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Minimally invasive neurosurgery

Sunnybrook’s neurosurgery team is using a navigational system to reach lesions and tumours deep in the brain to help better diagnose and treat patients. Learn more about it below.

What is this new minimally invasive system?

The new-to-Sunnybrook tube system (NICO BrainPath) is often combined with specialized magnetic resonance imaging (Synaptive’s BrightMatter™ Plan) to allow the surgeon to guide a protective tube into the deep white matter of the brain which may help reduce damage to other brain tissue along the way. During the procedure, the surgeon makes a small opening in the skull. The plastic sheath helps protect the brain matter as the equipment travels through the brain and remains in place as the surgeon then access the surgical site. The magnetic resonance imaging (MRI) provides a clear path through the brain’s intricate folds and connections.

“Within the brain there are folds and tracts connecting multiple regions that are important for brain function. Like highways for brain activity, these pathways are very important connections. The MRI technology today allows us to guide the tube through the brain following a path that can help avoid these connections and protect the brain’s function. It’s like a roadmap for us.”

Dr. Leo Da Costa, neurosurgeon

What is this for?

The system can be used to reach primary or secondary brain tumours located in the brain’s white matter in order to obtain a sizeable sample for biopsy or to remove the entire tumour.

It can also be used to target brain hemorrhages (a type of stroke caused by bleeding within the brain) or other kinds of brain lesions such as cavernous malformations.

How are these typically treated?

When a tumour is located deep in the brain, surgeons might try to reach it with a small needle to do a biopsy to remove a small piece for further testing. It is challenging to conduct diagnostic tests on a small sample of cells. Typically surgeons don’t operate to remove brain tumours in deep parts of the brain.

For brain hemorrhages deep in the brain, so far no surgical treatment has been proven more effective than non-surgical intervention. Part of the issue seems to be the damage caused by the intervention itself when trying to gain access to remove deep clots. With minimally invasive techniques and imaging guidance, surgeons may be able to now reach the hemorrhage, avoid important areas in the brain, and may remove it without causing more damage to the brain.

How does this help patients?

For many patients who are currently not candidates for surgery, this new system could help surgeons carefully remove tumours deep in the brain for both diagnosis and treatment. Using this minimally invasive system, patients may have shorter stays in the hospital. Some may even go home the next day.

For intracerebral hemorrhages, it can help surgeons remove the bleed and stop the known negative effects of blood breakdown and increased pressure in the brain. While this won’t reverse any damage the bleed has already caused in the brain, it can minimize “secondary injury” and help patients by allowing them to get to rehab faster.

Does this mean you will now operate on everyone?

Some tumours remain inoperable depending on where they are located and what parts of the brain they are affecting. Sometimes removing the tumour would cause too much damage to the surrounding tissues. This new system is mainly to reach tumours that are in the white matter in the brain.

“While this system does not allow us to remove all tumours, it certainly allows access to tumours that previously would not be removed, and it’s a less aggressive approach to others that could be removed with standard techniques.”

— Dr. Leo Da Costa, neurosurgeon