Neurosurgeons in the Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, are the first in Florida to adopt the Reveal fluorescence-guided system. This head-worn device provides better illumination, giving surgeons more precise guidance to differentiate between brain tumors and healthy tissue.
"We know from the data that the more we resect, the better patients do," said Michael Ivan, M.D., who co-directs the Sylvester Comprehensive Cancer Center’s Brain Tumor Initiative at the University of Miami’s Miller School of Medicine. "But it's exceptionally difficult in the operating room to distinguish the boundary between tumor and normal brain."
A High-Tech Headlamp
The system is essentially a super high-tech headlamp that shines light wherever the surgeon is looking. The system magnifies the surgical area and offers different light options to light up tumor cells. Also, because the technology is no longer fixed, surgeons can better orient themselves while working in the brain.
It's a benefit because brain tumors are shaped more like a sea anemone than a ball, generating small finger-like projections that infiltrate surrounding tissue as the cancer grows. In some areas, tumor cells are highly concentrated, making them relatively easy to remove. In other parts, the concentrations may be low – 100, 10 or even one cell per cubic inch.
This puts neurosurgeons in a challenging position – they want to remove as much tumor as possible but can’t risk damaging the brain. The solution comes in day-glow pink.
"Before surgery, patients take a drug that becomes a fluorescent metabolite and is only picked up by tumor cells," said Dr. Ivan. "When we shine a blue light on the tumor, it glows bright pink, while the surrounding tissue looks purple. The intensity of the pinkness highlights how much tumor is left, allowing us to keep going in areas where we might otherwise not realize we’re leaving tumor behind."
Providing Mobility
Neurosurgeons have been using fluorescence to delineate tumors for several years but have needed better tools to see these glowing cancer cells. Until now, surgeons used a special microscope to see the fluorescing cells; however, this device is expensive, bulky and challenging to maneuver, making it difficult to get good sight lines during surgery.
"It’s hard to see around corners with the microscope, which is incredibly important because the fluorescence will only glow when the light is directly on it," said Ricardo Jorge Komotar, M.D., who co-directs the Brain Tumor Initiative. "When you're working in a deep cavity, you may not realize you're leaving tumor behind because it's not glowing, but that's just because it's hard to get the light to it."
Reveal fixes that by adding mobility.
The new system also gives neurosurgeons a better tool to identify and remove cancer cells, taking much of the guesswork out of these procedures, and will likely elevate the quality of cancer neurosurgery.
"I think this will help the neurosurgical community provide a higher standard of care that's more consistent across the board," Dr. Komotar said. "We feel it's a much more effective method, allowing us to provide better resections for our patients and hopefully better outcomes and survivability."