Smarter tools for brain surgery
Dr. James Chandler has performed more than 4,000 brain operations in his career. In fact, Chandler, the surgical director of neuro-oncology at Northwestern Memorial Hospital and co-director of the Northwestern Brain Tumor Institute, often removes several benign pituitary gland tumors in a week, which means he personally does more of these surgeries in a month than most American hospitals do in a year.
(Full disclosure: One such removal, last spring, involved the brain used to write this piece.)
The volume is important in and of itself, given the correlation between experience and better patient outcomes. But there’s another benefit to the hours Chandler, 52, has spent maneuvering within the cantaloupe-sized slabs of grayish-pink tissue that lend us our identities: All this intricate work has helped him figure out how to improve the tools that let him operate through a small incision in a patient’s nose.
Minimally invasive neurosurgeries—ones that don’t require cutting through the skull—aren’t new, but the two ways of performing such procedures each have pros and cons.
Microsurgery relies on a high-powered surgical microscope that lets surgeons see in 3-D and operate on a tumor through a half-inch opening cut in the back of the nose. The problem, though, is that these microscopes are cumbersome and can’t be maneuvered for broader views. The second option uses an endoscope—a thin tube with an attached video camera that goes up through the same small hole in the nose and then projects images onto a monitor. Though they offer a wider view, it’s only in 2-D.
Chandler is pioneering the use of a mini-microscope a fraction of the size of the old ones that offers improved mobility and even better 3-D visibility. He’s also the first neurosurgeon to use a 3-D version of an endoscope, which significantly improves depth perception. The two tools can even be used interchangeably during an operation, because both offer similarly immersive views when Chandler and his team don 3-D glasses that resemble Ray-Ban Wayfarers.
“With the glasses on, it’s as though we’re right there working inside the brain,” Chandler says.
In brain surgery, where a millimeter can mean the difference between full recovery and significant handicap, the improved visibility matters a lot. “Any advancement in terms of imaging certainly leads to more complete tumor resections and improved patient outcomes,” says Dr. Maciej Lesniak, who joined Northwestern as its chair of neurosurgery last fall.
Chandler, who earned a medical degree from the University of Maryland after studying neurobiology at the University of California at Berkeley, came to Northwestern in 1990 to complete his neurosurgical residency. After helping create its Brain Tumor Institute in 2008, he was named the Lavin/Fates professor of neurological surgery at Northwestern’s Feinberg School of Medicine in 2014.
He says even larger leaps are on the horizon. “We’re only at the earliest stages of understanding the brain,” he says.