METROFOCUS: August 8, 2019

August 09, 2019 at 5:30 am

SPECIAL EDITION: MEDICAL MARVELS:

SCI-FI TAKES OVER THE O-R!
Tonight, we take you inside the operating room at New York’s Mount Sinai Hospital, where brain surgeons are using cutting edge technology to treat patients more effectively. Using high-tech treatments, doctors will give us a real-time interactive view of the brain. Plus, we have an exclusive look at a procedure that’s helping Parkinson’s patients reduce challenging tremors.

Aired on June 25 & August 8, 2019.

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TONIGHT ON METRO FOCUS, A
SPECIAL EDITION, SCI-FI TAKES
OVER THE OR.
FROM 3-D IMAGING TO AUGMENTED
REALITY, OUR NEW MEDICAL MARVEL
SERIES KICKS OFF INSIDE THE
OPERATING ROOM AT NEW YORK'S
MOUNT SINAI HOSPITAL WHERE BRAIN
SURGEONS ARE USING TECHNOLOGY TO
TREAT PATIENTS MORE EFFECTIVELY.
IN A MOMENT THE DOCTORS USING
THESE TREATMENTS GIVE US A
REVIEW OF THE BRAIN.
PLUS, WE'LL TAKE YOU INSIDE A
PROCEDURE THAT'S HELPING
PARKINSON'S PATIENTS REDUCE
TREMORS.
THOSE STORIES AND MORE AS THIS
SPECIAL EDITION OF "METROFOCUS"
MEDICAL MARVELS STARTS RIGHT
NOW.
>> THIS IS "METROFOCUS" WITH
RAFAEL PI ROMAN, JACK FORD, AND
JENNA FLANAGAN.
>> "METROFOCUS" IS MADE POSSIBLE
BY
JAMES AND MERRYL TISCH,
SUE AND EDGAR WACHENHEIM III,
THE SYLVIA A. AND SIMON B. POYTA
PROGRAMING ENDOWMENT TO FIGHT
ANTI-SEMITISM.
BERNARD AND IRENE SCHWARTZ,
ROSALIND P. WALTER,
BARBARA HOPE ZUCKERBERG,
AND BY --
GOOD EVENING AND WELCOME TO THIS
SPECIAL EDITION OF METRO FOCUS.
I'M JACK FORD.
THIS IS THE FIRST IN OUR NEW
SERIES OF REPORTS EXAMINING
ADVANCES IN THE MEDICAL FIELD
MAKING ONCE THE STUFF OF STAR
TREK REALITIES IN THE WORLD.
HOSPIT
HOS
ONE PLACE HIGH CHECK CHANGES
HAVE AN IMPACT THE OPERATING
ROOM.
AUGMENTED AND VIRTUAL REALITY,
3-D IMAGING AND GAMMA RADIATION
HAVE EMERGED TO BECOME TODAY'S
CUTTING EDGE TOOLS OF THE TRADE.
JOINING ME WITH INSIGHT INTO ALL
OF THESE MEDICAL MARVELS
HAPPENINGING ARE IN YOUR ROW
SURGEON DR. JOSHUA BEDERSON AND
CLINICAL DIRECTOR LESLIE
SLAKTER.
WE WANT TO THANK YOU BOTH FOR
JOINING US HERE.
THIS IS -- IT'S FASCINATING WHAT
YOU ARE ALL DOING NOW.
AND I SPENT THE NIGHT LAST NIGHT
LOOKING AT SOME OF THESE VIDEOS
AND MARVELING AT THE PROGRESS
BEING MADE.
TO SET THE STAGE FOR SOME OF
THIS, AND DOCTOR, LET ME ASK YOU
THIS FIRST, GIVE US A SENSE IN
THE YEARS THAT YOU HAVE BEEN
PRACTICING NEUROSURGERY,
GENERALLY SPEAKING, HOW SIG
ANYWHERE CAN'T HAVE BEEN THE
CHANGES, THE DEVELOPMENTS IN
YOUR FIELD OF MEDICINE?
>> IT'S BEEN ENORMOUS CHANGES.
THE TECHNOLOGY HAS MADE SAFER
THE SURGERIES.
IT HAS GIVEN US A SENSE OF
ORIENTATION TO GIVE YOU SOME
SORT OF ANALOGY, WE DIDN'T HAVE
GPS IN OUR CARS WHEN I STARTED
OPERATING.
AND WE DIDN'T HAVE GPS FOR THE
BRAIN.
AND NOW WE DO.
SO IN THE SAME WAY THAT YOU
COULD LOOK AT A SCREEN IN YOUR
CAR AND KNOW WHERE YOUR CAR IS
RELATIVE TO THE MAP OF
MANHATTAN, YOU CAN SEE YOUR
INSTRUMENTS IN RELATION TO THE
MAP OF THE BRAIN AND KNOW
EXACTLY WHERE YOU ARE.
YOU CAN SEE AROUND CORNERS AND
SEE THROUGH TISSUES.
SO THERE HAVE BEEN ENORMOUS
ADVANCES.
