JRSBRT 9.3, p. 189-198

Development of non-invasive genetic surgery
Antonio A.F. De Salles

While in my second year of neurosurgery training, operating on a woman in her fifties, a senior attending neurosurgeon I was helping told me: “The neurosurgeon must have an eye in his finger.” He proceeded to dissect the meningioma bluntly with his index finger through the large craniotomy, removed a parasagittal meningioma in minutes, and left the operating room, saying that, in my stage of training, I should already be able to complete the hemostasis in that bleeding tumor bed and close the patient. To my dismay, he left me there, struggling with the non-stopping bleeding. Terrified and working, I told the anesthesiologist: “I will need help here.” He went to the neighboring operating room and asked for help. A young attending came and took me out of my agony. Sadly, the patient woke up with a foot drop a terrible deficit, and the unfortunate woman had to wear a brace propping her foot for the rest of her life! After this experience, I realized I had to find a better way of dealing with a tumor ingrained in the delicate brain!

Living in Goiânia, the capital of the state of Goiás, Brazil, and training at a specialized neurosurgery hospital (Instituto de Neurologia de Goiânia), I had access to an excellent neurosurgery library, where I found an article describing the treatment of tumors with Proton Beam¹. I worked through the books to forge the opportunity to learn that promising noninvasive technique^2,3. I applied for graduate school to learn biophysics at the Medical College of Virginia (MCV), where I became acquainted with radiation safety by managing radioactive ¹³³Xe used to study the cerebral blood flow (CBF) of patients with severe head trauma 4. It was at that time, watching the news in 1987, that I learned of the ¹³⁷Ce accident in Goiania, my hometown, where over 200 people died from radiation exposure. It happened across the street from my childhood home at an abandoned public hospital. The event was so traumatic, as children were playing with the radioactive source, that a movie was made from the ordeal.

I also had my radioactive accident with ¹³³Xe when the bag I was using to collect the expired gas from an unconscious patient submitted to CBF measurements exploded, spilling the radioactive gas in the ICU. Fortunately, ¹³³Xe, a heavy gas set over the floor was easily aspirated with a vacuum cleaner brought by the radiation safety officer, without harm to the patients or health professionals. These lessons advised me of the power of radioactivity, enticing me to harness and fine-tune it for treating challenging diseases, as I had experienced with the blunt removal of meningioma.

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