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3D In The OR

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NEW YORK, N.Y. (Ivanhoe Newswire) - What do the new hit "Gravity," the block buster film "Avatar," and the latest version of "Alice in Wonderland" all have in common with the latest developments in the operating room? The same 3D glasses movie goers put on for these movies are being used by doctors in the OR.

"I think it's amazing.  I mean to see technology work its miracle on me?" Shantese Wilkinson told Ivanhoe.

The miracle is a simple pair of 3D glasses that Shantese Wilkinson's surgeon used to remove a tumor from her brain.

"It ultimately would have probably killed her, but it would have blinded her first," Mark Eisenberg, MD, FAANS, Chief, Dept. of Neurosurgery, LIJ Medical Center, Director, Skull Base Center, Cushing Neuroscience Institute, North Shore-LIJ Health System, told Ivanhoe.

Neurosurgeon Mark Eisenberg opened Shantese's skull. This endoscope with a special camera snaked through her nose, to her brain.  The reality of 3D comes in here.

The new camera sensor is a microchip located at the end of the endoscope. It allows doctors to see on screen, with true depth perception, what the tumor looks like, and precisely where it is. So they can remove it more accurately, safely, and get more of the tumor out than before.

"Having the knowledge of the anatomy, having the visual cues, and having it in 3D makes it easier to make a safe dissection," B. Todd Schaeffer, MD, FACS, Associate Chair Dept. of Otolaryngology, North Shore University Hospital Manhasset at North Shore LIJ Health System, told Ivanhoe.

Her surgery was a success. Now, this recent college grad is ready for a little reality of her own as she begins her career as an assistant train conductor.

The camera on that endoscope the doctors used is only four millimeters in size! That's about the size of a drinking straw.

RESEARCH SUMMARY

BACKGROUND: A brain tumor is defined as a mass of tissue that forms due to an accumulation of odd cells.  As of today, there is no known cause of brain tumors, but there are known risk factors that, if present, can help prevent developing one. Radiation and age are common risk factors, but they're not always the case. A common misconception of brain tumors is that they are all cancerous. This is not true, but may occur depending on your genetic makeup, exposure, lifestyle choices, etc. There are two types of tumors: benign and malignant. (Source:http://www.webmd.com/cancer/brain-cancer/brain-tumors-in-adults)

BENIGN TUMORS: Benign tumors are tumors that are non-cancerous. This type of tumor is clearly defined and is easier to remove because it is not deeply rooted in the brain tissue. Although they can be safely operated on, it does not mean that they will not return. Malignant and benign tumors can be reoccurring, but benign tumors run a smaller risk of reoccurrence. (Source: http://www.webmd.com/cancer/brain-cancer/brain-tumors-in-adults)

MALIGNANT TUMORS: This type of tumor is cancerous and very detrimental to a person's health. Malignant tumors grow faster in the brain and are more likely to spread to different regions. The nervous system, organs, and other parts of the brain can all be affected by a malignant tumor and can leave damage to surrounding cells. (Source:http://www.webmd.com/cancer/brain-cancer/brain-tumors-in-adults)

NEW TECHNOLOGY: 3D glasses that are used in movie theaters are now being used in the operating room. Doctors at Long Island Jewish Medical Center in New York are performing operations on patients with benign and malignant brain tumors with the help of these special glasses. The endoscopic procedure is called the skull-based tumor treatment. This procedure uses a 3D endoscope camera that is the size of a few millimeters. This camera is surgically inserted through the nose as it pinpoints the location of the tumor. To view the images from the 3D endoscope camera, doctors must wear the 3D glasses that perform the same function as when watching a 3D movie. The 3D view allows doctors to see the critical structures with the depth perception from the glasses. (Source: http://www.northshorelij.com/cushing-neuroscience-institute/our-centers/skull-base-center-treatments

INTERVIEW

Mark Eisenberg, MD, FAANS, Chief, Department of Neurosurgery at LIJ Medical Center, talks about a new type of 3D technology doctors are using in the operating room.

Tell me about this 3D technology.  What is it? What does it do?

