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A Virtual Reality Check

By: Caroline Trent-Gurbuz

The black and bulky headset fits snugly, though Aalap Herur-Raman, senior virtual reality program lead from Surgical Theater, can adjust the straps as needed. When he taps on the keyboard in front of a pair of computer screens, it’s impossible not to peer through the binocular-like eyepiece as the image — upside down, per the surgical point of view — zooms into a skull, revealing a maze of colorful vasculature and brain matter.

Virtual Reality Check

“There are the blood vessels,” points out Anthony Caputy, MD, chair of the Department of Neurological Surgery and Hugo V. Rizzoli Professor of Neurological Surgery at the George Washington University (GW) School of Medicine and Health Sciences (SMHS), on the corresponding computer screens. Herur-Raman adjusts the opacity of the brain matter — thick and gray — until it faded away. “You can always add some of the brain matter back in,” Caputy continues, “so you can see where the brain is in relation to the blood vessels. You can even see where the tumor is in relation to the blood vessels.”

The tumor, a bright green mass appearing behind the left eye socket, is the target of the unique device, which provides medical professionals and patients a 3-D glimpse of a specific condition.

Precision Virtual Reality (VR), a product of Ohio-based company Surgical Theater, is based on an F-16 flight simulation program. A chance meeting at a coffee shop with a neurosurgeon led the company’s founders — both Israeli Air Force officers — to tweak their simulator program for neurological surgery.

“[It’s] actually not terribly complex,” explains Todd Goldberg, vice president of sales at Surgical Theater. “We are essentially a VR studio; instead of making music or movies, like you think of studios in entertainment, we make personalized medical content that’s useful for patients and surgeons. The components consist of a very high-powered computer, with the latest, greatest, and most advanced graphics processing unit, or GPU, and the latest and greatest Intel chip. But the real brain of the system is the software itself.”

That software, which identifies potential surgical paths for brain and spinal conditions, is key for the SMHS Department of Neurological Surgery’s approach to patient outcomes. “It’s a huge part of this three-pronged process: education, patient engagement, and surgical planning,” says Jonathan Sherman, MD, associate professor of neurological surgery at SMHS, who, as a longtime proponent of the tool, led the campaign to bring it to GW Hospital.

Right now, budding neurological surgeons have access to the Ammerman Lab, a microsurgical lab in SMHS’ Ross Hall that focuses on skull base, minimally invasive, microvascular, and spine surgeries, as well as basic science research. There, residents can literally get a “feel” for surgery — the texture of tissues, vibrations, additional movements — but with Precision VR, they get a more in-depth understanding of the structural aspects of the brain and spine.

“[When it comes to] the education of residents and students, even professionals, Precision VR will help them better understand what we’ll encounter in surgery and the risks of the surgery,” Caputy says. “You can show [them], here’s the anatomy, here’s the motor pathways, here’s the sensory pathways, here’s the optic pathways. You can cut everything out around the pathway you want to show, whereas before, you would show it with brain slices. Their mind would have to put the 3-D together.”

Those complementary aspects, he adds, are critical to education. “We need both of those labs to train people.”

From a patient perspective, the tool is equally powerful for edification and engagement.

“Looking at an MRI or a CAT scan, patients almost tune you out because they don’t quite understand everything that’s going on, and they think they have to be a physician or health care professional to interpret a CAT scan or MRI,” says Michael Rosner, MD, vice chair of the Department of Neurosurgery and professor of neurological surgery at SMHS. “To be able to take all that data and just put it in the three-dimensional model is … very, very helpful.”

GW Hospital patient Roodelyne Jean-Baptiste, for example, previously had two surgeries to treat brain tumors, which were “brutal,” she says. Last winter, she was told she needed a third surgery, but she balked, thinking her tumor was relatively small. Her physician (Sherman) insisted, however: “He said, ‘No, we can’t hold off because of the size.’ We had to move so fast because it was already affecting me. The tumor was making me unable to eat and dizzy.”

After her surgery, Sherman used Jean-Baptiste’s MRIs and Precision VR to explain the complexity of her tumor. “He actually showed me exactly what he was talking about when he had to avoid a cut and what he had to stay away from when he went into the brain,” she recalls. “If I had had [the 3-D image] from the first time I encountered the procedure, I would have never hesitated to do it. You can actually see what the doctor is saying instead of agreeing with them just to agree with them.”

While Jean-Baptiste was able to get a better handle on her specific tumor, Sherman and his fellow neurological surgeons gained insight into what surgical strategies worked best. With a tumor, for example, Precision VR includes arrows for possible surgical entries, and surgeons get a clear view of what obstacles they may need to navigate around to ensure a successful procedure.
“Now, we can plan out ahead of time and really see the anatomy,” Sherman says. “It helps us get a better perspective on what we’re going to do surgically. We can use this technology to plan surgical [techniques], and then in the OR, we can actually use it to navigate to what we’re doing.”

Caputy agrees, adding that by visualizing the environment, surgical teams can identify areas of concern ahead of time. “Surgeons can devise a strategy that best allows them to achieve their goal: tumor removal and the preservation of functions,” he says. “You want the most effective approach, and Precision VR can help you plan for that.”

GW Hospital was the first hospital in the mid-Atlantic region to offer the tool, a boon for local patients and surgeons. “This is yet another way that we are moving the care standard higher at GW Hospital,” says Kimberly Russo, MBA, MS, CEO and managing director of GW Hospital.

Although the tool is primarily geared toward neurology-related conditions and procedures at GW Hospital, its potential extends far beyond its technological appeal. As Goldberg explained, health care has a tendency to create silos; Precision VR, however, promises to break down those divisions and allow for better collaboration.

“This is one of those rare technologies that has come along that builds bridges among different members of the health care team, among different departments of the hospital, and certainly among patients and their families,” Goldberg says.

Sherman likewise believes that the tool’s value isn’t limited to neurological surgery. “Ultimately, we’re [trying] to get this across disciplines,” he explains. “My goal is that this isn’t just a neurosurgical tool; this is … something we can use for all areas of subspecialty in surgery. We’re just touching the tip of the iceberg of what our potential is with this technology.”