Neurosurgeons and researchers at Cedars-Sinai Medical Center in Los Angeles are adapting an ultraviolet camera to possibly bring the technology into the operating room.
If the system works when focused on brain tissue, it could give surgeons a real-time view of changes unapparent with current imaging systems. The pilot study seeks to determine if the camera provides visual detail that might help surgeons distinguish areas of healthy brain from gliomas, which have irregular borders, as they spread into normal tissue.
Gliomas’ far-reaching tentacles represent a balancing act for neurosurgeons: Taking out too much normal brain tissue can have catastrophic consequences, but stopping short of total removal gives remaining cancer cells a head start on growing back. Delineating the margin where tumor cells end and healthy cells begin never has been easy, even with recent advances in medical imaging systems, said Keith L. Black, MD, chair of the department of neurosurgery, said in a release.
But the ultraviolet camera might be able to see below the surface, he said. Because tumor cells are more active and require more energy than normal cells, the chemical—nicotinamide adenine dinucleotide hydrogenase (NADH)—accumulates in tumor cells but not in healthy cells. NADH emits ultraviolet light that may be captured by the camera and displayed in a high-resolution image.
"The ultraviolet imaging technique may provide a 'metabolic map' of tumors that could help us differentiate them from normal surrounding brain tissue, providing useful, real-time, intraoperative information," said Ray Chu, MD, a neurosurgeon leading the study, said in the release.
In the clinical trial, neurosurgeons will study 20 patients, placing the camera near the surgical field and recording images as the tumor is exposed and removed. Images will not be used in decision-making or surgical technique but later will be correlated with tumor appearance, laboratory findings and MRI and CT scans to assess the ultraviolet technology's value in the operating room.