How a pioneering software system is transforming brain surgery 

11/03/2019 00:00 

A team of researchers, clinicians and engineers from UCLH, UCL, King’s College London and the Epilepsy Society have developed a world-leading software system called EpiNav, which stands for epilepsy navigation, in a bid to make epilepsy surgery safer and easier.

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.

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 pioneering 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.

Currently, EpiNav is being tested in an ongoing clinical trial, with EpiNav data 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.

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.

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