>> SO WITH THAT AS A SETUP, I
WANT TO TAKE A LOOK, I WANT OUR
FOLKS TO TAKE A LOOK AT A PIECE
THAT WE HAVE THAT BOTH OF YOU
WERE INVOLVED IN, AS A MATTER OF
FACT.
SO METRO FOCUS'S MADDIE ORTON
VISITS BOTH IN THE OPERATING TO
TAKE A LOOK AT THIS TECHNOLOGY,
THESE NEW TOOLS FIRSTHAND.
LET'S TAKE A LOOK.
>> LISA GALIO TA OF LONG ISLAND,
NEW YORK, WAS EXPERIENCING PAIN
IN HER NECK WHEN SHE GOT AN MRI
IN MARCH OF 2018.
IT REVEALED AN UNVEALED AND
SHOCKING DISCOVERY.
SHE HAD FIVE BENIGN TUMORS IN
HER BRAIN, ONE REACHED THE SIZE
OF AN ORANGE.
MAKING MATTERS OF THE WORSE IT,
HAD ARTERIES WRAPPED AROUND IT.
REMOVING A BRAIN TUMOR IS A
CHALLENGING PROCEDURE BUT
DR. JOSHUA BEDERSON AT THE MOUNT
SINAI HOSPITAL IN THE NEW YORK
CITY HAS HI-TECH TOOLS TO HELP
NAVIGATE THE TRICKY SURGERY
RIDS.
HE'S ONE OF THE FIRST BRAIN
SURGEONS IN THE COUNTRY TO USE
3-D IMAGES OF THE BRAIN
INTEGRATED WITH AUGMENTED AND
VIRTUAL REALITY.
>> AUGMENTED AND VIRTUAL REALITY
HELP US MANAGE A SITUATION LIKE
THIS IN MANY WAYS FROM THE
INITIAL PATIENT CONSULTATION ALL
THE WAY THROUGH THE PLANNING OF
THE CASE AND GENERALLY
NAVIGATING TOWARDS SAFE
CORRIDORS OF SURGERY.
>> HERE'S HOW IT WORKS.
2DMRI AND CT SCANS REFERRED TO
AS DIE COME I THINKS ARE
DIGITALLY FUSED 0 TOGETHER TO
CREATE A 3-D IMAGE OF THE
PATIENT'S BRAIN.
SOFTWARE IS THEN USED TO PAINT
OUTLINES OF THE TUMORS, ARTERIES
AND VEINS DIFFERENT COLORS ON
THAT IMAGE.
THIS CREATES A COMPREHENSIVE MAP
OF TARGETS AND NO-FLY ZONES FOR
THE PROCEDURE AHEAD.
HOLLY EMKE RESERVES NEW
TECHNOLOGY IN THE SURGERY
PROCESS AND HELPS DR. BEDERSON
IMPLEMENT AND OPTIMIZE THESE
TOOLS.
>> WE HAVE TELL THE COMPUTER
WHAT PIECES OF THE ANATOMY WE'RE
INTERESTED IN.
SO WE'RE USING A TOOL CALLED
SMART BRUSH TO ACTUALLY PAINT ON
THE DIE COME IMAGES THE TUMOR AS
A WHOLE.
>> ALL THOSE IN THERE, THOSE
HAVE TO GO.
>> WE'VE OUTLINED THE SINUS
WHICH IS A MAJOR VEIN IN THE
BRAIN AND THE ARTERIES THAT ARE
EITHER FEEDING THE TUMOR OR
CLOSE TO THE TUMOR THAT HAVE
POTENTIAL TO CAUSE DAMAGE IF
WEERN TO DISRUPT THEM IN SOME
WAY.
>> INFERIOR SAGITTAL SINUS.
>> MAYBE ORANGE IS A GOOD COLOR.
>> FOR LISA'S SURGERY THIS COLOR
CODED 3-D MAP HELPS DR. BEAD
BEDERSON AND HIS TEAM DEVELOP
THEIR PLAN.
>> BY PLANNING THIS CASE WE'RE
ABLE TO VISUALIZE AHEAD OF TIME
WHAT THE TUP MORE LOOKS LIKE
BEFORE EVEN GETTING INTO THE
OPERATING ROOM.
>> THE PATIENT GALIO TA IS THE
ALSO ABLE TO VISUALIZE WHAT THE
TUMORS LOOK LIKE AND HOW
DR. BEDERSON PLANS TO ADDRESS
THEM.
A BIG BENEFIT FOR LAY PEOPLE
ABOUT TO UNDERGO MAJOR SURGERY.
>> IT'S ONE THING TO BE TOLD BY
A SURGEON YOU HAVE A TUMOR AND
WE HAVE TO MAKE AN INDECCISION R
THE TOP OF YOUR HEAD.
IT'S ANOTHER TO SEE YOUR OWN
TUMOR IN THREE DIMENSIONS IN
RELATION TO YOUR OWN FACIAL
FEATURES AND TO UNDERSTAND
EXACTLY WHY WE WOULD BE MAKING
AN INCISION HERE AND WHERE WE
WOULD BE DOING THE OPENING.
