Future Horizons in Lung Cancer
Future smart surgical approaches for brain metastases
Dr Francesco Di Meco - Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
I’m talking about the future smart surgical approaches for brain metastases and I’m dividing this presentation into two parts. In the first part I’m trying to focus on some of the still open questions in the field of brain metastases. The first question is is it worth to do surgery, radiosurgery, in this kind of disease? Aggressive treatment is worth it in some way? And the second question is should whole brain radiotherapy follow surgery and radiosurgery or radiosurgery in any case? The third question is should we go for surgery or for radiosurgery in the case of metastasis?
In the second part of my presentation I wanted to focus on the recent developments in the field of surgery from a technical standpoint, particularly intraoperative imaging focussing on 5-ALA, for instance, on intraoperative MRI, neuronavigation, the concept of neuronavigation, and finally the real-time intraoperative ultrasound.
The last point that I’m going to touch is the recent introduction of simulation in the field of neurosurgery and we studied at my institute a programme last year based on neurosurgical simulation and we created the first European neurosurgical simulation centre which is probably one of the best equipped in the world, I would say, because it is equipped with four different simulators. Of course, those are prototypes so we work closely with the companies in order to achieve better software, so better machines. All those simulators provide excellent haptic feedback; it is possible to rehearse the case the day ahead, for instance, without causing any harm to the patients.
Finally, I would like to touch also on the virtual reality which allows the surgeon to really go deep into the head of the patients. You can cross the tumour, you can look at the tumour from different aspects. So providing you all the information you really need in order to have the perfect knowledge of the relationships of the tumour with the surrounding structures.
How often is this technique used?
We use this technique on a daily basis for every case. Of course, for the time being we are still exploring so usually we study just one single case per day. We cannot follow all the cases that we run in a single day. Actually, we set up at least two studies in collaboration with several universities where we wanted to estimate if the use of simulation can be of help in selecting best suitable students for a surgical career. Also at the same time working closely with the specialty schools, with some of the specialty schools in Italy, we wanted to check if the use of simulation can be of help in training residents to become better neurosurgeons.
