How a pioneering software system is transforming brain surgery
A pioneering new approach being trialled at University College London Hospital (UCLH) hopes to make epilepsy surgery safer and easier. A team of researchers, clinicians and engineers from Epilepsy Society, UCLH, UCL and King’s College London have developed a world-leading software system called EpiNav, which stands for epilepsy navigation, and their work is being featured on today’s episode (10 October 2018) of the BBC’s Trust Me I’m a Doctor.
Around half a million people in the UK suffer from epilepsy, a condition where abnormal electrical activity in the brain leads to recurrent seizures. The condition can be managed with anti-epileptic drugs, but up to 30% of patients don’t respond.
Trust me I’m a Doctor, BBC2, 7pm 10 October 2018
Watch the BBC clip
Electrodes in the brain
For these patients, another option is to undergo brain surgery to remove the part of the brain that is causing the seizures, but before this can be attempted the surgeons need to know exactly which parts of the brain are responsible. Often, this can only be determined through a complex procedure that involves temporarily implanting electrodes into the brain to measure the electrical activity.
Up to 16 electrodes could be required – all of which need to be positioned without damaging crucial blood vessels or vital parts of the brain such as those involved with speech, vision or movement. It’s extremely risky and challenging, so in many cases doctors and patients are reluctant to proceed.
The new approach is funded by the Wellcome Trust and the NIHR UCLH Biomedical Research Centre, and brings together CT scans and MRI scans of a patient’s brain to create an incredibly detailed 3D map that can be used to plan surgery with millimetre accuracy, calculating safe routes through the brain for each electrode that needs to be implanted. What’s more, the technology can be taken into the operating theatre to guide surgeons in real time.
Gabriel Weston met consultant neurologist Prof John Duncan at the National Hospital for Neurology and Neurosurgery,and Prof Sebastian Ourselin of King’s College London to find out more about this impressive new system.
Currently, EpiNav is being tested in an ongoing clinical trial with half of the surgeries being performed entirely manually by NHNN surgeons Andrew McEvoy, Anna Miserocchi, and UCL clinical researcher Vejay Vakharia.
In the other half, the EpiNav data is being passed to a robot which assists the surgeons by lining up the precise trajectory for each electrode. The researchers anticipate that the robot will help to make the process quicker and even more accurate, which in turn could make epilepsy surgery available to patients who may not previously been approved for the procedure.
The segment also follows the story of Alistair, who underwent a surgical resection after developing epilepsy as a child. In order to make sure he would be suitable for the procedure, Alistair first had a series of electrodes placed in his brain to measure the electrical signals in his brain. After monitoring this for a number of days in a controlled hospital environment, the clinical and technical specialists were able to pin-point the region of the brain responsible for his seizures which was removed in a second operation.
Both the diagnostic and interventional stage of the procedure are planned extremely carefully, making sure the risk of affecting an area of the brain responsible for key motor functions will not be affected – in many cases meaning patients are just not viable for this treatment.
Already, the EpiNav software has been used in over 150 epilepsy surgeries and the team anticipate that in future it will be integrated into operating theatres across the UK. This software could also have even wider applications in future, and could be used in other areas of neurosurgery to help treat conditions from brain tumours to Parkinson’s disease.
Find out more
Read more about how MRI scans and neuroimaging have changed the diagnosis and treatment of epilepsy.