> ALTHOUGH THIS IS STILL AN
INVASIVE SURGERY, IT SEEMS A
LITTLE LESS INVASIVE TO ME THAT
HE KIND OF KNOWS WHERE HE'S
GOING.
>> SHE GETS ROLLED INTO THE
OPERATING ROOM.
IT'S IN HERE THE TECHNOLOGY
PERHAPS COMES MOST IN HANDY.
THE 3-D COLOR CODE LINES CREATED
TO OUTLINE HER TUMORS, VEINS AND
ARTERIES ARE AVAILABLE TO
DR. BEDERSON IN THE OPERATING
ROOM THROUGH AUGMENTED REALITY.
HE CAN VIEW THE ANATOMY WITH THE
NAKED EYE AND THEN LOOK THROUGH
A MICROSCOPE THAT PROVIDES AN
OUT-LIONEL OVER THE OUT LINE SO
HE CAN SEE WHERE THE ARTERIES
AND VEINS LIE BEFORE HE REACHES
THEM, A HEADS UPDISPLAY.
PILOTS USE THE INFORMATION BY
LOOKING AHEAD AND FLYING RATHER
THAN LOOKING DOWN AT THEIR
INSTRUMENTS.
PRIOR TO HEADS-UP DISPLAY
CAPABILITY, A SURGEON'S METHODS
WOULD HAVE BEEN VERY DIFFERENT.
>> YOU WOULD HAVE USED A MAP,
LOOKS AT THE CT SCAN, GONE BACK
TO THE PATIENT, LOOKED AT THE
PATIENT INTERNALIZING WHAT
YOU'VE SEEN ON THE SCAN AND
TRYING TO PROJECT THAT ONTO THE
PATIENT IN THE AN ACCURATE WAY.
>> MORE RECENTLY, DR. BEATER SON
RELIED ON A GPS-LIKE NAVIGATION
PROBE.
THE TIP OF WHAT LOOKS LIKE A PEN
TOUCHES THE PATIENT'S ANATOMY
AND SINKED WITH A MATCH THE
BRAIN TO TELL THE SURGEON WHERE
IS HE IN REALTIME.
THIS IS WHAT MOST SURGEONS
CURRENTLY USE.
HE ALSO INCORPORATES THIS
NAVIGATION PROBE INTO HIS
PROCESS BUT DOESN'T HAVE TO RELY
ON IT SOLELY ANYMORE.
>> THAT'S A BIG ADVANCE BUT
STILL REQUIRES THAT YOU STOP
WHAT YOU'RE DOING, LOOK AT THE
MAP, AND THEN GO BACK TO WHAT
YOU WERE DOING.
IN THE ANALOGY OF FLYING A
PLANE, YOU HAVE TO STOP FLYING
THE PLANE TO LOOK AT YOUR
INFORMATION AND THEN START
FLYING THE PLANE AGAIN.
>> THAT'S NO LONGER AN ISSUE.
DR. BEDERSON SAYS HEADS UP
DISPLAY TECHNOLOGY FOR SURGERY
MADE HIS WORK FASTER AND SAFER.
>> TO USE THE HEADS-UP DISPLAY
PROJECTION OF THE VIRTUAL
REALITY RECONSTRUCTION ONTO THE
SCALP WHILE WE'RE PLANNING THE
SKIN INCISION SO THAT WE CAN
POSITION THE OPENING PRECISELY
AND GIVE US THE MAXIMUM EXPOSURE
FOR THE MINIMUM OPENING,
LIKEWISE AFTER THE SKIN INCISION
WE'LL BE ABLE TO BE POSITION OUR
CRANIOTOMY WHICH IS THE OWN
OPENING OVER THE TUMOR BY
PROJECTING THE TUMOR ONTO THE
SURFACE OF THE SKULL AND SEEING
THROUGH THE SKULL TO THE TUMOR
TO MORE PRECISELY OUTLINE THE
OPENING.
>> IT HELPS THE REST OF THE TEAM
SEE WHAT DR. BEDERSON SEES IS,
AS WELL BECAUSE THE MICROSCOPE
HE USES ALSO FUNCTIONS AS AN
EXOSCOPE PROVIDING A MAGNIFIED
VIDEO FEED TO A SCREEN CLETE K
COMPLETE WITH THE COLOR CODED
OUTLINES VIEWED IN 2D OR 3-D
WITH GLASSES.
THE TEAM CAN SEE THE CLEAR SOLID
OUTLINES OF THE PATIENT'S TUMORS
AND VEINS AND ARTERIES DESPITE
FLOWING IN THE TUMOR AND
ANTICIPATE WHERE THE STRUCTURES
ARE AS THEY MOVE FURTHER INTO
THE BRAIN THANKS TO DOTTED
OUTLINES THAT PROVIDE DEPTH
PERCEPTION SIX HOURS LATER, THE
SURGERY IS A SUCCESS.
>> CAN YOU STAND ON ONE FOOT?
EXCELLENT.
THEN THE OTHER FOOT.
GOOD.
>> TODAY IS MY FOLLOW-UP VISIT
DR. BEDERSON.
I HAD BRAIN SURGERY TWO WEEKS
AGO.
AND I'M FEELING AWESOME.
