot.

For people with faster growing tumors like GBM the tumor will usually kill them before the side effects of radiation hit.

But for people with slower growing tumors like oligodendroglioma, the side effects of radiation can force them to quit their job and go on disability, years before they actually die of the cancer.

The better we get at treating these tumors and extending patients' lives, the more important it will be to avoid radiation as long as possible to ensure that extra quantity of life also has quality.

OJFord2• 2 years ago

In medicine/surgery, 'invasive' is a bit of a term of art, meaning that implements physically enter the body. 'keyhole surgery' (a small incision with a scope and tiny tooling pushed through) for example is often described as 'minimally invasive'.

pknomad2• 2 years ago

I didn't realize how aggressive GBM could be until watching this video: https://www.youtube.com/watch?v=VSLPq010Q-o

That much growth in 4 months is eye watering.

The better we get at treating these tumors and extending patients' lives, the more important it will be to avoid radiation as long as possible to ensure that extra quantity of life also has quality.

This is a good point.

HeadsUpHigh• 2 years ago

Radiosurgery has it's limits and also horrible side effects esp in CNS tumors. If the tumor can be accessed without damaging too much healthy tissue and it's a histological type that has clean borders you are probably better off cutting it out.

vsuperpower2021• 2 years ago

article fails to load text partway through. why are websites so bad at doing this?

Muromec• 2 years ago

To make sure you watch ads

Ylpertnodi• 2 years ago

Should have asked this question beforehand?

vanderZwan• 2 years ago

The key is knowing exactly where to aim. While the MRI machine took readings, Elias ran a test at a low intensity to see if he could gently heat up the spot on Doby’s thalamus he was targeting. Satisfied with the result, he then proceeded to blast an area millimeters wide with 6,000 joules of focused sound energy for a few seconds. A graph on his monitor showed the temperature jumping to about 60C (140F). Everything around it stayed at a normal 37C. Other than a brief sensation of heat inside his head, Doby said he didn’t feel a thing. Elias repeated the process three more times, checking the tremor after each. By the fourth, it was gone.

Leaving it at "knowing where to aim" is severely underselling the problem, because then the next step is how to aim.

Back in 2003 when I still studied physics I attended a talk back by a Dutch biomedical researcher who worked on shock wave lithotripsy - a procedure where ultrasound is used to break kidney stones. So same idea as this, except kidney stone

So what he pointed out was that the human body is not a medium of uniform density, so the way the sound waves propagate is hard to calculate.

Worse, the human body tends to move, even when the patient is under anesthetics. Even if you sedate someone enough to lie perfectly still, the heartbeat means blood vessels grow and shrink, breathing causes miniscule motions that can throw off the ultrasound beams.

Maybe this is specific to kidney stones though, maybe kidneys are just a lot more "floppy" organs and maybe kidney stones move a lot. Maybe the brain is a lot more "stable" in the skull. And I suppose the method of destruction is different (kidney stones need to be shattered by ultrasound waves, whereas this method uses heat), so that might also be an influence.

I'm not being critical of this technology btw, just trying to point out that the engineering problems involved are likely a lot more interesting than that this article is suggesting.

[0] https://en.wikipedia.org/wiki/Lithotripsy

saas_sam• 2 years ago

Interesting. Maybe part of the solution is better predicting and controlling the motion inside the human body. I could imagine using a method to guarantee a particular organ be at a certain place at a certain moment: perhaps by accelerating the body a certain way to shove the organ into a position for a moment. Or maybe by injecting microscopic machines to surround and hold an area still. Someone will figure it out.

kelsey98765431• 2 years ago

Science needs more cadavers! Bring out ya dead

FiatLuxDave• 2 years ago

In radiation therapy, respiratory gating is a common method to deal with the problem of breathing movement: https://www.oncolink.org/cancer-treatment/radiation/support/...

I was not aware of respiratory gating being used in SWL. So, I did a brief search and saw that the efficacy of gating had definitely changed over the years:

https://pubmed.ncbi.nlm.nih.gov/7858616/ (1994)

https://pubmed.ncbi.nlm.nih.gov/22471349/ (2012)

https://pubmed.ncbi.nlm.nih.gov/38515108/ (2024)

So, it looks like that engineering problem has been worked on a lot since that talk in 2003.

randerson• 2 years ago

I once had to have a Heart MRI, which was fascinating because movement normally messes up an MRI. For the heart, they attach a pulse monitor and the MRI machine pauses its movement for a split second each time the heart beats.

pknomad2• 2 years ago

I'm a bit confused on the use of word non-invasive in this context.

I was under the impression that non-invasive meant no cutting of tissue. Even if ultrasound separated the cancerous tissue from the healthy tissue - how would the surgeons get it out of the head without cutting into the skull? I also thought some surgeons used diluted hydrogen peroxide irrigation for removing potential neoplastic cancerous tissues post excision?

Surgeons Cut a Giant Tumor Out of My Head. Is There a Better Way?

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