[Image: MetroHealth neurosurgeon Dr. Deven Reddy uses a virtual reality system developed by the Chicago company ImmersiveTouch to view and work on a virtual model of a patient’s brain to prepare for a complex surgery. Credit: Evan MacDonald, cleveland.com]
Virtual reality giving MetroHealth neurosurgeons a chance to ‘pre-do’ brain surgery: Brain tech in Cleveland
By Evan MacDonald
March 18, 2021
CLEVELAND, Ohio — If you walk into the office of MetroHealth neurosurgeon Dr. Deven Reddy at the right moment, you might think he’s playing a virtual reality video game.
In actuality, he’s preparing for a complex brain surgery.
Virtual reality technology developed by the Chicago company ImmersiveTouch is making it possible for MetroHealth neurosurgeons to view and work on a virtual model of a patient’s brain prior to the actual procedure. That makes the surgeon more prepared and helps keep patients safe, MetroHealth experts said.
The technology is particularly helpful in preparing for some of the most complicated brain surgeries. Those include skull base surgery, which is a procedure to remove a tumor from the base of the skull; and vascular neurosurgery, which involves the treatment of aneurysms and other conditions involving blood vessels.
Virtual reality represents a massive shift for neurosurgeons, who previously relied on two-dimensional images and their mind’s eye to visualize a case prior to surgery. Now VR is making it possible to “pre-do” those tough cases.
“The advantage I think it gives us the ability to get a more comprehensive perspective of what we’re dealing with,” Reddy said.
As part of Brain Awareness Week, cleveland.com is highlighting some of the advanced technology being used in brain surgery at each of Cleveland’s three largest health systems. The three-day series began Wednesday with artificial intelligence used at the Cleveland Clinic and will conclude Friday with robotics used at University Hospitals.
MetroHealth has been a national leader in VR in recent years.
In 2017, neurological surgical residents started using the technology to practice ventriculostomies at the health system’s Simulation Center. MetroHealth also in 2017 became the first hospital in the U.S. to test out using the ImmersiveTouch system to practice for actual surgeries.
The partnership between MetroHealth and ImmersiveTouch is the result of the health system’s hiring of Dr. Ben Roitberg as the chair of its department of neurosurgery in the summer of 2017. Roitberg, who is also a professor at the Case Western Reserve University School of Medicine, has been working with ImmersiveTouch since 2006, when he was at the University of Illinois at Chicago.
Roitberg saw the potential for VR back back then, but until recently the technology could only be used for training. It took too long to use images of a patient’s brain to build virtual models for current cases, he said.
“To me, that was always deficient. It’s not only the early trainees who need rehearsal. The specialists need rehearsal, too, but at a very different level,” Roitberg said. “The specialists need rehearsal ahead of a difficult and unusual case.”
Now the technology has finally caught up, and it’s much quicker to create a virtual model. MetroHealth physicians can load a patient’s MRI or CT scan onto a disc and send the images to ImmersiveTouch. The company uses those images to create a virtual model that is uploaded into a computer system.
Over the past few months, Reddy has been using the technology to prep for challenging cases. Seeing the virtual model gives him a better sense of important aspects of the surgery, such as the size of the opening he needs to make in a patient’s skull, and the best trajectory to access a tumor or an aneurysm.
“It allows me to visualize the area of interest, whether that’s a tumor or an aneurism, in a 3D, immersive, virtualized platform,” Reddy said. “That allows me to plan in advance a strategy for surgery.”
To use the system, Reddy dons a VR headset and holds a pair of hand-held controls that resemble the popular Oculus Rift system. Those controls allow him to navigate and manipulate the virtual model. On the surface, the experience appears like a video game, but it’s a highly advanced tool to help neurosurgeons.
Reddy and Roitberg believe the technology will continue to evolve. The next step could be introducing touch, or haptic feedback, into the handsets. The haptic feedback would be similar to the type of rumble you get from a video game controller or the device that lets you know your table is ready at a restaurant, but more advanced. Haptic feedback could offer a sense of what a neurosurgeon will feel during the actual procedure.
“That’s probably coming in the next generation of this technology,” Reddy said.
Both Reddy and Roitberg believe VR shows enough promise that it will become standard practice for complex cases in the future. There are no do-overs for a complicated brain surgery, so the ability to “pre-do” an operation in VR is invaluable, Roitberg said.
“We’re fortunate to be at that cutting edge,” Roitberg said.