>> AND YOU NEVER HAD ANY
SEIZURES.
I THINK THAT DRIVING IS OKAY FOR
YOU NOW.
>> GREAT.
GET MY INDEPENDENCE BACK.
>> I THINK THE TECHNOLOGY MADE A
BIG DIFFERENCE.
IT HELPED US IDENTIFY THE
IMPORTANT VASCULAR STRUCTURES
THAT HAD BEEN DISPLACED AND
ENVELOPED BY THE TUMOR AND WERE
AT CONSIDERABLE RISK WHEN WE
REACHED THE DEEP PARTS OF THE
TUMOR REMOVAL.
SO KNOWING EXACTLY WHERE THOSE
WERE, BEING ABLE TO NAVIGATE TO
THEM AND THEN TO STAY AWAY FROM
THEM ONCE WE WERE NEARBY WAS KEY
IN PREVENTING A STROKE.
>> DR. BEDERSON IS ALREADY
EXCITED ABOUT NEW TECHNOLOGICAL
FEATURES UNDER DEVELOPMENT WITH
SELF OF THE HOSPITAL'S PARTNERS.
>> WHAT IF WE COULD ALSO PROVIDE
HAPTIC FEEDBACK TO MY
INSTRUMENTS?
WE COULD PROVIDE AUDITORY
INFORMATION, ASSIGN DIFFERENT
TISSUES DIFFERENT SOUNDS, FOR
EXAMPLE.
>> WITH EACH TECHNOLOGICAL
ADVANCE, THE HOPE IS FOR MORE
AMOUR OUTCOMES CAN LIKE LISA
GALIOTO'S.
>> SHE'S AS NORMAL AS CAN BE.
YOU CAN'T MAKE SOMEONE BETTER
THAN NORMAL I DON'T THINK.
>> THIS IS NOT A MEDICAL TERM
BUT I THINK I'M SAFE IN
CHARACTERIZING THESE AS
BREATHTAKING ADVANCES IN
TECHNOLOGY.
I'VE GOT A COUPLE QUESTIONS FOR
BOTH OF YOU AND WANT TO GET INTO
THE SPECIFIC KAYS.
LESLIE, TALK ABOUT HOW THIS AIDS
IN DEALING WITH PATIENTS AND
HELPING THEM UNDERSTAND THEIR
CIRCUMSTANCES AND AND PERHAPS
MORE IMPORTANT WHAT IT IS THAT'S
GOING TO TAKE PLACE IN THE
OPERATING ROOM.
>> MY GOAL AS A PHYSICIAN
ASSISTANT IS TO HELP THE PATIENT
THROUGH THE PERIOPERATIVE
PERIOD, EVERYTHING THAT HAPPENS
BEFORE AND AFTER THE SURGERY AND
HELP THE DOCTOR AS NEEDED DURING
THE SURGERY AND MAKING SURE THE
PATIENTS ARE COMFORTABLE AND
AGREEABLE TO WHAT'S ABOUT TO
HAPPEN TO THEM.
YOU FIND OUT R YOU HAVE A TUMOR
AND YOU HAVE TO SEE A IN YOUR
ROW SURGEON AND MEETING SOMEONE
TALKING ABOUT YOUR BRAIN.
YOU'RE LOOKING AT INS THAT ARE
BLACK AND WHITE AND GRAY.
WE TURN THAT INTO COLORFUL
PICTURES THAT THEY CAN INTERACT
WITH.
IT OPENS UP A DOOR TO A
CONVERSATION ABOUT EXACTLY WHERE
WE'RE GOING TO SHAVE THEIR SKIN,
WHERE WE'RE GOING TO CUT THE
SKIN, OPEN UP THE BONE AND WHAT
OUR APPROACH IN REPAIR IS GOING
TO BE.
BECAUSE THEY CAN TOUCH IT AND
FEEL IT AND PLAY WITH IT AND
HAVE TIME WITH MYSELF AND MY
TEAM, NO QUESTIONS GO YOU BE
ANSWERED.
AND EVEN IF THERE ARE POTENTIAL
SIDE EFFECTS OR COMPLICATIONS
THEY WERE ABLE TO VISUALIZE WHAT
THAT IS IN COLOR OF THEIR OWN
BRAIN.
IT REALLY IS COMPLETELY CHANGING
THE WAY WE INTERACT WITH
PATIENTS.
>> I'VE HAD 13, 14 ORTHOPEDIC
SURGERIES OVER THE YEARS.
THE UNCERTAINTY IS ALWAYS
TROUBLING.
EXACTLY WHAT ARE YOU GOING TO
DO?
WHAT IS IT GOING TO LOOK LIKE
BEFORE AND AFTER?
MY GUESS IS HELPS THEM, IT'S
GOING TO BE ANXIETY RIDDEN, BUT
TAKE AWAY SOME OF THE
UNCERTAINTY.
>> RIGHT AND BUILDS CONFIDENCE.
>> MOUNT SINAI IS A GREAT
TEACHING INSTITUTION.
SO OF YOUR FOCUS IS TEACHING
PEOPLE IN THE MEDICAL FIELD.
