Surgical Theater creates a 360-degree virtual reality model of a patient’s brain. Norton Children’s Hospital is the first hospital in the region with this technology.

Published: October 2, 2019 | Updated: November 27, 2020

There is an amount of uncertainty with any type of neurosurgery. Neurosurgeons study a patient’s medical history, current condition, and computed tomography (CT) and magnetic resonance imaging (MRI) scans to plan for surgery. However, those images can show only so much. Once surgery begins, surgeons may face issues that they couldn’t have anticipated. Now, however, there is a way for neurosurgeons to simulate a procedure and practice before they ever step into the operating room.

Norton Children’s Neurosurgery, a Part of Norton Neuroscience Institute, now has Surgical Theater virtual reality (VR) technology that creates an immersive, 3D view of a patient’s brain. This allows neurosurgeons, patients and families to see inside the patient’s brain to get a greater understanding of the condition and any potential procedures. Norton Children’s Hospital is the first hospital in the region to use this technology.

How Surgical Theater works

Surgical Theater gives neurosurgeons and patients an interactive way to experience the brain. When a neurosurgeon looks at 2D imaging scans, each one shows something different. A CT scan can show blood vessels and bone, for example. An MRI can show soft tissue and issues such as tumors. Functional magnetic resonance imaging (fMRI) shows brain activity by measured blood flow. Neurosurgeons have to study these 2D images closely to understand a patient’s unique anatomy and condition.

With Surgical Theater, all of these different black-and-white, 2D images become a 360-degree color virtual reality model of a patient’s brain. From there, patients and physicians can use a VR headset and video-game-like controller to explore every part of the patient’s brain.

The operating room portion of Surgical Theater offers the same technology for neurosurgeons during a procedure. This makes it possible for the surgeon to see his or her tools in real time and navigate them through the surgery as planned.

Making complex technology accessible for patients

This kind of technology on which Surgical Theater is based is available at large medical research centers. However, using it takes a multidisciplinary team of radiologists, scientists and neurosurgeons. Creating these kinds of models is extremely technical and difficult to do, and is time consuming. Surgical Theater is able to render these models somewhat quickly — up to a few hours for a case that requires several scans.

The Surgical Theater technology provides patients with benefits such as:

• It can give a greater understanding of a child’s condition. Children and families are able to see the precise location of tumors, lesions, etc. Patients with epilepsy are able to see affected parts of their brain — which can help them to make good decisions about their seizure care.
• It provides for more informed decisions with your care team. The neurosurgeon can show you and your child exactly what he or she will do in the operating room. This can help families understand the benefits and risks of particular surgeries and procedures in a much more illustrative way. This model can show more easily all the information we need to do a safe surgery.
• It’s a fun, cool way for kids to understand their condition.

“Kids don’t stop to wonder about the joystick or the VR headset,” said Ian S. Mutchnick, M.D., neurosurgeon with Norton Children’s Neurosurgery, a Part of Norton Neuroscience Institute. “They just step up, take the controller and start flying around their brains.”

This technology allows neurosurgeons and other care team providers to:

• Locate issues quickly. Physicians would need to study several scans to discern where a tumor or aneurysm is in reference to the rest of a patient’s anatomy. This technology allows for them to move through all of the scans at once.
• Plan and practice procedures. The technology allows surgeons to plan and practice surgery with ease. Surgeons can use the joystick to select different “tools” to complete the procedure within the VR. This can help them try different approaches to the procedure to plan and choose the safest approach possible to treat a condition.
• Choose the right treatment plan. The model can help physicians get together to discuss the right way to treat a child with a complex condition. For example, a child’s 3D model could show how to better treat a case of epilepsy or suggest a better approach to a tumor. Surgical Theater helps providers have discussions about the best way to treat such situations without being surprised in an operating room.

“This is revolutionizing how we use our information to decide how to treat patients,” Dr. Mutchnick said.