Technology increases precision, safety during neurosurgery

STATE COLLEGE, Pa. — Precision is crucial for James Fick, an esteemed neurosurgeon from the nationally ranked Penn State Hershey Neuroscience Institute. Fick frequently operates within millimeters of the delicate nerves in his patient’s brains and spinal cords. 

To combat the inherent risks associated with brain and spinal column surgeries, such as paralysis and loss of functionality, Fick employs a unique combination of specialized technology to safeguard his patients during surgery. These technical procedures are the centerpiece of neurosurgery today, he explained, and are leveraged in the hundreds of procedures his team performs every year.

“The level of patient care I received from the neurosurgery staff, both before and after the operation, was something I wasn’t used to at the time,” said Patti Fantaske, a former patient who underwent two spinal surgeries with the neurosurgeon. “Dr. Fick’s team knows you’re scared and upset. They are very reassuring and comforting — and the technology they employ just makes the whole process easier.”

Collaboratively recruited by Penn State Milton S. Hershey Medical Center and Mount Nittany Medical Center in 2004, Fick is a board certified neurosurgeon who, today, heads up the only neurosurgery practice in State College, Pa. His neurological practice has been an inspiration within this community of 40,000 people — while introducing technology into the operating room has resulted in increased confidence, precision and safety, even allowing operations to be done that would have been judged inoperable years prior.

Electrophysiological monitoring is one such technology. According to Fick’s team members, the monitoring works by placing electrodes within the muscles of the scalp, neck, arms, hands, legs and feet to activate the sensory and motor pathways and report on the neurological functioning of patients under anesthesia. 

The role of the on-hand monitoring technician is to study the patient’s vitals and alert the surgeon as to whether they are operating too aggressively or if the spinal cord or nerves are showing signs of trouble, based on second-to-second readings that appear on a laptop screen. During the operation, the technician also communicates with an off-site neurologist, via a secure form of instant messaging, who is available to answer questions, discuss the patient’s drug levels and consult regarding any concerns.

“When we’re so close to the nerves in the face responsible for movement and hearing, we want to monitor our progress very carefully,” observed Fick. “There can be 18 reasons why the surgical neurophysiologist sees a change in the patient’s readings, which can ultimately change the way I do the surgery. So there’s constant interaction between us.” 

The team also relies on image-guided technology for the most complicated procedures.

“Most people think that neurosurgery is very cut and dry — they think a tumor is like a grape in the middle of a bowl of Jell-O. So, they believe there's no doubt about it: there it is, cut it out,” Fick added. “And some lesions are that way, but others absolutely are not.” 

However, in a lot of circumstances, the distinguishing features are less obvious, according to Fick. As the lines between tumor and normal tissue begin to blur — in areas of the body that may never recover if damaged — the need for absolute precision during surgery becomes imperative. 

The image-guided technology creates three-dimensional images of a patient’s face, head and brain, helping surgeons to decide where to make an incision, how to approach a lesion or how to move through the brain to locate a tumor. 

“We’re doing operations where I’m millimeters away from the patient being permanently paralyzed, unable to speak, unable to move their right hand,” Fick explained.

“The computer knows, with unbelievable accuracy, the mathematical equation of the patient’s forehead. I can touch the patient’s head with a sensor and it shows me on the computer that I am exactly 2.7 millimeters from the front of the tumor and 32 millimeters from the side of the tumor,” he added. 

“The computer knows, with unbelievable accuracy, the mathematical equation of the patient’s forehead. I can touch the patient’s head with a sensor and it shows me on the computer that I am exactly 2.7 millimeters from the front of the tumor and 32 millimeters from the side of the tumor.”                                                                                                 

— James Fick, neurosurgeon , Penn State Hershey Neuroscience Institute

Though unlike a car’s GPS, Fick explained that image-guided tools can’t completely guide a surgeon through an entire operation. He is still responsible for making thousands of decisions during the long hours of surgery and for walking back and forth from the operating table to the computer images, sometimes up to 50 times. 

Still, the elements of surgeon and nurse experience, confidence and skill are absolutely invaluable — they are simply enhanced by the technology. 

“The image-guided technology coupled with the live electrophysiological monitoring brings an unbelievable amount of precision and thoroughness to our surgeries,” said Fick. 

“Nevertheless, when you do delicate surgery in very critical areas of the brain, the patient’s recuperation time can be longer,” he stated. “But, a longer period of recuperation is often coupled with longer survival, better performance, and, many times, it’s even curative.” 

Understandably, the technology changes the whole mood in the operating room — and the emotions of the surgeon. 

“Honestly, I can sleep better the night before surgery,” Fick stated. “It’s very reassuring during times of very difficult surgery that I know I’ve done everything I can to bring a new element of safety using these technologies.”

Another reassurance, is getting to know patients and their children, parents, friends and co-workers, as well as seeing them at the grocery store, restaurants and everywhere throughout the region in this small town, according to Fick.

“I like the opportunity here. There’s a tremendous amount of opportunity to make a difference — and to define a way of practicing,” he added.

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Last Updated August 28, 2013