VCU news

By Joe Kuttenkuler

RICHMOND, Va. (Nov. 9, 2004) – A Virginia Commonwealth University Medical Center neurosurgeon was the lead developer of a new piece of equipment that is now being used by physicians in 20 hospitals around the world to perform delicate surgical procedures deep inside the brain.

The new equipment, which is about the size and weight of a plastic coffee cup, replaces a bulky, halo-like stereotactic metal frame that had to be bolted to a patient’s head and then to the operating table. The so-called “frameless” device is being used in deep brain stimulation procedures, highly precise surgical techniques that involve placing tiny electrodes into remote areas of the brain to treat Parkinson’s Disease, tremors and dystonia, which is characterized by involuntary twisting body movements or postures.

The NeXframe device – a small, lightweight plastic tower that affixes to a patient’s head during surgery to support surgical instruments – was developed through a collaboration among VCU neurosurgeon, Kathryn Holloway, M.D.; Jaimie Henderson, M.D., a neurosurgeon from Cleveland Clinic; and Image Guided Neurologics, a medical-equipment development firm. Holloway and her colleagues recently presented results of a two-year study of the device at international movement disorders conferences in Rome and Vienna. 

“The new frameless method for performing deep brain stimulation is truly a revolution for this area of neurosurgery,” said Holloway. “The frameless device offers surgeons equal accuracy with the previous equipment, while making patients, who must remain awake for the surgery, much more comfortable.” 

Deep brain stimulation is an interactive procedure that requires surgeons to pinpoint precise areas inside the brain that are misfiring. Tiny electrodes are implanted into the brain and then connected to a pacemaker that can be programmed to “turn off” the areas that are causing tremors or walking difficulty. During surgery, patients are asked to make eye contact with doctors and to perform various movements so surgeons can identify the areas of the brain that need treating. Holloway said the frameless configuration makes patient movement much easier and allows them to shift positions during the six- to eight-hour operation.

In addition to patient comfort, Holloway said the frameless configuration also reduces surgery time by about two hours, since the magnetic resonance imaging and computed tomography scans required to map the brain before surgery can be done days in advance.  Previously, brain scans had to be done once the large frame was in place.

The new device fits into a larger trend in neurosurgery toward frameless stereotactic neurosurgery, a method adopted for other similar types of procedures more than 10 years ago. Surgeons had been reluctant to abandon the large metal frames because of the high-accuracy requirements of deep brain stimulation, often in the 1-millimeter to 2-millimeter range.

“Until now, the theory has been that the large frame was the best way to stabilize the patient and support surgical instruments,” said Holloway. “Now we’re able to do both, while making the patient more comfortable.”