Dr. Lloyd Zucker, a Florida-based brain surgeon, likens his job to flying a plane. When he goes into someone's skull to operate, he has to navigate the nerve fibers, and like a pilot flying by buildings, he wants to avoid damage. To avoid a crash, Zucker uses brain scans as maps. To figure out the best pathway, he works with a radiologist to interpret the MRI, a process he likens to something like "flying blind"—not a very encouraging metaphor to hear from someone operating on people's brains. "The scary thing is that if you look at the brain," he said in an interview with a local Florida news station, "all the fibers that exist within the brain, we can't see them. When we go below the surface of the brain, we have no idea what's really there." Yikes.
Thanks to a new technology called Bright Matter Planning from Synaptive Medical, though, Zucker can now see the brain's airspace, so to speak. "If I was to fly through Fort Lauderdale, now I can fly through the buildings because I know where the buildings are," explained Zucker, who started using the visualization technology about six months ago.
Conventional MRI scans only offer a 2-dimensional rendering of the brain. Using a complex color system and other signals, radiologists and neurologists work together to piece together various flat images to understand what's going on underneath the surface. "It's a cognitive nightmare to try and layer all this information," says Sheryl Thingvold, an engineer and marketing manager at Synaptive Medical, while pointing to conventional brain scans. "You can see it's not even very detailed. It's not even a rich picture."
The technology from the Toronto-based startup highlights fiber bundles through a 3-D, multicolored interactive image that lets the surgeon better understand what the nerve pathways look like and how they run. "There are tens of billions of connections in your brain," says Cameron Piron, a magnetic resonance physicist and engineer by training, and one of the founders of Synaptive Medical. "If you show all of those to a surgeon at once it's a little overwhelming. We try to [help the surgeon] prune down that information based on what's important," he added, a process you can see in the animation below.
In practice, for someone like Zucker, seeing how the fibers run allows for better planning and less traumatic operations. With intel from older images, Zucker would often take the shortest path from the skull to a tumor, but that's not always the safest route. With Bright Matter, the image can be manipulated to show only contextually relevant information, like the fibers that lead into and surround a tumor, for example. "Looking at fiber bundles, we can plan a path to get to where the abnormality is," explained Zucker. "Now we're choosing a path that creates the least damage on the way there." A less traditional route, it turns out, might save someone's eyesight, for example. "You want to image the good and the bad and find the appropriate pathway finding the natural folds of the brain," added Piron. "To get to deep brain access tumors has always been a challenge. By using the natural folds of the brain to guide your way deep into the brain, you want to marry the tumor and the structure to plan your route."
Bright Matter Planning can also help with diagnosis. Synaptive Medical is working with a doctor in Chicago to use the technology to better detect concussions, some of which are difficult to see with traditional brain scans. CTE, the brain disease found in football players with a history of head injuries, can only be diagnosed postmortem, for example. The imaging technology can help detect strokes, tumors, and degenerative brain disorders like Parkinson's.
After launching late last year, Synaptive Medical has installed its software in 20 different medical centers, with five more to come this month. Medical professionals have been more receptive to the technology than Piron expected. "That field has been pretty stagnant for a long time," he says.
For Synaptive, improvements in reading MRIs is just one part of a larger plan to become the Google Maps of brain surgery. Piron, who sold his first startup Sentinelle Medical, a breast cancer imaging technology, to the med-tech giant Hologic, is working to create "a fully integrated operating suite that provides the right information to the surgeon at the right time in the right scale in the right contrast." Even with Bright Matter Planning, the neurosurgeon can only use the visualizations for planning. In the future, the surgeon will be able to see where he is going and what he is doing in real time, just like that little progress dot on Google Maps' GPS. "Traditionally, you would detect a tumor under MR based on blood flow and other imaging parameters. When you actually did the surgery, you move to optics, you're moving to white light imaging. You’re looking at the tissue in two different ways and it's up to the surgeon to correlate the two," explained Piron. "What we would like to do is bridge those together more effectively."
So far, in addition to the MR vizualization, Synaptive Medical has also released a robotics platform. The long-term plan is to integrate as much of the imaging and surgical technology as possible. "You have all this different technology and you rely on the surgeon to integrate it all," said Piron. "They already have a very difficult job; it’s an incredibly tough, tough, tough profession." Synaptive Medical wants to make brain surgery, well, not as hard as brain surgery.