Q&A Topic: Using Technology to Make Brain Surgery Safer

Marc Otten, MD

Q: What are the riskiest aspects of brain surgery?

A: We have a spectacular understanding of the structure of the brain, which is like opening up a computer and knowing where all the wires go. The hard part is understanding the functional anatomy, which is like knowing what each of those wires does. This is particularly challenging because in the human brain the wires might look like they all go to the same place, but each person is unique. Special MRI techniques and intraoperative testing allow us to understand the unique anatomy in each of our patients. Much of the research we perform today aims to understand the brain better, and thus remove pathology in delicate areas without damaging normal nerves.

Q: How do researchers test new brain surgery technologies safely?

A: We have a careful process through which we prove treatments are safe before we test whether they are effective at our sister campus, NewYork-Presbyterian/Columbia University Medical Center. We make sure that before we do anything untested, a patient has already received all proven treatments. Furthermore, no research is done without approval of an institutional review board, a body that provides significant oversight and helps protect patients from any research that would be unethical.

Q: Can you summarize some game changing new neurosurgical tools/technologies?

A: The same technological advances that give us more computing power in our pockets than used during the Apollo space missions are making surgery safer and more effective. We have been able to use special imaging techniques to look inside the brain for decades, but only recently have we been able to process all this information, and link it to our equipment in the operating room. I can already remove some brain tumors without any external incisions, and the microinstruments and enhanced visualization tools are consistently improving.

Q: How will brain surgery evolve over the next 10-20 years?

A: The way things have been going over the last 10-20 years, I think the possibilities are mostly up to our imagination. The great challenge in medicine is tailoring treatment to the individual. We already know that certain brain tumors that were once considered a single disease actually represent a huge variety of illnesses, which require different courses of treatment. We are near a point where each patient will have a unique treatment prepared exclusively for him or her.

One thing I learned early as a medical student, and then as a neurosurgeon, is that as much as I might think that I know, there is always so much more to learn. I am fortunate to be in a top academic institution with colleagues who are in the top of their respective fields. We take a multi-disciplinary approach to neurologic problems, and thus assure that we offer our patients the best available treatment.

Q: What inspired you to become a neurosurgeon? What do you love about your job?

A: I studied Philosophy in college, where I learned about human nature, and how to reduce problems to their basic components, and then work on each component. This attracted me to medicine, where humanity and science come together to understand human disease. When I was in medical school, I loved neuroscience and neuroanatomy. When I started working in the operating room, I loved that neurosurgery requires careful planning, and then the surgery itself is a delicate balance between taking out a tumor while preserving normal structures. Years later, it’s a tremendous privilege to work with people at NewYork-Presbyterian Lawrence Hospital to help them understand their diseases and reassure them that we will help them in every way possible.

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