HOW DOES THIS HELP YOU IN
TEACHING PEOPLE WHO ARE GOING TO
BECOME IN YOUR ROW SURGEONS?
>> IT'S PRETTY HELPFUL.
THE RESIDENCY IS SEVEN YEARS
ALONG.
THEY GET A LONG EXPOSURE TO IT
AND TAKE ON GRADUATED
RESPONSIBILITY AS THEY BECOME
MORE SKILLED.
BUT TRANSLATING WHAT WE TALK
ABOUT IN A CONFERENCE TO THE
OPRYING ROOM, FOR EXAMPLE,
POSITIONING THE PATIENT YOUR
VERY FIRST TIME, WHAT'S THE
EXACT RIGHT ANGLE OF THE HEAD TO
MAXIMIZE OUR EXPOSURE AND MAKE
IT EASY ON THE SURGEON AND
PATIENT.
THAT'S A BIG STEP FROM LOOKING
AT A SCAN AND TRANSLATING
THATTING INTO THREE DIMENSIONAL
SPACE INTO A PATIENT POSITION.
NOW, WITH THE TECHNOLOGY THEY
CAN CHECK WHAT THEY'VE DONE
BEFORE WE GET IN THERE BY
LOOKING AT THE HEADS-UP DISPLAY
AND THE VIRTUAL REALITY AND THEY
WILL ADJUST THE POSITION BEFORE
I EVEN COME INTO THE ROOM SO
IT'S OPTIMIZED.
LIKEWISE, WHERE DO YOU SHAVE THE
SCALP?
THAT'S A VERY IMPORTANT ISSUE
FOR THE PATIENT.
>> SURE.
>> AND THE RESIDENT --
>> YOU'RE NOT TAKING ALL THE
HAIR OFF.
>> NOT ANYMORE.
WE USED TO.
>> YOU WANT TO BE MORE PRECISE.
>> THAT'S RIGHT.
>> LET ME ASK YOU THIS, TAKE US
THROUGH.
WE'VE GOT A COUPLE OF VIDEOS,
ABOUT 30 SECONDS EACH, NO AUDIO
ON DIFFERENT SURGICAL
PROCEDURES.
I WANT TO ASK YOU TO NARRATE
THEM FOR US.
IT WILL SHOW THE INTRODUCTION OF
HIGH TECHNOLOGY.
THE FIRST ONE HAS TO DO WITH A
BRAINSTEM TUMOR.
WHAT DOES THAT MEAN AND WHAT ARE
YOU HOPING TO DO IN THIS
PROCEDURE?
IN THIS CASE IT'S A VERY LARGE
BRAINSTEM TUMOR IN A VERY HIGH
FINGERSENING PERSON WHO STARTED
BOUNCING AFTER THE WALLS.
SHE HAS FIVE KIDS AND SHE JUST
THOUGHT THAT IT WAS TAKING A
TOLL ON HER BUT IN FACT, SHE HAD
A HUGE TUMOR CAUSING MAJOR
COMPRESSION OF HER BRAINSTEM.
>> THAT'S WHAT WE'RE SEEING
RIGHT NOW?
>> THAT'S THE YELLOW IS THE
TUMOR.
AND WHEN SHE CAME IN, SHE MET
LESLIE AND I AND WE SHOWED HER
THIS AND I THINK BOTH SHE AND
HER HUSBAND WERE PRETTY SHOCKED
TO ME THE SIZE OF THIS TUMOR AND
TO UNDERSTAND WHY SHE WAS HAVING
THESE SYMPTOMS.
>> THERE'S A SECOND ONE I WANT
YOU TO TALK ABOUT THAT HAS TO DO
WITH APY DUERY TUMOR.
EXPLAIN WHAT WE'RE GOING TO BE
SEEING HERE.
>> THIS PATIENT HAD A GIANT
PITUITARY TUMOR LOCATED RIGHT IN
THE CENTER OF THE HEAD PRESSING
UPWARD ON THE OPTIC NERVES AND
CAUSING BLINDNESS AND VISUAL
LOSS.
WHAT WE FOUND OUT AFTERWARDS AND
BEFORE THE SURGERY WAS THAT IN
ADDITION TO THE PITUITARY TUMOR,
HAD HE TWO ANEURYSMS WHICH ARE
BUBBLES ON THE BLOOD VESSELS
WHICH YOU CAN SEE HERE RIGHT NOW
POINTING INWARD.
THESE ARE AT RISK OF RUPTURE AND
CERTAINLY IF YOU TOUCH THEM
DURING THE SURGERY, THEY'RE
GOING TO RUIN YOUR DAY AND HIS.
AND SO IT WAS REALLY IMPORTANT
TO BE ABLE TO NAVIGATE AND TO
SEE THESE ANEURYSMS THROUGH THE
TISSUE WHILE WE WERE DOING THE
CASE TO STAY AWAY FROM THOSE.
>> I WANT TO SHOW OUR VIEWERS
SOMETHING AND THEN I'LL TALK
MORE HERE.
