How Neurosurgeons Navigate Inside The Brain

– I’m taking a couple of
weeks off and while I’m gone, some brilliant people are
standing in for me here. First is Alex from Brainbook,
he’s a brain surgeon. There’s nothing gruesome in this video, but there is the answer to a
question I never knew I had, how do neurosurgeons find their
way around inside the brain? – Neurosurgery is fraught with risk. The brain is packed with
almost 100 billion neurons compartmentalised into
complex bundles of nerves and other structures that
make you who you are. Small parts of your brain
are vital for allowing you to speak, move, think, learn and love. As neurosurgeons, we operate in and around these vital structures and
spend a great deal of time learning the anatomy so
that we can operate safely. The room for error can be millimetres as we manoeuvre around blood
vessels and critical nerves and damaging any of these can
cause either life changing or life ending complications. No matter how good the
surgeon and no matter how good their knowledge,
we can still go astray and need a helping hand. Neurosurgery is a
specialty that’s inherently intertwined with cutting edge technology, and we can use that to guide us when we’re navigating the brain. Today I’m going to show
you how neurosurgeons can use infrared and electromagnetic
image guidance systems to show us exactly where
we are in the brain during critical operations
like brain tumour surgery, or inserting biopsy needles
deep into the brain. This is a Medtronic StealthStation S8. It’s a combination of
hardware and software that uses special trackable instruments, such as this pointer and this stilette. To be able to guide the neurosurgeon, the system tracks the
position of these instruments in relation to the surgical anatomy and sends that information
to the software. The software then displays
the instrument’s position on either the CT or MRI
scan of that patient. The system can track
instruments either optically using an infrared camera
or electromagnetically. With optical tracking,
this camera sends out and then detects infrared light that’s reflected from these silver balls. The camera then transmits
the instrument’s location to the navigation software. Similarly, with electromagnetic tracking, the emitter emits a low
energy magnetic field with unique characteristics
at every point. The electromagnetic
instruments contain sensors, which allow the navigation software to identify the instrument’s location
within the electromagnetic field. For the software to display
the instrument’s location in relation to images of
the patient, you’ve got to help the software by creating a map between points on the patient
and points in the images. This process is called registration, and it’s essentially the
same for both optical and electromagnetic types. After registration is
complete, whenever the surgeon touches a point on the patient
using one of these tracked instruments, the computer uses the map to identify the corresponding
point on the images. This identification is called navigation. And now I’m going to show
you both systems in action. Here we’ve got an MRI
scan of a brain model that we’re going to use. Coming up, you see this
white blob, which is supposed to be a simulated brain
tumour on the MRI scan. Up here, you can see an
eye coming into view, and then the nose. So this is the brain that’s going to
correspond with the model. In the bottom right hand corner,
we’re using infrared tools, and you can see the pointer
coming into reference with the reference array
that we’ve got fixed to the patient’s head. We’re going to be doing
registration as we mentioned before, marking out lots of points
with the infrared pointer. Now we can verify the registration. We’ve got 1.5 millimetre accuracy, which will do for this simulation. So, we’re going to touch the
tip of the nose on the model and you can see in the MRI
that that correlates well. Let’s look at the inner part
of the eye and that looks good. The outer part of the eye
and the tip of the ear, and this is all looking like it’s corresponding really nicely. We put the pointer into
this hole that’s pre made, we’re on the tumour, so
that’s looking good as well. And this is a pre made craniotomy
or trapdoor in the skull that’s going to allow us to just
access the tumour straight away. In real life, we’d make this hole and that would take about
45 minutes to an hour, having cut through the skin
and drilled off this bone. So we can operate around
this tumour and see exactly where we are in the brain
avoiding critical structures like blood vessels, nerves
and parts of the brain that are important for speaking
and seeing, for example. Now let’s move on to the
electromagnetic form of navigation, which is also called axiom guidance. We’re going to be using a
Rowena neurosurgical simulator and thanks a lot to
Susie Glover from Delta and Stephanie Brown from
NHS Healthcare Horizons. This model is quite cool because it
actually has fluid systems within it and here you can see
us actually scanning it and we’re going to take these CT images
and plug them into the software. Here you can see we’ve
put the model in pins, but we don’t usually do that
because it can interfere with the electromagnetic system. We’re going to be using
this stilette to guide a piece of tubing deep into
the brain’s fluid reservoirs. This pointer is what we’re going to use
to do a registration. This is the actual catheter
that we’re going to be inserting deep into the brain and we’ll take out the little metal stilette
that comes with it, and insert the tracked axiom stilette that comes with the
electromagnetic system. So now that catheter is
tracked, we can use this pointer to mark out exactly what
trajectory we’re going to be using and see where we’re going
to need to make a cut and then later on where we’re
going to make a burr hole which is a small hole in the skull that allows us to access the brain. Now we’re going to mark it
with a red marker in this case and start drilling. [high speed drilling] Once we’ve made the hole
and done a bit more work in real life, we’re ready
to put the catheter in. On the right so you can see
that the StealthStation is showing us how far we need
to go and shows us a target that we’ve pre-planned. We’re going to follow that trajectory and make sure the green dots line up. As we advance the catheter down, it gives us a countdown in millimetres. Once we reach zero, we should
be in the ventricle system and as I take out the metal
stilette from inside the tubing, fluid should start coming out. And there we are, we are in.
And in real life we’d now secure this catheter
and get out of there. – Go and subscribe to Brainbook,
start with his video on a day in the life of
a neurosurgeon on call. Next week, we go from brain
surgery to settling on Mars.

