New Advancements at Sylvester for Diagnosing and Resecting Brain Tumors

Precision is essential in surgery, especially when dealing with the brain. Three new tools being used at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine are designed to make the biopsy, diagnosis and removal of a brain tumor more precise.

The ROSA robot being used for brain biopsy at Sylvester.
The ROSA robot being used for brain biopsy at Sylvester.

“ROSA robotics, 5-ALA tumor fluorescence, and the NIO intraoperative histology system represent cutting-edge technologies that allow patients treated at Sylvester Comprehensive Cancer Center to achieve optimal outcomes,” said Sylvester’s director of surgical neuro-oncology, Ricardo Komotar, M.D.

On January 7, Dr. Komotar performed the first robotic assisted brain biopsy at Sylvester. Using the ROSA, a stereotactic needle biopsy was used to diagnose a patient’s tumor.

“The ROSA robot provides the highest quality patient care by improving efficiency and reducing morbidity via minimally invasive techniques,” Dr. Komotar explained after the procedure.

The two other initiatives are being led by Michael Ivan, M.D., assistant professor of neurological surgery and leader of the Sylvester Neuro-oncology Site Disease Group.

The NIO Imaging System is described as game-changing technology, using Stimulated Raman Histology (SRH) for rapid intraoperative diagnosis of brain tumors.

“We can now obtain almost instantaneous results during the removal of brain tumors, which shortens surgeries and provides more informed intraoperative decisions,” said Dr. Ivan. “The research we are performing at UM is leading the way to allow SRH to be used across the country to help surgeons, pathologists, and patients.”

Accurate histopathologic diagnosis is crucial for planning during the surgical removal of brain tumors. Conventional methods for intraoperative histology are time consuming and require sectioning and freezing. SRH provides label-free high-resolution images of fresh, unprocessed surgical specimens.

For patients with gliomas, 5-ALA fluorescence is being used to visualize malignant tissue during surgery. This optical imaging agent was approved by the Food and Drug Administration in 2017 and just released for clinical use in the U.S. in 2018. One study has found 5-ALA fluorescence resulted in more complete resections (64 percent) compared with the control group (38 percent).

“5-ALA literally lights up the way during surgery and is the most advanced way to ensure there is a complete tumor resection. Increased extent of resection is critical in allowing improved progression-free survival,” said Dr. Ivan.

Tags: brain tumors, Dr. Michael Ivan, Dr. Ricardo Komotar, Sylvester Comprehensive Cancer Center