Reducing the Cognitive Footprint of Brain Surgery

Michael McDermott, M.D. and Michael Sughrue, M.D.
[Transcript]
- [Dr. McDermott] So Mike Sughrue is currently a neurosurgeon at Prince of Wales Hospital in Sydney, Australia. Born in the United States, he did his neurosurgical training at the University of California San Francisco. I was one of his instructors when I was there. Mike left and went to University of Oklahoma, where I think he was doing something on the order of like, 500 cases a year, which is insane. I don't know how that's possible, but Mike did it, and in the meantime, took up a particular interest in this topic of connectomics and published an 18-chapter supplement to one of our neurosurgical journals on connectomics, and the introductory chapter, I had to read it twice to try and get my head around everything. So he's gone on to found a company called Omniscient, and when I saw the video presentation, the first one that Mike made on this technology, I must say, it was one of two things I'd seen in the last 10 years that I thought was amazing, and this is the more amazing of the two. So we're looking forward to Mike making a presentation. We have some of our laypeople from the Baptist Healthcare system who we asked to join us this morning. So Mike, take it away.
- [Dr. Sughrue] Thanks for having me, guys. So, I've given some variation of a talk on connectomics probably 300 times, and over the years, I've refined it to really state why I got interested in the first place, which is, how do we reduce the cognitive footprint of things that we do to the brain when we treat the brain? And if you think through this topic, it's a topic that I've been interested in since I was a junior resident fielding calls from patients at two o'clock in the morning, where the patients were concerned about things that were not life-or-death emergencies, that always made me think, how could we do better? But in the search to do this, I think it really starts to touch on an impressive convergence of multiple fields of medicine who deal with the brain. So I kinda wanna take you guys through it. As Mike pointed out, I founded Omniscient Neurotechnology. We're not gonna directly talk about the software, but we will talk about the technology about it. So when we're taking out a brain tumor like this, what we're trying to do, no matter what the tumor is or what the anatomy is, we're trying to get the patient on the left to the outcome on the right with as few problems as possible, little collateral damage. Now, we're pretty good at putting holes in the brain, especially as brain tumor surgeons. We're pretty good at getting very good resections, and we can often preserve some of the more core functions like motor and speech, because we have techniques for this. But part of it is, the reason we can do that on a reliable basis is that we've known the basic anatomy of these systems for over a hundred years. If you think about this, while we've added to that model, we haven't really changed the fundamental model. But in that model, what it basically implies is that there's nothing else in any other part of the brain that is worth saving. So if you're not in the, quote, "eloquent areas," well then, you can't really do anything wrong. And of course anybody who's spent time talking to patients who've undergone brain surgery know that they'll often tell you that that's not true. But we also know that we can get away with brain surgery. So we know that there's something we're doing wrong that we don't understand. Now, as I and many people who are neurosurgeons have learned, we think about the brain in terms of eloquence versus noneloquence. So basically, if you pick a noneloquent entry point, you stay out of the eloquence areas if you can avoid it, you stay in the tumor, and you don't cut the cord of the spinal tract, you'll get a good outcome. And this is true to an extent, right? These are the worst complications, or at least the most obvious ones. But again, it again argues that the rest of the brain is relatively important, that we should spend our time to really try to understand it and minimize our damage to it, or at least avoidable damage. And we know that we're not doing as good of a job as we could be, because if we talk to our patients, they often have cognitive or neurological deficits that we don't understand. If we don't have tools that help us learn what we did wrong, we really aren't gonna improve. And so, that which is not measured does not improve. So a concept has come, particularly in glioma surgeries, which is called the onco-functional balance. We generally know that the further you take the tumor resection, the more of the tumor you remove, the more likely you are to get a good oncological outcome and control the tumor. There's pretty good evidence for this now.
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