Tiresias and the arrogance of skeptics, complainersn luddites and wetblankets

My friends,

Why, after all the advances the neuroimaging, surgery, chemotherapy and radiotherapy in the last half a century, the survival of malignant brain tumour has not improved at all. The prognosis is still dismal. Well, it is very simple. There has been no actual practical advance in neurosurgical excision of malignant brain tumour cells in the actual place where it matters, in the brain itself. You see my friends, contrary to what you led to believe, though it costs more, the current practice cancer brain surgery is not exactly rocket science. Though well remunerated for the doctors, it is dull, it's slow, it’s frustrating, thus far, does no good tall. The brain is a frustrating organ to operate in. It has the consistency and appearance of a pinkish porridge. Do anything to it and it bleeds. Not big gushing bleed, unless you hit a major vessel, but continuous pink ooze, obscuring what little view you have in the actual operating field. You can't press on it to staunch the bleeding. You don't have any landmarks of where the tumour is where the edge of it is. It doesn’t have an edge. There is no capsule. The tumour looks exactly like the rest of the brain. You know that if you go too far or do anything you might damage a vital structure and a patient will wake up from the anaesthetic much worse than they went in. And you know you are doing no good anyway, because the brain tumour cells are still there, far from where the MRI has shown the main bulk of the tumour. Then you take a piece; a biopsy. You send it off to the histopathologist for frozen section and wait half an hour or more, sit on your hands, cover the brain over, and wait. And wait. And surgeons are not known for sitting on their hands comfortably. And so you wait for an answer from the histopathologist as to what you just took a bite of. The pathologist looks at this bit of pink grey material on a microscope slide and tries to discern what in the world it might be. Most of the time they have no clue. Sometimes they'll see some malignant cells. The neurosurgeon does not want to hear that there's malignant cells because he wants to stop so at least they don’t inflict some real damage. Most of the time the pathologist will say; I'm not sure; can I have another piece. Neurosurgeon swears at him, sends another piece and waits for another half an hour, or swears and says he can’t give another piece, sucks the ooze, diathermies, and closes up. It's not surprising that there are cancer cells left over at the end of a 6 hour operation or whatever. The next day says to the patient, “I think we got it all”. They know they have never “got it all”. So, they administer radiotherapy and chemo, “just to make sure”. Three months later the tumour has “recurred''.

Well that's how it has been for the last 50 years. Now, at last, things are about to change. Zeiss is now instituting the Optiscan confocal endomicroscopy, which, even with the current widely used with present fluorescene stain shows actual cancer cells. There are also already new more highly sensitive and specific stains in development. The neurosurgeon, with the assistance armed with the endomicrosclope, with cellular level resolution, 1000 time better than the best MRI resolution, and with the aid of real time diagnostic artificial intelligence, and the histopathologist, looking in n a screen from his office, at the continuous, real time “digital biopsying”, will be able to see the cancer cells and will know when and where there are cancer cells, and deal with them appropriately. This is the new paradigm.

Naturally revolutions take time, and naturally there are luddites and naysayers. It will however displace the current standard of practice and will become the new standard. It has to. With improvements in AI and stains this will only expand and become much much better and hopefully for the first time since surgery for malignant brain tumour started, will actually produce an improvement in survival. But there is more! Tiresias would be surprised if the therapeutic potential of Optiscan’s laser endomicroscopy has escaped the notice of Optiscan’s optical engineers. You see that optical fibre of the endomicroscope, which now transmits a low energy light for imaging, can equally well transit a higher energy laser beam, which can destroy the labelled cancer cells. The increased the energy, becomes a very focal highly selective treatment.

And Tiresias considers neurosurgery only a very small part of Optiscans applicability.