Surgery at VGH/BrainCare:
- Diagnostics- MRI/CT/PET/DTI
- Tocagen trial
- Stealth, Brainlab, Synaptive
- Robotic exoscope
- Brain tumor banking
- Access to POG
- Supportive of Vaccine trials
In dealing with brain tumors, the surgical goals of BrainCare are quite simple:
Safe, Aggressive, Maximal tumor removal.
Because of this attitude we rarely perform only biopsies- the vast majority of tumors that we encounter are operated on for removal- regardless of how aggressive the tumor is or where they are located in the brain.
In order to achieve this goal however takes a combination of expertise, experience and technology.
In order to accurately and precisely remove a brain tumor thorough pre-operative imaging is mandatory. BrainCare is enabled to expediently attain such brain imaging prior to creating the plan for surgical removal. Along with CT scanning, we utilize the advanced MRI brain imaging at the Vancouver General Hospital (VGH), with algorithms that are specifically developed for brain tumor physiology. Using these scans enables us to assess tumor blood volume and via spectrometry, also the chemical make-up of the tumor. This is particularly helpful in discerning true tumors from lesions that only appear to be tumors. Furthermore, specialized MRI protocols (DTI) allow us to visualize the fibre tracts in the brain- the axons that convey the pivotal impulses for movement, speech, vision, etc. By utilizing these DTIimages, the surgeon is able to plan an attack on a tumor that avoids these critical fibre tracts- thus avoiding major complications such as paralysis, blindness and language disabilities. In collaboration with the BCCA, BrainCare has utilized PET-CT scanning techniques to actually observe the biologic activity of brain tumors- this in turn has allowed us to focus on the aggressive removal of the most biologically active regions of the tumor.
BrainCare and the Vancouver General Hospital if privileged to receive extremely generous philanthropic support- as a result some of the best and greatest brain tumor technology is available, and only available, at the Vancouver General Hospital.
Neuro-navigation: this is the ability to accurately localize brain structures and brain tumor coordinates in the confines of the operating room; it is in essence GPS for the brain. The Vancouver General Hospital has three distinctive devices for this goal: Medtronic Stealth, BrainLab Curve and Synaptive Servo. These units are able to import all modes of brain imaging into one common platform that allows the surgeons to navigate as the operation proceeds.
Under the management of Dr. Brian D. Toyota, VGH is the only hospital in Canada with Neuroblate, laser tumor ablation technology. This represents a minimally invasive method of eradicating brain tumors, in particular those tumors in deep, often difficult to access, areas of the brain. (please click on the Neuroblate tab for more information).
The Vancouver General Hospital is also one of the few hospitals in Canada that has a robust Intra-Operative Monitoring (IOM) program. This allows surgeons to actively and in real-time, monitor the physiologic functions of the patients as we operate on them. Using IOM we can monitor motor movements, speech, seizure activity and cranial nerve function- ensuring they are not compromised in the course of the aggressive tumor resection.
VGH/BrainCare is also one of the few operating rooms in the country that is enabled to perform brain tumor removal under local anesthetic (an awake craniotomy). This is specifically useful when removing brain tumors from the speech/language area.
VGH became the first Canadian hospital to adopt the Synaptive technology. This platform encompasses robust neuro-navigation technology, advanced DTI and a robotically driven exoscope. The exoscope replaces the traditional microscope - it is more ergonomic for the surgeon and allows for greater optics, magnification and depth of field.
Tocagen: Viral GBM Trial.
VGH/BrainCare is one of the few sites in Canada actively participating in the Tocagen Viral therapy for GBM. This study is directed at recurrent GBM and involves the direct injection of virus into the brain surrounding the tumor, in an effort to eradicate the invading brain tumor cells. (please click on the Reseaerch tab for more information).
Brain Tumor Banking.
Unique to the brain surgery performed by Dr. Toyota, is the banking of all brain tissue. This process does not at all impact the surgical procedure, but instead takes place after tumor removal. At most every other site where brain tumors are removed, the tissue is immersed into wax (paraffin). This process destroys a great deal of the vital biologic and genetic information concealed inside of tumor cells. Indeed one could argue that this information is crucial to the eventual cure for brain cancer.
Thus, at VGH /BrainCare, some of the brain tissue is also flash frozen to -40 degrees C. This greatly preserves the key components of biologic activity, receptors and genetic markers- these charactheristics are crucial to today's fight against cancer. The BCCA Personalized OncoGenetics project (POG) requires this type of tumor harvesting, and some of the BrainCare patients have been able to participate in POG as a result.