Dr. Eisenberg: Using endoscopes in surgery has been around for a very long time. It has been used in sinus surgery for a very long time.. Then, it was adopted into general surgery to take out gallbladders. Now, in neurosurgery we've adopted it to begin taking out a skull base tumors and pituitary tumors, things like that. Endoscopes by virtue of the technology are two dimensional images that are produced; that's just the way the technology is. So, working with an endoscope you're working off of a TV screen just like looking at your TV at home. As surgeons you  learn how to gauge depth perception by other cues, tactile cues. The newer technology with the 3D endoscope has really changed that completely in that we now have a 3D image that we're looking at on the TV by wearing 3D glasses, just like going to the movies and seeing a 3D movie. So, when we're looking at a structure surgically, we don't have to try to gauge depth of something behind or in front of something else, we can see it visually exactly as it is in 3D. It has had a huge benefit in our abilities to take out tumors more safely and more completely.

What do you think about the fact that you guys actually have 3D glasses?

Dr. Eisenberg. For me it took a little getting used to because I don't wear glasses. I had to adjust a little bit, but it wasn't hard to adjust and the glasses themselves are really pretty comfortable. They're almost like regular glasses that you wear. So, it hasn't had any real impact on our surgeries.

Can you talk about Miss Wilkinson and her case?

Dr. Eisenberg:  Miss Wilkinson was a young woman who came to see me. She was about 21 at the time. She was having trouble with the vision in her left eye for a number of years. Since the time she was, I think 13 or 14.  She was told that she had a lazy eye or something like that. It was only within the last year before she saw me that she began noticing not only worsening vision, but now really bad vision in her right eye. That led to a workup by the ophthalmologist and that led to an MRI.

Can you explain how this technology came into play?

Dr. Eisenberg:  So, in Miss Wilkinson's case, the MRI showed a very large tumor in the beginning region of where her pituitary gland is, but then growing upwards and filling almost the whole front part of her brain and her frontal lobes. It was really very large with tremendous compression on the optic nerves. So, she actually had a staged procedure. The first stage was to take the tumor out through what's called a craniotomy, where we open up the front part of the skull and then very carefully, under the microscope,  took out probably about 90 percent of the tumor, took it away from her optic nerves, from her optic chiasm, and from the carotid arteries. However, there was a small amount of tumor that was tucked down around the corner, down by where her pituitary gland is. We realized at the time that it actually would be rather easy for us to come back as a second stage and take that it out through her nose. So, the plan was to let her recover from that surgery, which she did. Her vision got much better; in fact it got back to normal. Then, as a second stage we came back through her nose using the 3D endoscope in order to have the depth perceptions that we wanted and took out the remaining part of her tumor.

What was at stake for her? What would have happened if this wasn't available for her?

Dr. Eisenberg: Well, if the 3D technology wasn't available, we still would have been able to take it out with standard endoscopes that we've been using for years, which are 2D images. We can do very well with those 2D image endoscopes. However, it just makes the operation a little bit more difficult. There are cues that we have to use in order to judge depth, so the 3D technology for us has just advanced our abilities to take these tumors out a bit easier and safer.

So, does the patient have a choice whether they want 2D or 3D?

Dr. Eisenberg:  Well, since we have it now we tend to use it on almost all the time. Patients always have a choice about everything and patients who do their research can certainly find out what institutions have the 3D technology available and which don't. There are very few centers, we are one of the few centers that has the 3D endoscope available and are using it on a regular basis.

Was her life at risk because of this?

Dr. Eisenberg:  The tumor was really very large, she was almost blind. She had very poor vision particularly in her right eye. Her vision in her right eye was about 20/400, which is nearly blind. In her left eye she had lost almost all of her peripheral vision before surgery. The tumor was really pushing not only on the optic nerves, but it was pushing on the under surface of her frontal lobes. If the tumor had continued to grow and had continued to compress it, it ultimately probably would have killed her. However, it would have blinded her first and then ultimately, like other large tumors, would rob her of her life.

For more information, please contact:

Mark Eisenberg, MD, FAANS
Chief, Department of Neurosurgery at LIJ Medical Center
Director, Skull Base Center
Cushing Neuroscience Institute
North Shore-LIJ Health System
516-773-7737

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