100 thoughts on “How Neurosurgeons Navigate Inside The Brain

  1. We need a video on that drill mechanism now.
    How something can be that brutal and yet precisily "know" when to stop is just fascinating.
    No to metion it also needs to stop the medic hand from just keep going.

  2. We talked about this in class today and if I had watched this video beforehand, I might've been able to show off. Deep regrets.

  3. I know these are already recorded but this brought up a question for me. The neurosurgeon said that they would spend an hour or so drilling a large hole in the skull to access a tumour, well that's all fine and well but what do they do about the fluid that's supposed to protect your brain and keep it afloat so it doesn't press against the skull too much? Would they drain it out and re-insert it after they're done? Or would they use a different fluid? And does this impose any time constraints on the operation, having reduced fluid in the skull? Thanks in advance to anyone who can answer any of these questions.

  4. I have a sort of morbid curiosity (don't know if that's the right term) with neurosurgery, I'm generally extremely squeamish but the idea that medical technology has advanced enough that doctors can operate literally INSIDE someone's head is absolutely fascinating to me

  5. Honestly those were by far the most frightening minutes I have seen in a while. Cut off my legs, give me a heart attack, shoot me in the chest – nothing is frightening to me, because at worst it's alot of pain or painless death. But somebody using those tools on me – with or without pain – frightens me. I'm a software engineer and to me the brain is essentially just the hard-and-software-combined that defines my person. In my job changing one little bit of code will destroy everything on the users screen. So I won't imagine what happens to ME if someone needs to do such an operation on my brain.

  6. Omg! All that caution doesn't seem necessary after you CHOPPED THE GUYS HEAD OFF AND PAINTED IT BLUE FOR SOME REASON! Murderer.

  7. what happens with the part of the brain that got cut out, what consequences does it have? and what about the hole in the skull?

  8. Modern medicine and doctors are awesome!

    But can we take a moment to also appreciate the physicists and engineers who make it all possible?

  9. That is absolutely awesome! I have actually wondered this before–glad to finally know how it's done! I do like how…uhm…ungentle the drilling was–cracked me up!

  10. This is a fascinating video, but the irritating background music is intrusive and distracting. What purpose is it meant to serve? Why is it included?

  11. 6:14 you say its sage and the dril stops but there was a drop the dude holding it just plunged ad rill in to the models brain.

  12. It's Mars next week? Cool, so we'll get to see if brain surgery is not exactly rocket science? Special guest David Mitchell, I assume?

  13. “Next week we go from brain surgery to settling on Mars”.

    In other words, brain surgery may be complicated, but it’s not exactly rocket science, is it?

  14. Brilliant video. As a Radiographer, seeing how imaging can be used alongside cutting age tech is fascinating. I've seen similar RF tech being used in Orthopaedic procedures to accurately locate screw holes inside patients without using X-Ray.

  15. "OK Google, navigate to brain and remove tumor "
    Google: Navigating to brain, tumor removed.

    "Hey Siri, navigate to brain and remove tumor"
    Siri: Here is what I found on the web…

  16. The brain doesn't have around 100 billion neurons, as Alex the neurosurgeon stated.
    The more accurate, more contemporary estimate is around 80 billion. And this difference is huge.

  17. The drilling part caught me off guard. It suddenly got my heart beating fast. Hahaha

    Btw, what happens to the skull afterwards? Will there be a hole there forever or are they going to do something to close it?

  18. Wait… what do they put there to close the hole again? I assumed they‘d saw a piece open and then put it back…

  19. Buckaroo Banzai: See, you can check your anatomy all you want, and even though there may be normal variation, when you get right down to it, this far inside the head, it all looks the same. {pause} No, no, no, no. Don't tug on that. You never know what it might be attached to.

  20. I am SOO glad the editor of this video added the music to it, that made it worth watching, and highly entertaining. 🙄

  21. This was very interest as someone who has a VP shunt in place. I’m amazed I survived before this technology back in the 80s.

  22. The reason I subscribed is that this has English closed caption or subtitles ,this helps me with my English learning.

  23. "All instruments are on target, now for the critical move!"

    please wait while Windows is being updated
    remaining … 3h 45min …
    [Ok] [Continue] [Remind me in 10min]


  25. Eeeeeeew. Mad respect to the doctors but I haven't felt this strong of a wish for my mind to be transferred into a machine somehow ever in my life. My best friend has had a surgery to remove a brain tumor over a year ago. All went well and he's fine and dandy, but holy crap, I do not even want to know how scary it is due to even the slightest chance of something going wrong. Shivers…

  26. In the end, you're still poking instruments through soft neuronal tissue. I wonder what brain damage you should expect from even simpler surgeries.

  27. They say its so delicate but surgeons are just butchers. If you evee get the chance have a look at how they literally just carve cut bang bash etc. Sure neurosurgeons are a little less butchery, but still rough.

  28. Beware a scientist wearing a lab coat or a doctor wearing scrubs in a video that doesn't get messy. Both are there to intentionally get you to think they're authoritative.

  29. This is really inspiring how even the smallest nerves can impact your life in a big way, neurology really is incredibly marvelous!

  30. Well, my mom suffered an aneursym back in February and is luckily recovering, so let's see how exactly they saved her :/ (though they did damage her perfect lung on the way there…. FOR SOME REASON)

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