Executive Director, Centre for the Advancement of Teaching and Learning University of Manitoba
Researcher of the month:
The NeuroBlate® saga
The idea for NeuroBlate®, a pencil lead-thin laser probe that can treat inoperable brain tumours, began long ago but not so far away in a hospital cafeteria in Winnipeg, MB.
On that day, Dr. Michael West, a neurosurgeon at St. Boniface Hospital, invited a colleague, Dr. Mark Torchia, to witness a new surgical tool that enabled him to biopsy brain tissue through a tiny hole in the skull. The technology was revolutionary at the time, replacing risky open-skull procedures.
Afterwards, the two doctors sat down for a cup of coffee. They fell into conversation and daydreamed about the future of brain surgery. Both were conscious of the plight of patients with inoperable brain tumours due to glioblastoma multiforme, an aggressive, deadly cancer.
Wouldn’t it be great, fantasized Torchia, a surgical researcher at the St. Boniface Hospital Albrechtsen Research Centre, if you could treat unreachable brain lesions with an instrument that would fit through a tiny hole?
“That was the starting point of the adventure,” he muses after working 30 years to turn that dream into reality. “I knew that, in order to perform a procedure appropriately, it needed to be done in a minimally invasive way and it needed some sort of feedback mechanism that would enable surgeons to see the progression of therapy.”
With a small National Research Council grant, Torchia rolled up his sleeves, but it quickly became apparent that the available technology wasn’t up to the task. His idea was ahead of its time. Optical-fibre lasers and magnetic resonance imaging (MRI) were still in their “teenage years”, he says.
“It was going to take some time for technology to catch up to where we were, but we continued to build prototypes.”
His goal was to create a laboratory bench model that would excite investors. The process was more difficult than he had anticipated. “It’s one thing to build a really cool thing in the lab, but it’s quite another to convert it into something that, in a surgeon’s hands, has a positive impact on patients. You’ve got to get it to the next step, and sometimes, that’s the most difficult part.”
Fortunately, he and his team succeeded. The prototype attracted $1.5 million in funding from the St. Boniface Hospital Research Foundation and local Winnipeg investors, who believed in the project enough to dig deep.
“It was a significant shot in the arm,” he says. With the injection of funds, his team developed a preclinical prototype. In the late 1990s, when concept and technology finally merged, this prototype attracted $7.5 million from the Business Development Bank of Canada (BDC) and venture capitalists.
The team continued to refine the device, until it was ready for clinical trial.
Torchia felt “moments of terror and ecstasy” when the system was first used to treat a patient at The Cleveland Clinic. “You have all the confidence in the world that the engineering processes are in place,” he says, “but there’s still that one galvanizing moment when you think, we’re actually going to stick this device through a tiny hole in someone’s head. You have incredibly strong, mixed emotions about what’s going to happen.”
With NeuroBlate®, brain surgeons can go where none have gone before – with or without general anesthesia. One patient got up from the operating table, moments after surgery, and walked to the washroom. “It was surreal.”
Whether patients hop off the operating table or walk out of hospital less than 24 hours after brain surgery, they reap benefits from the minimally invasive procedure, including reduced rehabilitation time. During laser ablation, it appears that tumours may release antigenic material that may activate a helpful immune response within the brain.
How it works
Surgeons slip the pencil-thin NeuroBlate® System laser probe into the brain through a tiny hole, drilled in the skull. Guided by real-time MRI scans and advanced navigation software, they slide the probe inside the brain tumour. Once activated, laser interstitial thermal therapy (LITT) exposes cancerous cells deep within the brain to a lethal dose of laser-generated heat, killing the tumour from the inside out.
Metaphorically, the laser energy eats the inside of the “apple” but leaves its “skin” intact, preserving healthy tissue beyond its boundary, Torchia explains.
NeuroBlate® “sees” progressive, real-time MRI images of brain tumours by analysing the vibration of water molecules within cells. The frequency of vibration shifts when cells heat or cool. By measuring changes in vibration (proton resonance frequency), NeuroBlate® generates thermal maps to guide surgery.
About 50 devices are in use across North America, including three in Canada. Scientists are investigating how LITT may benefit other brain disorders, such as intractable epilepsy, and cancers in other body regions.
In 2016, Torchia and engineer Richard Tyc, who devised the technology, won the Governor General’s Innovation Award for the development of NeuroBlate®. In 2015, they won the $100,000 Ernest C. Manning Principal Award.
Torchia, an associate professor of surgery at the University of Manitoba College of Medicine, is now Executive Director of the U of M’s Centre for Advancement of Teaching and Learning. Tyc is vice-president of technology and advancement at Monteris Medical, the spin-off company created in 1999 to advance the development of NeuroBlate® and other surgical technologies.
About 60% of NeuroBlate® patients were originally deemed inoperable in a recent study, says Torchia. “When I see images of some locations of therapy, it almost stops my heart. The fact that they continued to improve after surgery and survive for longer is even more meaningful.”