Ottawa Hospital team pioneers virtual reality to treat Parkinson's patients

Elizabeth Payne 3 minute read March 19, 2019

With a virtual reality goggles fixed on his head and wands in his hands, neurosurgeon Dr. Adam Sachs can step inside a patient’s brain for an extreme close up of where he will place an electrode during deep brain stimulation surgery — virtually, that is.

For now, the cutting-edge technique, created at The Ottawa Hospital’s virtual reality lab, is still in development.

But Sachs, director of neuromodulation and functional neurosurgery at TOH and a researcher with the Ottawa Hospital Research Institute, expects to be using it in the operating room within months.

Virtual reality has been used in medicine for several years, mainly to help train physicians or to assist patients with rehabilitation, PTSD or other issues.

But it has never been used like this. The technique developed to improve the accuracy of the game-changing surgery for patients with Parkinson’s and other neurological diseases represents a world first for The Ottawa Hospital.

Deep brain stimulation surgery involves implanting electrodes inside the brain connected to a stimulator device something like a pacemaker. Where the electrodes are placed determines the symptoms being treated.

Dr. Adam Sachs virtually pokes around inside a virtual human brain at The Ottawa Hospital’s General campus Monday, March 18, 2019 with the help of new virtual reality technology. The 3D Virtual Reality Lab at the hospital has innovated technology scheduled to be rolled out this year that is the first of its kind, allowing neurosurgeons to increase their accuracy during deep brain stimulation for patients. Julie Oliver / Postmedia

The surgery can help to reduce tremor, slowness, stiffness and walking problems caused by Parkinson’s and other neurological diseases. It has the potential to not only improve mobility, but can decrease reliance on medications that can come with side effects.

“It makes a remarkable difference in a patient’s quality of life,” said Sachs, who has been performing the surgery at The Ottawa Hospital for five years.

Implanting a microelectrode that is no thicker than a human hair through the skull into a specific area of the brain is technical work. Surgeons use MRIs and brain atlases (visual brain mapping) to get a mental picture of what the patient’s brain looks like. But the brain atlases are two-dimensional and made from a compilation of many patients’ brains.

“That is why this virtual reality environment is so helpful, because it actually allows us to turn it into an intuitive, visual three-dimensional experience that can be used to more accurately place the electrode, as opposed to looking at the top of the skull and closing your eyes and trying to think, Where am I?”

Using virtual reality helps to improve precision because surgeons are using accurate images from the patient’s own brain in 3-D using MRIs and CT scans.

And precision is crucial when it comes to deep brain stimulation.

“We are talking about a refinement of millimetres,” said Sachs. “But millimetres matter.”

Sachs has worked with Dr. Justin Sutherland and Dr. Daniel La Russa on the technique. Both are medical physicists in the hospital’s radiation oncology department.

Although virtual reality has been used for patients, “doctors wearing the headsets instead of patients is fairly limited, largely because technology wasn’t there in the past,” said Sutherland. But that will change, he said, and could change the way medicine is practised in some cases.

Sutherland envisions it being used throughout the hospital in coming years.

For now, there is potential for the virtual reality technique to spread around the world.

“As far as we know, no one else is pursuing this type of thing and it could have a global impact,” Sutherland said.


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