STANFORD, CALIFORNIA - It wasn’t a typical headache that bothered Felicia Luna, 41. It was painful pressure “like someone was squeezing my head really tight.” The pain was so bad that Luna says she couldn’t lie down with her head on the pillow.
Her primary doctor and a specialist told her to stop worrying. Then she went to Stanford Medical Center. The head of neurosurgery, Dr. Gary Steinberg, scheduled her for brain surgery. Her aneurysm was in danger of rupturing.
Because of the complexity of the upcoming surgery and Luna’s curiosity, Steinberg decided to use virtual reality to perfect the surgical route. To do this, contrast dye was injected during Luna’s CT scan and angiograms, two medical scans, to highlight the width and shape of the vessels.
WATCH: Virtual Reality Allows Patients to Preview Their Own Surgery
Stanford’s Malie Collins, who works with Steinberg, builds the reconstructions in 3-D and prepares the patient-specific VR cases for Steinberg. Collins formerly worked for Surgical Theater, an Ohio startup that designs the software to transform the scans to be viewed in VR via Oculus Rift and other headsets.
Flying through the brain with VR
Collins trained Stanford’s staff on the equipment and then joined the team. She and Steinberg created the Neurological Simulation and Virtual Reality Center, the first VR clinic for spine and neurosurgery in the United States. Now Collins is applying to medical school in June, to become a neurosurgeon.
Part of Collins’ job is to create a “fly though” virtual reality video for patients.
The night before Luna’s surgery, Collins gives her a headset to wear and lets her travel through her own brain. Luna admits being “a nervous wreck” before seeing the path Steinberg would take to locate the aneurysm. She sees where he will clip off its growth so the clot can be resorbed, eliminating her pain.
“Now I understand exactly what’s going to happen,” Luna says. Her husband also took a turn at the virtual reality flight.
“This makes me understand it 100 percent,” Rene Luna says. “That extra understanding gives me a lot more confidence.”
?VR theater ‘rehearsal’
Later that evening, a group gathers in what resembles a home theater, with darkened lighting, padded recliners and large monitors. They all wear big black goggles. Their arms are outstretched, directing the empty air around them with controls wrapped around their knuckles. This is a Stanford medical school class taught by Steinberg.
Collins has loaded the 3-D reconstruction of Felicia Luna’s aneurysm and a virtual craniotomy so students can follow in virtual reality as Steinberg explains his surgery strategy.
Steinberg uses his controls to turn the virtual skull. He virtually “erases” a bone, glides along a vessel, and reveals his target.
“That’s exactly where the aneurysm is, where that turn is,” he says.
He shows where he plans to place a clip, cutting off the blood that can thin the aneurysm’s walls, causing it to rupture. The virtual procedure, which Steinberg describes as a “kind of GPS navigation with 1-2 millimeter precision,” is invaluable to him.
“In a sense, it allows me to plan for surgery ahead of time and rehearse it,” he says.
?In the operating room
The next day, the 3-D images appear on monitors in the operating room.
Steinberg makes last-minute checks and “practices” his surgery one final time before he begins the five-hour operation. At this point, the VR is there for reference.
Collins sees the benefit from all sides, from “the patient, then into the operating room, then for education. The fact that it’s so versatile makes it unique and powerful,” she says.
Future VR/high-tech medical surgeries
Technology may someday place the 3-D virtual reality in a head’s up display in surgical microscopes. Or the doctor may manipulate robotic surgical controls remotely, eliminating the need for him or her to be in the operating room.
But technology is not yet able to eliminate the lag time between the remote location and the operating room, where vessels constantly change and move.
In his three decades of neurosurgery, Steinberg says VR has “transformed the way we can prepare for and adjust surgery in the operating room.”
He says just being able to see around the aneurysm in 360 degrees is something that was impossible before VR. He says for patients it means “remarkably improved outcomes, in terms of safety and efficacy.”
Luna on the road to recovery
Felicia Luna had a good outcome, but her right eye is still recovering.
Because of her aneurysm’s irregular shape, Steinberg needed two clips, one more than he planned. The naked eye in this case proved more accurate than virtual reality.
She left the hospital two days later, to recuperate with her husband and four children.