New Technique Slashes Diagnosis Time During Brain Surgery

Neurosurgeons want the quickest, most accurate information to help them make decisions during brain tumor surgery. A new method could accelerate that process.

11:00 AM

Author | Haley Otman


A new approach to the practice of surgical pathology for brain tumor patients could make for a powerful combination: more accurate, safer and more efficient operations.

MORE FROM THE LAB: Subscribe to our weekly newsletter

Neurosurgeons and pathologists at Michigan Medicine are the first to execute stimulated Raman histology (SRH), a method that improves speed and diagnostic efficiency, in an operating room. They detail the advance in a new Nature Biomedical Engineering paper.

The researchers imaged tissue from 101 neurosurgical patients using conventional methods and the new method. Both techniques produced accurate results, they found, but the new method was much faster.

SRH, if applied widely, could change the pace and structure of an operation.

"By achieving excellent image quality in fresh tissues, we're able to make a diagnosis during surgery," says first author Daniel A. Orringer, M.D., assistant professor of neurosurgery at the University of Michigan Medical School. "This eliminates the lengthy process of sending tissues out of the OR for processing and interpretation."

Today's workflow for determining a diagnosis during an operation requires the surgeon wait 30 to 40 minutes while tissue is sent to a pathology lab for processing, sectioning, staining, mounting and interpretation. The entire team in the operating room may be idle while waiting for pathology results, Orringer says.

Using SRH also would save money.

"Our technique may disrupt the intraoperative diagnosis process in a great way, reducing it from a 30-minute process to about three minutes," Orringer says. "Initially, we developed this technology as a means of helping surgeons detect microscopic tumor, but we found the technology was capable of much more than guiding surgery."

Near-perfect agreement

Stimulated Raman scattering microscopy, the technology behind SRH, was developed in 2008, but the hazardous lasers involved made it unsuitable for use in an operating room. A clinical version has now been developed and tested in the operating room for more than a year at U-M, with the fiber-laser-based microscope mounted onto a clinical cart that plugs into the wall.

SEE ALSO: Seeing Tumor Tissue Under a Better Microscope

To interpret the samples, researchers developed SRH, which creates images similar to those currently in use.

SRH uses virtual coloring to highlight the cellular and architectural features of brain tumors, with a result resembling traditional staining. The pathologist is then able to differentiate the tumor tissue from normal brain as usual.

"It's very similar to what we currently do in our intraoperative diagnosis, with the exception that the tissue is fresh, has not been processed or stained," says senior author Sandra Camelo-Piragua, M.D., assistant professor of pathology at U-M.

In the Nature Biomedical Engineering study, neuropathologists were given 30 specimen samples processed by SRH or traditional methods. They were told the same information about each patient's medical history and the location of the tumor and asked to make a diagnosis.

Those pathologists, the U-M researchers found, were equally likely to make a correct diagnosis, whether they used SRH or conventional slides.

"SRH imaging will ensure that appropriate and good-quality tissue is collected to reach our ultimate goal: accurate diagnosis," Camelo-Piragua says.

Artificial intelligence

As Orringer and his team improve this imaging technology, they're also teaching a computer how to use SRH images to make diagnoses.

The team built and validated a machine-learning process that was able to predict brain tumor subtype with 90 percent accuracy in a subset of 30 patient samples.

"The more we feed the computer, the more accurate its diagnoses will become," Orringer says.

Connecting hospitals

Using SRH might also improve the workflow for facilities without access to expert neuropathologists. Orringer notes that smaller hospitals may be able to partner with larger systems that do have access, since there are fewer than 800 board-certified neuropathologists but about 1,400 U.S. institutions performing brain surgery.

"Bringing the SRH to smaller hospitals would extend their capabilities, because the images can be interpreted remotely," he says. Sample preparation is minimal, and the SRH could quickly deliver virtual histologic sections to aid diagnosis remotely.

The next step is a large-scale clinical trial, with a goal of showing equivalence between conventional methods and the SRH technique for making diagnoses, Orringer says. The prototype system is intended for research use only.

Disclosure: Daniel A. Orringer, M.D., and co-author X. Sunney Xie, Ph.D., are advisers and shareholders of Invenio Imaging Inc., a company developing stimulated Raman scattering microscopy systems. Co-author Christian W. Freudiger, Ph.D., is an employee and shareholder of Invenio Imaging, Inc.

The University of Michigan, Harvard University and Invenio Imaging have intellectual property used in this research.

More Articles About: Health Tech Emerging Technologies Neurosurgery & Neurological Procedures
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories person in white coat at laptop green fruit in hand
Health Lab
Both virtual and in-person nutrition visits help to lower cholesterol
The use of telehealth remains high, with over 20% of American adults taking appointments online. These visits include video calls with registered dietitian nutritionists, who have a critical role in helping patients take on lifestyle changes through medical nutrition therapy. With a focus on the changing digital landscape, researchers at Michigan Medicine found that telemedicine patients with hyperlipidemia — an excess of cholesterol or fats in the blood — experienced similar positive health benefits compared to those who had in-person visits.
smart watch on wrist
Health Lab
Clinical smart watch finds success at identifying atrial fibrillation
A Michigan Medicine research team developed a prescription wristwatch that continuously monitors the wearer’s heart rhythm and uses a unique algorithm to detect atrial fibrillation. The clinical-grade device, called the Verily Study Watch, proved very accurate at identifying atrial fibrillation in participants.
expert at stand hearing in suit
Health Lab
Keep telehealth alive and well, experts tell Senate subcommittee
Telehealth coverage by Medicare is scheduled to expire at the end of 2024; experts told Senators what they think should happen to preserve it.
man in scrubs sitting with scrub cap with headset on in clinical setting
Health Lab
Medical students use virtual reality to improve diabetes
A physician invents a creative approach for medical students in diabetic care.
two scientists next to eachother smiling at camera white coats
Health Lab
Free online tool expands anatomical science to the world
The tool, which is free to use, includes photography, videography and virtual reality learning resources from anatomical donors, along with comprehensive lab manuals and interactive files with click-to-reveal testing capabilities.
Health Lab
Tumor-destroying soundwaves receive FDA approval for liver treatment in humans
Michigan Medicine has developed a new technique that provides a non-invasive alternative to surgery, chemotherapy and radiation treatments for cancer.