A major challenge in neuro-oncological surgery is the intraoperative identification of fiber tracts and the differentiation between tumorous and healthy tissue. In search of an innovative approach to overcome this challenge, neurosurgeons at Inselspital launched the HORAO project.
It started with a crowdfunding challenge to generate financial resources and a subsequent crowdsourcing challenge which resulted in a research collaboration with the winning research team from Ecole Polytechnique in Paris in 2019. In 2021, the HORAO research project won a 4-year Sinergia grant for groundbreaking projects from the Swiss National Science Foundation (SNSF).
After a promising initial series of near-in-vivo measurements in 2021 at the Department of Neurosurgery of the University of Bern, the HORAO research team has grown and continues with enhanced expertise, now re-enforced with a machine-learning sub-group.
Project leader: Prof. Dr. Philippe Schucht, MD
Project manager: David Hasler
Mapping and Modeling of Deep Brain Stimulation
Deep brain stimulation (DBS) treats movement disorders such as Parkinson's disease. It is a surgical procedure on the brain: electrodes are precisely implanted in the deep brain, where they then deliver electrical impulses to specific brain structures. To reduce side effects and improve treatment, segmented electrodes were developed a few years ago. These enable a more targeted stimulation of the brain structures and more possibilities to program the stimulation. However, this brings the previous manual programming to its limits and requires several hours of consultations..
The main goal is to develop and clinically evaluate computer-assisted programming. We expect that this new DBS programming will show similar improvements in the patients' motor skills as the previous manual programming, but will require significantly less time and thus be beneficial for the patient, the doctor and the health care system.
|Dr. sc. Thuy Anh Khoa Nguyen ETH
Information = relevance
The "Peers for Peers" platform was founded by medical professionals to help doctors and researchers find the really important articles from the plethora of current publications – new findings that could already flow into the treatment of patients, but are usually found only later in textbooks. Peers for Peers offers the easiest and fastest route to new therapies in neurosurgery. The platform starts as an initiative of the European Association of Neurosurgical Societies (EANS) initially in the vascular area.
Project leader: Prof. Dr. Andreas Raabe, MD
Project coordinators: Luisa Tonarelli
Support Peers for Peers
The DNA for knowledge in the digital age
Making the right diagnosis and choosing the best therapy requires extensive medical knowledge. Doctors must therefore be lifelong learners. In our new information age, books and journals are more and more being replaced by digital documents and presentations, which are available millions of times with different contents and in different qualities at the push of a button. However, hit lists on the internet do not yet mean knowledge in the minds. And it is precisely at this point that doctors are left to their own devices. With our software project "Elumity" we are creating a system that helps users to build up personal knowledge permanently. It starts where a knowledge source has been identified as personally valuable. "Elumity" contains new tools for interacting with digital documents to extract the essential information – the pearls of knowledge – and link them to existing knowledge. It also provides an innovative learning system and organizes collected documents into priority levels to keep a clear view of what is important. Our project "Elumity" offers a solution for exactly what more than 300 international doctors defined as a problem in a survey.
Project leader: Prof. Dr. Andreas Raabe, MD
The effect of increasing transcranial electric stimulation current or pulse duration on intraoperative patient movement and motor evoked potential amplitude
In this study, a medical product, the IOM device (IOM = intraoperative neuromonitoring) is used, which is certified for this use and has been used successfully for several years. In the study, we compare the effects of different stimulation parameters. Specifically, different combinations of current strength and pulse duration are tested to find out which of them causes the patient to move minimally and thus affects the surgeon the least. During an operation on the brain, it is important to act with millimeter precision and thus any unnecessary movement of the patient should be avoided.
Confocal laser endomycroscopy for brain tumors
The aim of the study is to enable tissue diagnosis without tissue removal.
A "photo" of a patient's brain tissue is created with the CONVIVO® system. CONVIVO® can zoom in down to the cellular level of the brain. The aim is to be able to distinguish healthy tissue from tumor tissue.
