LLU&MC Scope Autumn 2000

Holographic surgery

Pediatric neurosurgeon combines two technologies to remove tumor

Chief of the department of pediatric neurosurgery, John J. Collins, MD, comined two technologies for the first time to help precisely and efficiently remove a tumor from the brain of a 13-year-old boy on August 29.

Jesus Mayen of Cathedral City speaks to Colleen Sullivan, a reporter for KESQ-TV, a television station located in Palm Desert, California, about the removal of his brain tumor-a process which combined two technologies.

The tumor, deeply located near critical structures, was a type that could only be seen by magnetic resonance imaging (MRI) brain scans. These technologies utilized the MRI scan data to inform the surgeon of the exact tumor location and, in this way, facilitated complete removal.

One technology, the Voxel Digital Holo graphy™ System, turns computerized tomography (CT) and MRI scans into three-dimensional holographic images.

An image of the brain is projected in space like a sculpture of light that surgeons can walk around and examine, says Dr. Collins.

These pro jections in space show physicians the size, shape, and exact location of a brain tumor relative to other structures such as arteries and veins in the brain.

The second technology, Medtronic Image Guided Surgery or IGSÙ, relates the CT and MRI images of the brain to the actual patient so that the surgeon can use a hand-held instrument during surgery to locate the tumor.

Successfully combining these two technologies is a first and something that neurosurgeons welcome. Some types of low-grade brain tumors blend together with normal tissue in such a way as to make it impossible by visual inspection alone to distinguish between a tumor that must be removed and normal brain tissue that may control critical function and so must not be disturbed. Combining these two technologies shows physicians the size, depth, and location of such lesions within the brain, allowing them to plan surgeries more precisely.

This was especially necessary in the case of 13-year-old Jesus Mayen of Cathedral City, who had suffered several epileptic seizures each week since last October.

When it happened, I would stay still, open my mouth and start drooling. My face got dark purple, and I wouldn't remember it afterward, Jesus said at a press conference on August 31.

Scans of the boys brain showed that a low-grade glioma, or tumor, was causing the seizures. The tumor was located at the base of the brain near the midline, deep within the right temporal lobe, the area responsible for memory and learning.

If left alone, the tumor would continue to cause seizures and could eventually have led to more neurological problems or even death.

Because removing such a tumor without leaving any traces behind can often result in a complete cure, Dr. Collins was anxious to know its exact dimensions and location.

During preoperative planning, with these two systems linked together, Dr. Collins performed a virtual operation by moving the navigation probe through the hologram of the patient's brain. During this process the navigation computer reported the precise location of the probe tip while the hologram revealed all of the surrounding anatomy. In this way Dr. Collins was fully informed of the tumors three-dimensional shape and precise position . The technology also alerted Dr. Collins to the location of critical normal structures nearby.

This virtual surgery gave Dr. Collins exactly the information he needed to go into Jesus brain the next day and completely remove the tumor with no damage to the surrounding structures.

Although Jesus may suffer some temporary short-term memory loss, brain scans taken after surgery show that not even a trace of the tumor remains. Jesus will visit a neuropsychologist to determine if he does indeed have some memory loss caused by the surgery.

Dr. Collins, who gave a press conference demonstrating how he combined the two technologies, is a recent addition to the neurosurgical team at LLUMC.

Prior to joining the department at Loma Linda, Dr. Collins was a fellow in pediatric neurosurgery at Salt Lake City Primary Childrens Hospital. A diplomate of the American Board of Neurological Surgeons, he has had seven years of pediatric and adult neurosurgical practice experience in the United States Navy.

He served as chief of neurosurgery at the Oakland Naval Medical Center in Northern California. Subsequentl y , he became chief of neurosurgery at the Tripler Army Medical Center in Honolulu. There he treated many complex pediatric referrals from Pacific Rim military bases and island nations. He has held civilian neurosurgical staff positions at the Santa Clara Valley Medical Center in California and at the Kaiser Permanente Moanalua Medical Center in Hawaii.

Dr. Collins is a recipient of awards and commendations for his research in neuroscience . He has published and lectured on brain axonal regeneration and intraoperative holography for neuronavigation .

Experienced with brain function mapping and skull base surgery, his focused interest is in pediatric brain tumors. His training has also emphasized the surgical treatments of spasticity and seizures in children, plus the latest techniques for pediatric spinal operations.

Dr. John Collins explains the combination of holographs and guided imagery used to remove a tumor from 13-year-old Jesus Mayen. Photograph courtesy of Peter Phun of the Riverside Press Enterprise.

[Scope, Autumn 2000]