ANOTHER ADVANCEMENT THAT WE'RE
SEEING A DESIGN CHANGE TO
SMALLIE LEK ELECTRODES IMPLANTED
IN THE BRAIN DURING DEEP BRAIN
SIMULATIONITION SURGERY PRI.
THIS TINY TWEAK HAS A WORLD OF
IMPACT.
>> ANNE WAS DIAGNOSED WITH
PARKINSON'S DISEASE IN 1986.
12 YEARS LATE ARER, SHE BECAME
ONE OF THE FIRST TO RECEIVE DEEP
BRAIN STIMULATION OR DBS SURGERY
TO TREAT HER DISEASE.
IT'S A PROCEDURE WHERE A DEVICE
IMPLANTED IN THE UPPER CHEST
SENDS ELECTRICAL IMPULSES INTO
THE BRAIN THROUGH WIRES CALLED
LEADS THAT ARE TIPPED WITH
ELECTRODE CONTACTS.
THE NEUROSTIMULATION CALMS THE
SYMPTOMS LIKE TREMORS BUT
RECENTLY, HER 20-YEAR-OLD DEVICE
STOPPED WORKING.
SO TWO DECADES AFTER HER FIRST
DBS SURGERY, SHE'S SCHEDULED FOR
ANOTHER ONE AT MOUNT SINAI
HOSPITAL IN NEW YORK CITY.
DR. BRIAN COPPELL IS HER
SURGEON.
>> THE LEAD FRAUD AND LIKE ANY
MANMADE DEVICE, THIS CAN --
THESE LEADS CAN BREAK.
DBS IS A PACEMAKER FOR THE
BRAIN.
IF IT BREAKS, ELECTRICITY CAN'T
FLOWEN AN THEY LOSE EFFICACY.
THAT'S WHAT HAPPENED WITH ANNE.
>> GOING INTO HER SECOND OF TWO
LEAD IMPLANT SURGERIES, SHE IS
OPTIMISTIC.
SHE SAYS SHE KNOWS THE PROCEDURE
WILL ALLOW HER TO GO BACK TO
DOING ACTIVITIES WITHOUT TREMOR
BECAUSE HER FIRST DEEP BRAIN
STIMULATION SURGERY TWO DECADES
AGO WORKED WONDERS.
>> IT WAS A MIRACLE.
PLAIN AND SIM, A MIRACLE.
I WAS SHAKING WHEN I WENT INTO
THE OPERATING ROOM AND I WASN'T
WHEN I CAME OUT.
>> NURSE PRACTITIONER JOAN WHO
IS ALSO ASSISTING McCLOSKEY WITH
THIS PROCESS SAYS IT'S NOT
ENTIRELY KNOWN WHY
NEUROSTIMULATION CALMS THE
SYMPTOMS.
BUT IT'S USED IN A CASE LIKING
THISSING IS CLEAR.
>> FOR SOMEONE HOB HAS SO MANY
YEARS OF PARKINSON'S DISEASE,
IT'S HARD FOR US TO COVER THOSE
SYSTEMS WITH JUST MEDICATION
ALONE
SHE RESPONDS WELL TO MEDICATION
BUT IT DOESN'T AS LONG, SO THE
DEEP BRAIN SIMULATION HELPS US
TO MANAGE THE FLUCTUATIONS SO
THE OFF TIMES BECOME BETTER AND
SO HER MEDICATION CAN REALLY
LAST THROUGH THE DAY.
>> Reporter: THE NEW DBS SYSTEM
WILL BE IMPLANTED IN BOTH SIDES
OF HER BRAIN SO THE SURGERY IS
DONE OVER TWO DAYS.
ONCE THE LEADS ARE IN AND SHE'S
HAD TIME TO HEAL, McCLOSKEY WILL
RETURN TO HAVE THE DEVICE
CALIBRATED TO THE LEVEL OF
STIMULATION SHE REQUIRES.
THIS PROCESS HAS BECOME MORE
ACCURATE THANKS TO A RECENT
ADVANCE IN THE FIELD.
>> THE PRODUCT THAT WE USE TODAY
IS THE FIRST OF THE ADVANCES IN
THE DBS LEAD DESIGN SINCE DBS
WAS INTRODUCED IN.
THE UNITED STATES IN THE LATE
'90s.
THE TRADITIONAL DBS LEAD HAD
FOUR CONTACTS AND EACH FOUR
CONTACTS LOOKED LIKE A LITTLE
CYLINDER.
SO WHEN YOU SIMULATED YOU
CREATED A FIELD THAT WAS
SYMMETRIC AND OWL SIDES OF THE
LEAD.
IF THE LEAD WERE SLIGHTLY TOO
CLOSE TO SOME AREA THAT YOU
DIDN'T WANT TO STIMULATE, YOU
HAD TO SORT OF TRADE OFF BETWEEN
EFFECTIVE STIMULATION AND SIDE
FECTS.
>> HE SAYS SURGEONS LIKE HIM
WANTED A LEAD THAT PROVIDESES A
SYMMETRICAL STIMULATION ALLOWING
DOCTORS TO STIMULATE IN ONE AREA
BUT NOT AFFECT AT ADJACENT AREA.
THESE NEW LEADS PROVIDE THAT
CAPABILITY.
