“You Can’t Respect the Brain and Be a Neurosurgeon” and Other Tall Tales

[Daisy Gallardo]

In Meet-the-Expert webinar, “You can’t respect the brain and be a neurosurgeon” we joined Dr. Wael F. Asaad in a discussion about what it means to respect the brain and the development of less-invasive neurosurgery therapies. 

Dr. Asaad became fascinated by the brain, at a young age, due to his deep interest in computers. He leaned into the idea of computers being a model for understanding the brain. His passion led him to major in Neuroscience and English at Amherst College, then receive his PhD from MIT and complete medical school at Yale University. From there, he was drawn into neurosurgery and did his residency at the Massachusetts General Hospital. He is now a professor of neurosurgery and neuroscience, the Sydney A. Fox and Dorothea Doctors Fox Professor of ophthalmology and visual science, director of functional and epilepsy neurosurgery, and vice chair for research in neurosurgery at the Brown University Alpert Medical School & Rhode Island Hospital.

He differentiated “respect” for the brain as: respecting the structure versus respecting the function. In functional neurosurgery, respecting the function takes precedence over respecting the structure. Neurosurgeons have the ability of targeting more precise circuit-based interventions, compared to administering pharmacological agents that may target multiple sub-regions. While some procedures in functional neurosurgery are invasive, there are newer procedures that are becoming less invasive and more precise. The current methods are lesions, electrical stimulation and soon there will hopefully be ways to administer DREADDs, use stem cell therapy, use gene therapy and use optogenetics for clinical intervention. Specifically, one of the less-invasive and more precise methods is MRI-guided ablations where Dr. Asaad’s lab has used a machine learning algorithm to determine the optimal trajectory to ablate. Another method is responsive neurostimulation, as a treatment for  epilepsy. This is done by applying stimulation in order to regulate the seizure from getting more severe or spreading. As a treatment for OCD, deep brain stimulation (DBS) can be used. Although, lesions are often preferred since it’s a one-time procedure rather than sending the patients off with a DBS system that requires upkeep. Dr. Asaad’s lab has been investigating the use of DBS to stimulate the fornix as a treatment for dementia caused by Alzheimer’s disease. What was interesting about this work was that it led to an acute disruption of memory encoding, but the patients long-term performance became better. Dr. Asaad mentioned that this may be due to the chronic effects of stimulation that release other factors and change metabolism. 

Overall, Dr. Asaad has given us an in-depth description of how neurosurgery is shifting to precise methods of “fixing” the brain while aiming to maintain respect for its structure and function.