July 20, 2015

New surgical handheld finds those tough-to-reach nerves and zaps pain John Hewitt

If your neurosurgeon asks you to”‘open wide,” don’t worry — you are not in the wrong place. That’s because many of the most sensitive nerves exiting the base of the brain and upper spine can best be gained through the oral cavity. The problem is that not only do all the neural highways and byways that intersect here at nerve central look exactly like each other, they also look very similar to blood vessels.


An errant swipe of the electro-surgical Bovie, the Swiss army knife of the OR that cuts, coagulates, and cauterizes, will nullify one of your senses faster than you can say “who turned out the lights?” Fortunately, a new device known as Chimaera aims to prevent mishaps like that by giving surgeons a conveniently labelled neural netlist that is superimposed over their workspace in real time.

To use Chimaera one simply holds the wireless wand-like device over the region where the next operative stroke is to be made. The device then captures the relevant biogeographical coordinates and combines them with preoperative computerized tomography data to create a 3D X-ray image that is rendered on Google glass. There is a nice YouTube video that shows it all, however the manufacturers have disabled the embed function on it, so you will have to go there directly to see it.
If all goes well in trials, production of the device would be ramped up just in time to meet the glut of patients soon to be seeking implantable stimulators that can mod and prod their state of mind. Most acutely, this means zapping pain messages before they make it up to the brain. It is hard to put a price on the ability to wirelessly shunt migraine pain, or that due to any number of cranial or bodily maladies at the mere touch of the button.
As mentioned, the place to be is in the head. Unfortunately, very few surgeons have the skill to safely navigate within the narrow recesses behind the eyes and beyond the oral cavity. There may be just a half a dozen or so in possession of the surgical trust the job needs. The Chimaera could potentially level the playing field so that surgeons everywhere could begin to install the many so-called neuromodulatory devices now coming to market.
Once upon a time the implantable stimulator shopping cart was a one size fits all world. The same basic buzz box would be used to target pain signals coming up from deep in the spine as would be used to target superfluous motor commands going in the opposite direction in uncontrolled tremor. Now there are custom devices not only to fit in the many unique nooks and crannies of the head’s anatomy, but also to operate in a way that uniquely suits the properties of a specific nerve.
Ultimately the Chimaera device would not only let surgeons navigate to the ideal location, it would also be used to physically deploy (or as the case may be, retrieve) the implant. That would probably require close collaboration between both surgical tool and implant manufacturers. The creators of the device, Cambridge Consultants, are now looking for partners to commercialize their technology and hopefully lead it through the product development cycle.

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