IN THE OPRYING ROOM, HE ORIENTS
THE LEAD TO TAKE ADVANTAGE OF
THE NEW ELECTRODE LAYOUT.
PRIOR TO THE IMPLANT SURGERY,
COPPELL DOES SEVERAL CHECKS OF
BRAIN IMAGING TO MAKE SURE HE
IDENTIFIES THE OPTIMAL IMPLANT
LOCATIONINGS.
>> ALL RIGHT, ANNE, DO ME A
FAVOR.
>> SHE IS AWAKE BUT SEDATED.
IN ADDITION TO FOLLOWING THE MAP
PROVIDED THROUGH BRAIN IMAGING,
HE LISTENS TO FREQUENCIES GIVEN
OFF BY THE BRAIN'S NUKE KLEE WHY
I WHERE THE LEAD IS STIMULATING
WITHIN THE LEAD.
ONCE THE LEAD IS IN THE TARGETED
LOCATION, HE TURNS ON THE
ELECTRODES AND ASKS THE PATIENT
TO FOLLOW COMMANDS.
HE CHECKS HER REACTIONS TO SEE
WHETHER THE STIMULATION CAUSES
CAN HER NORMAL TREMOR OR
STIFFNESS TO SUBSIDE.
>> OPEN AND CLOSE YOUR HAND BIG
AND WIDE.
HOW DOES THAT FEEL?
>> ONE MONTH LATER, McCLOSS SKI
VISITS IS MOUNT SINAI FOR A
FOLLOW-UP APPOINTMENT WHERE HER
NEW DBS DEVICE IS PROGRAMMED BY
THIS NURSE PRACTITIONER.
>> TODAY IS HER FIRST INITIAL
PROGRAMMING VISIT.
WE'RE GOING TO BE TURNING ON HER
ELECTRODES TODAY.
SHE'LL BE OFF MEDICINE AND WE'LL
SEE WHAT THE STIMULATION DOES BY
ITSELF AND THEN WE HAVE HER TAKE
HER MEDS SO WE CAN SEE WHAT
MEDICATION AND SIMULATION DOES
AT THE SAME TIME.
>> FIVE, FOUR, THREE, TWO, ONE.
>> JUST A LITTLE TREMOR.
>> SHE USES SOFTWARE ON A SMART
DEVICE THAT ALLOWS HER TO GO
THROUGH EACH ELECTRICAL CONTACT
IN THE BRAIN, SET THE AMPLITUDE
AND TEST WHAT HAPPENS TO HER
SYMPTOMS.
>> TYPICALLY WE CAN TREAT THE
SYMPTOMS OF PARKINSON'S CALLED
MOTOR SYMPTOMS.
WE CAN TREAT TREMOR, STIFFNESS
HAD, MOVEMENT AND DYSKINESIAS
WHICH ARE EXTRA MOVEMENTS AFTER
PATIENTS TAKE MEDICINE.
>> ANNE'S SYMPTOMS LESSEN IN
INTENSITY AS SHE IS TESTED HER
ABILITY TO DO BASIC MOVEMENTS
DURING STIMULATION.
THE APPOINTMENT IS RELIEF FOR
ANNE WHO ARRIVED IN A WHEELCHAIR
SUFFERING FROM FROZEN AND PREM
MORES BUT LEAVES WALKING.
WITH THE HELP OF HER MEDICATION
AND THE DEEP BRAIN STIMULATION.
>> SO WOULD YOU HAVE EVER
THOUGHT WHEN YOU STARRED MEDICAL
SCHOOL WE WOULD BE DOING THINGS
ON TELEPHONES, ON YOUR PHONES
NOW, THINGS LIKE WE'VE SEEN
THAT?
>> AMAZING ADVANCES.
>> LET ME ASK YOU, THERE HAVE
BEEN SO MANY ADVANCES.
WE HAVE A FEW MORE MINUTES HERE.
THERE'S ONE THAT YOU INVOLVE TO
SOME EXTENT WITH YOUR SURGERY
REFERRED TO AS A GAMMA KNIFE.
TELL ME WHAT THAT IS AND ISN'T
THAT SOMETHING OF A MISNOMER.
>> YES, IT'S NOT A KNIFE.
IT'S ONE OF THE SEVERAL TYPES OF
RADIATION THAT CAN BE FOCUSED TO
PENCIL THIN BEAMS TO TREAT
TUMORS MAINLY.
WE CAN ALSO DESTROY TISSUE IF WE
THINK IT IS FUNCTIONING AB
NOR
NORMALLY.
IT'S AN ADVANCE BUT IT IS NOT
REALLY DIFFERENT FROM OTHER
TYPES OF RADIATION IN ITS
EFFICACY P.
IT'S TOTALLY NONINCE VASIVE.
THAT'S WHY THE TERM GAM MAP
KNIFE IS A LITTLE BIT.
>> SOUNDS KIND OF PRIMITIVE YOU
HAVE A KNIFE FOR SUCH A PRECISE
TECHNOLOGY.
LET ME ASK YOU BOTH, A LITTLE
BIT LESS THAN TWO MINUTES.