Restrictive use of dexamethasone in glioblastoma
This study investigates whether neurosurgical treatment of brain tumors in certain patients can be performed without the additional administration of dexamethasone (cortisone), or only with a minimal dose of dexamethasone.
Randomized Controlled Comparative Phase II Trial on Surgery for Glioblastoma Recurrence
To date, there are two established strategies for treating a recurrent brain tumor:
- Re-surgery of the brain tumor followed by second-line therapy (chemotherapy or radiotherapy).
- Immediate second-line therapy (chemotherapy or radiotherapy) without prior surgery.
Which of the two treatment strategies has the greater success has not yet been clarified. The aim of this study is to investigate exactly this. It is to be clarified which of the two treatment strategies has the greater success.
Comparison between transcranial and direct cortical stimulation of motor evoked potentials during the resection of supratentorial brain tumors in terms of prognostic accuracy for postoperative motor deficits
During operations on tumors within the skull, which are located in an area of the brain which, among other things, controls the movement of certain parts of the body (hand, arm, leg or foot), it is necessary to monitor the movement functions during the operation in order to remove the tumor as much as possible without impairing the movement function.
The aim of this study is to compare two methods of motor function monitoring: transcranial stimulation and direct cortical stimulation. The transcranial stimulation is carried out by electrodes that are fixed at certain points on the scalp. The direct cortical stimulation is carried out by strip electrodes, which are pushed under the meninges after opening the skull and come to rest directly on the brain surface.
Suprafascial vancomycin powder for prevention of surgical site infections after instrumented posterior spinal fusion: A randomized controlled phase-II trial
We want to investigate whether the antibiotic vancomycin in its powder form, which is given into the superficial wound at the end of the operation, reduces the rate of surgical wound infections in open, instrumented (with a screw-rod system) surgery on the spine with posterior access. In addition, the safety and tolerability of this method should also be examined.
Vancomycin is an antibiotic that inhibits cell wall formation in susceptible bacteria. The drug has been used routinely worldwide for decades for the prophylaxis and therapy of certain bacterial infections. However, there is no official recommendation anywhere in the world, including Switzerland, for the use of the (undissolved) powder form for infection prophylaxis ("off-label" application).
Swiss Trial of Decompressive Craniectomy versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage: A Randomized Controlled Trial.
Spontaneous cerebral hemorrhage is one of the most severe forms of stroke and affects over 2 million people worldwide each year. Approximately 1/3 to 1/2 of these patients die shortly thereafter and most of the survivors suffer severe neurological deficits with long-term disability. To date, other than ICU care, there are no options for helping these patients.
With this study, we would like to investigate whether the removal of parts of the skull bone (relieving craniectomy) is able to reduce the mortality and the degree of disability of these patients compared to the best possible medical treatment. The goal of this study is to be able to offer patients with cerebral hemorrhage a treatment in the future that can reduce both mortality and the degree of disability.
The neurological deficits in a cerebral hemorrhage are caused on the one hand by the hemorrhage and on the other hand by the secondary swelling of the brain. Removal of parts of the skull bone is a standard surgical procedure that is successfully used in patients with brain swelling after severe deficiency of blood supply to the brain, after brain injuries caused by an accident, but also in certain brain inflammations. To date, no study that randomly divided patients into 2 groups has investigated the efficacy of removing the skull bone in cerebral hemorrhage.
Thalamic-Burst-DBS for Neuropathic Pain
About 1-10% of all stroke patients subsequently develop a chronic neuropathic pain syndrome, which can often only be inadequately treated with conventional therapies and medications. In these cases, there are alternative treatment methods such as deep brain stimulation (DBS). In this procedure, electrodes are implanted in specific anatomical structures of the brain to deliver therapeutic electrical pulses. Despite an initially good response to this therapy, many patients unfortunately experience a return of pain to baseline levels.
In our research project, we now want to find out whether a new form of stimulation, known as burst stimulation, works well or equally well or better in patients with deep brain stimulation in the area of the thalamus.