Deborah Howell (Host): What is neurotechnology, and how do doctors use it to care for kids? Today, we'll discuss how technology is changing the outcomes for kids with neurological conditions and the process of planning for neurosurgeries. With us today is Dr. James Wheless, epileptologist and Le Bonheur Neuroscience Institute Co-Director and Chief of Pediatric Neurology; and Dr. Nir Shimony, a board-certified neurosurgeon with Le Bonheur. Welcome to you, Dr. Wheless and Dr. Shimony

Dr Jim Wheless: Thanks, Deborah, for having us here.

Dr Nir Shimony: Thank you for having us.

Host: Wonderful. Dr. Wheless, let's begin with you. You're an epileptologist. Can you give us an overview of the kind of technology that Le Bonheur has in the Neuroscience Institute and how you use it to help kids?

Dr Jim Wheless: The technology, just like it's changed all of our personal lives, from computers to iPhones to you name it, has really changed what we do in medicine. And in neuroscience, it's been critical because our technology has really enabled us to, one, take better images or pictures of children's brains to say, is there a structural reason that they're having a problem? And then, the other huge aspect of the technology is what we call functional technology. So not only can we look at the structure, but we can actually measure processes in the brain in real time. So, things like speech or how the child moves their right arm, and get a sense for that all non-invasively and in a painless manner for the child.

Host: Oh, that's wonderful. Now, has the role of technology changed the way you care for and diagnose patients in the last couple of years? And if so, how so?

Dr Jim Wheless: Yes, our improved ability to image the brain and target areas down to very small scale has allowed us to treat children that in the past we couldn't treat. And our ability to more accurately assess brain function has allowed us to really hone in on the exact specifics of that prior to anything being done surgically. So when our surgical colleagues have a discussion with the family, they can have a calm discussion well before surgery about the approach, how far away they are from critical areas of brain function, and kind of what to expect in the outcome. It's very different conversation in the years gone by.

Host: I can imagine. Now, Dr. Wheless, what are some of the most vital advancements in technology that you've seen?

Dr Jim Wheless: I think the couple of key advancements we've seen is improvement in brain imaging, so mainly MRI technology that really allows us to get detailed view of the brain, often down to the size of 1-2 millimeters. So, we're down to 16th of an inch or less. And then, our ability, as I said to function of the brain, to really even down to very young children, to preschool age, to be able to say how are they processing language, where are critical areas for language; in the same group, to say exactly what are areas that are responsible for movement, for motor function, so for moving the right arm, moving the right leg and to superimpose those on the MRI for the surgeon. So, not only can we tell about the function, but we can put them exactly on top of the image of that child's brain and show the family, and more importantly, the surgeon, exactly where those functions are.

Host: Right. Now, this is something that I'm very, very interested in. What is Le Bonheur's suite of brain imaging products and how do you use it as an epileptologist?

Dr Jim Wheless: So luckily, for me and our group, I guess, Le Bonheur has always been at the forefront of incorporating this new technology into how we take care of children, how we make diagnoses and utilizing it for treatment. Because of that, Le Bonheur's Neuroscience Institute is one of the most advanced from a technology standpoint of any children's hospital in the world. We have kind of all of the current state-of-the-art imaging technology in one hospital that you can find anywhere in the world. So, it's really allowed us to take care of all sorts of children's problems and some that in the past we just couldn't take care of.

Host: Wow. That's impressive. Are there any clinical trials underway for technology at Le Bonheur?

Dr Jim Wheless: So beyond the technologies I've kind of mentioned, we're looking at other technology that we can validate at Le Bonheur that potentially could help the parents at home. So, we're looking at a technology, for example, that would use artificial intelligence to monitor kids during their sleep and alert parents if they had a seizure. Some of these are very futuristic-sounding, but we want to be able to validate these with kind of our standard diagnostic testing at the hospital and reassure families that, yes, these can actually perform the functions we say they can, if they're using them at home.

Host: Wow, incredible tools on the horizon. Final question for you, can you tell us what else is on the horizon? Are there any technologies in the works that'll continue to improve the care of your patients?

Dr Jim Wheless: Yeah, I think the other technologies that will continue to improve our care will continue to be advances in our imaging technology. So for example, our ability to say how different areas of the brain are connected and to compare how we think those connections should be in a normal child, compared to a child has, say, a brain tumor or seizures, and then see if there's strategies that will help us in treatment, whether it's improving those connections to where they're normal or not interfering with the normal connections if they're there, just interfering with the abnormal connection. So, I think understanding much more about the brain connectivity between different areas will be another huge step going forward in our ability to do that in a very quick fashion.

Host: It certainly sounds like it. Thank you, Dr. Wheless. Dr. Shimony, now some questions for you. Let's talk a little bit about neurosurgery technology because it's a rapidly evolving area. ROSA One Brain is a new robot technology that Le Bonheur has received in the past year. What is ROSA and how do you use it to care for patients?

Dr Nir Shimony: We are using the ROSA nowadays and very excited that we started using it in the last year. This technology is basically a way for us to implant devices. We'll start very general, and we'll go down to epilepsy in the brain in the most accurate way. For epilepsy specifically, we are able to implant electrodes to the depth of the brain. Something that we couldn't do before in such accuracy that we can nowadays, and basically then get information from the brain itself regarding where the seizures are coming from where is the network that is affecting the epilepsy and then, of course, help us to get a much better way to treat the patients. If we want to get into details, for example, the incisions that we make, the drilling that we make in the skull in order to implant those electrodes nowadays are extremely small. We're talking about anything between 1-2 millimeters, where in the past we were talking about big surgeries. So, it's a completely different era.

