Laser Interstitial Thermal Therapy in Brain Treatments
Laser Interstitial Thermal Therapy (LITT) has rapidly ascended the ranks of neurosurgical procedures, serving as a minimally invasive treatment for a spectrum of brain disorders. Most commonly used in the management of brain tumors and refractory epilepsy, LITT has revolutionized the way neurosurgeons approach certain challenging pathologies.

The principle of LITT is deceptively simple: it employs laser light to deliver finely-calibrated thermal energy to specific tissue sections within the brain, leading to localized cell destruction. This mechanism contrasts starkly with traditional brain surgeries, which might necessitate larger incisions or even the removal of skull fragments. Instead, LITT involves inserting a small laser applicator through a diminutive cranial opening.

One of the defining advantages of LITT is its accuracy. Real-time MRI guidance ensures that surgeons can view and control the procedure's progress, guaranteeing that only the targeted tissue is affected. This meticulous approach is especially useful for lesions deep within the brain or those located in areas difficult to access through conventional surgery. In such cases, LITT presents an option where the risks of traditional surgical intervention might outweigh the benefits.

However, like all medical interventions, LITT is not without its side effects. Although the procedure offers reduced hospital stays, faster recoveries, and a minimized risk of complications compared to traditional surgeries, it's essential to recognize its potential drawbacks. Some patients might experience swelling in the treated area, neurological deficits, or infection. There's also a risk, albeit small, of the laser damaging surrounding healthy tissue if not accurately targeted.

Furthermore, while LITT is effective in shrinking or destroying tumors, there's no guarantee that it will eliminate all cancerous cells. Residual cells can potentially lead to tumor recurrence, making it crucial for patients to have regular follow-ups post-procedure.

Laser Interstitial Thermal Therapy offers a novel avenue for the treatment of specific brain disorders, marrying the worlds of radiology and surgery. Its precision is commendable, but its side effects, although comparatively few, are noteworthy. For patients considering LITT, a comprehensive discussion with a neurosurgeon will provide insights into its appropriateness for their unique condition, ensuring the best possible outcome.

References: Carpentier, A., et al. (2016). "Real-time magnetic resonance-guided laser thermal therapy for focal metastatic brain tumors." Neurosurgery.

Curry, D. J., et al. (2012). "MR-guided stereotactic laser ablation of epileptogenic foci in children." Epilepsy & Behavior.

Willie, J. T., et al. (2014). "Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy." Neurosurgery.

Hawasli, A. H., et al. (2013). "Magnetic resonance imaging-guided focused laser interstitial thermal therapy for intracranial lesions: single-institution series." Neurosurgery.

Restorative Neurosurgery

Neuro-restorative surgery is a branch of neurosurgery that aims to repair and restore the function of the nervous system. Imagine your brain and spinal cord as a complex network of electrical wires, controlling everything from movement to sensation. When these "wires" are damaged, it can lead to a range of issues, like paralysis or loss of sensation. Neuro-restorative surgery seeks to fix these problems by either repairing or rerouting these "wires."
Neuromodulation Spinal Cord Stimulation for Paraplegia: It's like placing a pacemaker for the spinal cord. Electrodes are implanted in the spine and send electrical signals to help people with paraplegia (paralysis of the legs) regain some movement.
Nerve Transfer: Think of this as re-wiring a plug. If a nerve is damaged, surgeons can "transfer" a working nerve from a different part of the body to the damaged area, restoring function.
Tendon Transfer: If a muscle isn't working because its nerve is damaged, this procedure moves a working tendon (which attaches muscle to bone) from one muscle to another, helping restore movement.
Spasticity Surgery: When the muscles become tight, they need to be loosened either via medications directly acting on the nerves like in intrathecal baclofen pumps.Sometimes a surgery may be required to deactivate only those nerves which are hyperactive and contributing to the tightness of the muscles.
Sacral Nerve Stimulation for Bladder: For those with bladder control issues, electrodes can be placed near the sacral nerves in the spine. By stimulating these nerves, it helps the bladder function more normally.
Brain-Computer Interface (BCI): This is like science fiction come to life. A device is implanted in the brain that allows people to control external devices, like computers or prosthetics, with their thoughts.
Neuralink: This is a company started by Elon Musk that's working on advanced BCIs. They aim to develop ultra-thin threads that can be implanted in the brain, allowing for direct communication between the brain and external devices.
In essence, the future of neuro-restorative surgery is incredibly exciting. With advancements like these, we're moving closer to a world where damage to the nervous system doesn't necessarily mean a lifetime of disability. As technology and medicine continue to merge, the possibilities seem almost limitless.
Disease conditions managed:
Paraplegia,
Tetraplegia,
Hemiplegia,
Neurogenic bladder,
Spasticity,
Pain
In Future - Aphasia, Language issues, disorders of consciousness

Among all the negativity surrounding Covid-19 this year, a major technological milestone in brain tumor diagnosis via deep learning has given a small reason to smile and bring on some positivity and hope. The breakthrough has the potential to permanently change the way the brain tumors are diagnosed. I present my views on this amazing technology, which should be carefully watched for time to come.

