New tool to help brain surgeons one step closer to operating room

A new tool that could allow for faster, more comprehensive testing of brain tissue during surgery successfully identified the cancer type, grade and tumor margins in five brain surgery patients, according to a Purdue University and Brigham and Women's Hospital study.

The tool sprays a microscopic stream of charged solvent onto the tissue surface to gather information about its molecular makeup and produces a color-coded image that reveals the nature and concentration of tumor cells.

Researchers analyzed specimens removed from the patients, but the goal is to one day be able to perform the analysis on intact brain tissue during surgery, said R. Graham Cooks, the Purdue professor who co-led the research team.

"We hope to eventually be able to perform this analysis during surgery to help guide brain surgeons so that the borders of tumors can be identified and the cancer status of a site can be established before any tissue is removed," said Cooks, who is the Henry Bohn Hass Distinguished Professor of Chemistry. "We aren't there yet, but this was a critical step in the process. It shows we've found easily identifiable molecular patterns that can be used to diagnose the type and concentration of cancer cells."

Purdue researchers designed the tool and collaborated with researchers and physicians at Brigham and Women's Hospital at Harvard Medical School to perform the study. The brain surgery was performed in the Advanced Multi-Modality Image Guided Operating suite, or AMIGO, and in standard operating rooms at Brigham and Women's Hospital. A paper detailing the results will be published in an upcoming issue of the Proceedings of the National Academy of Sciences and is published online.

Dr. Nathalie Agar, director of the Surgical Molecular Imaging Laboratory within the neurosurgery department at Brigham and Women's Hospital, said the findings showed the analysis method's potential and achieved an important step in the path to assessing its value in improving patient care.

"This approach could lead to real-time, image-guided surgery without interference with surgical care and without the administration of labeling agents," said Agar, who co-led the study. "Such extensive and detailed information about the tissue was previously unavailable to surgeons and could lead to more precise tumor removal. In addition, having access to a detailed diagnosis on the day of surgery could help the oncologist more efficiently design the course of adjuvant therapy."

Dr. Alexandra Golby, director of Image-Guided Neurosurgery in Brigham and Women's Hospital's neurosurgery department and paper co-author, said brain tumors are particularly challenging to remove.

"Tumor tissue within the brain often closely resembles normal brain tissue and may have indistinct boundaries, so it is difficult to determine where the tumor ends and the normal brain tissue begins," said Golby, who also is the clinical co-director of AMIGO. "We want to preserve as much functional brain tissue as possible, especially when a tumor is in a critical area of the brain, like that which supports movement, speaking or vision."