SAME QUESTION TO YOU BOTH IF I
CAN.
LESLIE, YOU START.
WHERE DO YOU SEE US GOING IN THE
VERY NEAR FUTURE COMPARED TO
WHERE YOU STARTED IN THIS
PROFESSION.
WHERE DO YOU SEE US GOING IN
TERMS OF PATIENT CARE AND
PATIENT KNOWLEDGE?
>> WELL, WE'VE BECOME SO DIGITAL
WITH WHAT WE EXPECT IN LIFE.
WE DO AFGHANISTAN OFF OF APPS.
WE'RE FULLY EDUCATED CONSUMERS
WHEN WE PURCHASE THINGS.
THE SAME IS HAPPENING IN HEALTH
CARE WHEN PEOPLE ARE LOOKING FOR
A NEUROSURGEON OR FIND OUT THEY
HAVE A CONDITION, THEY WANT TO
BE FULLY EDUCATED AND INFORMED
AND THEY WANT TO FEEL LIKE THEY
HAVE A SAY IN WHAT THEY'RE
DOING.
BECAUSE AT MOUNT SINAI WE HAVE
ALL SORTS OF AMAZING
TECHNOLOGIES AT OUR FINGERTIPS
AND YOU CAN ESSENTIALLY WALK A
PATIENT THROUGH THEIR SURGICAL
EXPERIENCE WITHOUT IT ACTUAL
HAPPENING, I FEEL THAT WE CAN
OFFER A HI-TECH DIGITAL PATIENT
SATISFACTION EXPERIENCE.
THAT'S WHAT I'M FOCUSED ON
HELPING FOR THE PATIENTS SO THEY
FEEL LIKE THEY'RE JUMPING IN
WITH EYES WIDE OPEN.
>> A LOT TO ASK YOU IN 45
SECONDS BUT WHERE DO YOU THINK
WE'RE GOING TO BE THE NEXT TEN
YEARS IN NEUROSURGERY?
>> WELL, SURGERY IS STILL A
FIELD THAT USES HANDS.
ALL THE ADVANCES SO FAR HAVE
BEEN WITH INFORMATION PROVIDED
TO OUR EYES.
TO HELP US INTERPRET WHAT WE SEE
AND IMPROVE THE QUALITY OF WHAT
WE DO WITH OUR HANDS FOR THE
PATIENTS.
WHERE I SEE THE NEXT ADVANCES
ARE IN HELPING OUR HANDS.
SO WHAT I'D LIKE TO BE ABLE TO
BE DO IS TRANSLATE THE
INFORMATION ABOUT THE BORDER OF
A TUMOR OR THE VICINITY OF AN
IMPORTANT ARTERY, TRANSLATE THAT
FROM THE SCREEN TO OUR HANDS SO
THERE WILL BE DIRECT FEEDBACK
INTO THE INSTRUMENTS THEMSELVES
EITHER BY PROVIDING A LITTLE
PHYSICAL RESISTANCE AS APPROACH
SOMETHING DANGEROUS OR GUIDING
US PHYSICALLY TOWARDS THE
IMPORTANT AREAS WE NEED TO GO.
>> I WANT TO THANK YOU BOTH FOR
SPENDING SOME TIME WITH US.
DR. BEDERSON, LESLIE SCHLACTER,
IT'S MARVELOUS WORK THAT'S BEING
DONE BY YOU AND EVERYBODY UP AT
MOUNT SINAI.
AND YOU KNOW, WE'LL PLAN ON
GETTING YOU BACK AGAIN SOMETIME
SOON TO KEEP US UP TO DATE ON
ALL THE THINGS GOING ON.
THANK YOU VERY MUCH FOR JOINING
US TONIGHT.
THANK YOU FOR JOINING US FOR
THIS SPECIAL EDITION OF METRO
FOCUS.
I WANT TO THANK ALL OF YOU AT
HOME.
LET US KNOW WHAT YOU THOUGHT
ABOUT TONIGHT'S PROGRAM BY
HEADING OVER TOLL
METROFOCUS.ORG.
ON BEHALF OF ALL OF US HERE,
THANKS FOR JOINING US.
HAVE A GOOD NIGHT.
>> "METROFOCUS" IS MADE POSSIBLE
BY
JAMES AND MERRYL TISCH,
SUE AND EDGAR WACHENHEIM III,
THE SYLVIA A. AND SIMON B. POYTA
PROGRAMING ENDOWMENT TO FIGHT
ANTI-SEMITISM.
BERNARD AND IRENE SCHWARTZ,
ROSALIND P. WALTER,
BARBARA HOPE ZUCKERBERG,
AND BY --

Mutual of America PSEG

Funders

MetroFocus is made possible by James and Merryl Tisch, Sue and Edgar Wachenheim III, the Sylvia A. and Simon B. Poyta Programming Endowment to Fight Anti-Semitism, Bernard and Irene Schwartz, Rosalind P. Walter, Barbara Hope Zuckerberg, Jody and John Arnhold, the Cheryl and Philip Milstein Family, Janet Prindle Seidler, Judy and Josh Weston and the Dr. Robert C. and Tina Sohn Foundation.

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