Host: What are some of the benefits of ROSA for you and for your patients?

Dr Nir Shimony: The main thing is accuracy and the error margin for most technologies in the past in terms of localizing an area in the brain was around anything between 1-3 millimeters at best. That was the best that we had, which sometimes is enough. ROSA gets you to about half millimeter error margin, which is extremely accurate. And of course, we can get a lot of information from the brain nowadays without performing large surgeries. Those are minimal invasive surgeries. Patients are doing very well, basically from the moment they are waking up.

Host: That's pretty incredible. iMRI is another technology that's important during neurosurgery. What is iMRI and why is it important?

Dr Nir Shimony: So, iMRI stands for intraoperative MRI. This is a magnificent technology because it allows us to perform surgery either for tumor resection or for epilepsy. And then once the patient is still asleep and the room is still sterile, basically perform a full MRI scan and then see if we need to do more surgery. If we need, for example, in epilepsy, to disconnect more fibers, or if we have a tumor, we have something left behind that we need to take out. This completely changes the way that we do surgeries nowadays. Because in our hospital, for example, if we're taking tumors out, if we can, we're always going to get a gross total resection of the tumor. We are not okay with 95% resection and the iMRI allows us to do it.

Host: That is just fantastic news. How has technology changed the way that neurosurgeons can care for their patients

Dr Nir Shimony: I think this question can be divided into two. It's about the decision-making and about the accuracy in surgery itself. In neurosurgery in particular, accuracy is the key. You cannot go into the brain and explore. So, technology helps you to be extremely accurate in your targeting lesions, either epilepsy or tumors. And then, it basically creates what we call a minimal invasive approach, and the patient's doing much better afterwards. In terms of the decision-making, a lot of the technologies that we use before surgery allow us to get a much better decision for the patient, which area we need to disconnect, which area needs to be treated in surgery and which one needs to be treated with medicine. We didn't have these technologies in the past

Host: That's the past. Dr. Shimony, let's talk about the future. How do you see technology changing neurosurgery in the future?

Dr Nir Shimony: Especially in surgery, we like new gadgets. So, we always like to have something new that will help us to do whatever we do nowadays in a better way. I think for me, the way the technology will change neurosurgery, it's showing us the stuff that we don't see currently. For example, in epilepsy, I want to be able not just to see a lesion that the MRI shows me, but also the actual network that is affected. Because sometimes I cannot approach the lesion, I cannot take it out. But I can definitely approach the network and interfere in the way that the epilepsy is progressing. That's one thing that, for example, I would like to see.

Host: Okay. Well, let's hope we get there. How does Le Bonheur's suite of technologies compare to other children's hospitals?

Dr Nir Shimony: I think that we are lucky because we have the full package, both from before surgery and in the surgery itself. We rely a lot upon technology such as MEG and TMS that help us to get a much better decision before we are going into surgery itself, which make us basically much more accurate in our decision targeting lesion that we want to treat.

In surgery, like we just discussed, the iMRI completely changed the way that we approach our surgeries and give us much better result when you have, for example, a center that does not have iMRI.

Host: So, final question for you. What other technologies are important in a successful surgery?

Dr Nir Shimony: So, the other technologies will be the actual tools that we use. We tend to use a variety of technologies besides the robotic system that you just heard about that would include very advanced microscopes that allow us to visualize much better the brain, or endoscope that allows us to go through a very tiny hole with a camera and see what is going on in the brain and then perform surgery through a tiny hole. This is something that we do here quite a bit. We use what we call a keyhole approach and we perform surgery at the depth of the brain through a very tiny opening.

But I will expand this answer to what I think that we have here at Le Bonheur, is the fact that it's not just the technologies, it's the people that use the technology. And we're lucky to have people with a lot of experience that know how to use those gadgets and technologies to the better of the patient.

Host: I want to give you a chance to add anything to our conversation that you might want to.

Dr Jim Wheless: I'd say from my standpoint, the biggest advantage with all the technology we've talked about is for referring physicians. It really makes it easy for them because it's kind of one stop shopping, if you will. They know if they send the patient, that based on that patient and their individual needs that will determine which testing is best to apply for them, that we have it all available so they don't have to think about that. And that because of the testing we have available, it also means their patient will have the best outcome that's possible. And I think for the referring docs at the end of the day, that's the critical thing.

Host: Sure. And Dr. Shimony, anything you'd like to add?

Dr Nir Shimony: I'm basically going to echo what Dr. Willis just said. I think that for whoever wants to come, either families or referring physicians, the idea that we have here besides the technologies, also a large staff with a lot of experience in the field of epilepsy and oncology allow us to give a different kind of experience to the families, to the patients, and eventually, what's more important, the results themselves.

Host: Well, Drs. Wheless and Shimony, thank you so much for talking to us today about these amazing innovations in neuroscience technology. It has been fascinating.

Dr Jim Wheless: Thanks for having us, Deborah. We appreciate it.

Dr Nir Shimony: Thank you very much.

Host: To learn more about Le Bonheur's Neuroscience Institute and the suite of technology available for the care of kids, visit lebonheur.org/neuroscience. This is the Peds Pod by Le Bonheur Children's Hospital. Please visit lebonheur.org for all your pediatric needs. I'm Deborah Howell. Thanks for listening and have yourself a great day.