Brain tumors therapy involves multiple steps. The first is to know the type of tumor before initiating treatment. It indicates, nature of the tumor(for eg. infectious versus cancerous) , grade (high or low/ benign / malignant) and the possible course of treatment(antibiotics/radiation/chemo). During the process of diagnosis, often, a small bit of the tumor is sent for analysis under the microscope. Through the powerful eyes of a microscope, Neuro-pathologists who are expert in pattern recognition, decide what category a tumor belong to. The process of getting an accurate diagnosis can stretch up to a few days if not a week. In some cases, rapid diagnosis is possible while the surgery is performed, but it involves availability, logistics, and coordination at various levels which makes the procedure a multistep, highly neuropathologist dependent and time-consuming, making it prone to the errors.

In a eureka moment equivalent, the artificial intelligence-enabled computer algorithm was able to diagnose tumor types successfully in less than a minute! In a study published in Nature, Hollon et al, trained a computer algorithm using deep learning protocol, to learn “pattern recognition” ability, very similar to a trained Neuropathologist with astoundingly accurate results (94.6% accuracy), WITHOUT human intervention! It is a landmark moment for those working on Brain Tumors. In less than three minutes, artificial intelligence-enabled software enabled a tumor type diagnosis, where this could take about a week for a routine or half an hour(without confirmation) for a “frozen section”. In comparison, “human” reporting accuracy was 93.9%. There was no overlap in errors between the AI and the neuropathologists. This is truly remarkable and I do not think the day is far, when algorithm, would also tell you instantaneously the type of tumor that’s being operated on, the best surgical strategy, tailor-made chemo/gene/vaccine-based therapy to target the tumor. Though the achievement may look like a small step now, in the future, it will pave way for the AI to strongly impact patient care related to the Brain tumors.

Having said that, AI-based protocols require BIG data sets to achieve accuracy, therefore if the disease is rare, and the data set is sparse, then the accuracy of AI will be a limitation. Secondly, very often, various other factors apart from image/pixel characteristics/ are utilized in hypothesis formation such as patient’s age, imaging findings, clinical history, etc. These “classifiers” are currently hard to incorporate in the existing deep learning protocol, contributing to the errors. Therefore, to summarise, this technique in the current state cannot replace NeuropathoIogists and nor it should. However, it certainly is ready to be utilized as a tool to improve the speed and accuracy with which a preliminary diagnosis is made.

Reference: Hollon TC, Pandian B, Adapa AR, et al. Near real-time intraoperative brain tumor diagnosis using stimulated Raman histology and deep neural networks. Nat. Med. 26(1), 52–58 (2020)

According to the researchers - Prof. Dr. Janet Siegmund, Chair of Software Engineering at Chemnitz University of Technology, Prof. Dr. Sven Apel, Chair of Software Engineering at Saarland University and Dr. André Brechmann, head of the special laboratory for non-invasive imaging at the Leibniz Institute of Neurobiology in Magdeburg - Programming is like "talking". Talking is the vocal processing of appropriately "organised" thoughts. With non invasive tools, it was found, that the network that is responsible for langauge generation is activated when a programmer codes in a software. This means computer programmers are constantly "talking" to oneself "mentally". This doesnt come as a surprise as we know and through my personal experience, learning to code in many ways is akin to learning a new language. As with the normal language that you and me speak on a daily basis, computer language too, is bound by syntax, vocabulary, grammer, indentation, usage of memory etc. Therefore some similarity is expected and now proven as well.
Where is the language area located in the Brain?
The conventional view is that, in a large majority, the area of the Brain that is responsible for "Language" is located on the left hemisphere, just above the temple. However, this view has been questioned now. The emphasise is on the millions of interconnected nodes rather than a single location, and it's this network that subserves the function of Language. In the technical parlance, these nodes may be imagined as various servers that Google has placed across the world. These servers work, syronously and produce the output, whenever a user enters "Despacito" on youtube search bar, from any corner of the world! It makes the system, fast, efficient and safe. Something mother nature had planned and executed millions of yeard ago!!
Whenever there is a tumor located close the areas or network responsible for speech or language, every attempt is made to keep them safe from surgical trauma. There are few ways to do it.
1. Functional MRI (fMRI) - This is like a standard MRI, but, while a MRI is going on, specific task such as reading, vocalizing etc are performed. This lights up the important structures subserving language.
2. Diffusion tensor imaging (DTI) - This is again like an MRI. But various signal adjustments are made and the computers traces and carves out various connections between the "node" of the network as we talked about. The data from DTI and fMRI is used while surgery is being done so "geo-map" the network.
3. In the operation theatre - While the patient is "awake" during the procedure, she / he is asked to read, write etc. Simultaneoulsy, the brain structures are stimulated with a small amount of current. If the area falls within the language network, there is often a pause in patient's speech. Hence an entire area can be mapped out so that a safe excision of the tumor can be done without harming the vital structures.
Please do write up if you do have clarifications.

To see the location of google servers near you click HERE!

To think about the Science we just discussed and enjoy the song Despacito click HERE!