Like any great performer, Department Head Clark C. Chen, MD, PhD, knows how important it is to rehearse. When the opportunity arose to treat Oakdale, MN, resident, Kathleen Weichman, rehearsal became a critical part of creating a precise path for him to follow and helping her understand the procedure she would undergo.

Kathleen (pictured above with the family dog, Gracie) was diagnosed with Paget’s disease when she was 21. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Paget’s disease is a chronic disorder that causes bones to grow larger and become weaker than normal. The disease usually affects just one or a few bones, most commonly the pelvis, skull, spine, and leg bones (femur and tibia). What brought Kathleen into Chen’s care was a Paget’s related problem on the right side of her skull.

Images revealed mass
“I was clearing out the garden in November of last year and thought I got stung on my head by a bee,” said Kathleen. Having had a lung transplant at the U of M due to idiopathic pulmonary fibrosis, which could complicate any reactions from a bee sting, Kathleen knew she needed to seek medical help. After a CT scan revealed that instead of a bee sting, there was a large mass growing in that area of her skull, Kathleen was referred to Chen. To help her avoid traveling to and from appointments, they connected via telehealth.

“Based on different imaging modalities, I worried that it was a tumor growing on the skull,” said Chen. “Her Paget’s disease made that area of her skull two to three times thicker. And because her skull is different from everyone else’s, I needed to know exactly what to expect during surgery and rehearse my procedure beforehand. Virtual reality technology gives me a way to do that.”

3D image of Kathleen's skull

Chen used Surgical Theater, a 3D virtual reality technology that he showcased during the 2022 Minnesota State Fair. “It helped me understand how to plan my surgery and how to customize a piece of synthetic cranium, which was then 3D printed,” he said. “We planned how much of the skull to remove to enable us to take the entire tumor and to understand how thick the skull was in that area.” (The image shows one of the views of Kathleen's skull captured by Surgical Theater. The red area was the portion that needed to be removed/replaced. The whitish area near the center of the red indicates the bone tumor.)

Surgery preview
Kathleen was shown the 3D video preview of her surgery during a telehealth appointment. “It was marvelous,” she said. “Dr. Chen showed me where he would remove the skull, the patch he would use to replace it, and exactly how he would do it. I knew what would happen, which made me very calm.”

Chen could see that the technical preview he provided Kathleen took away a lot of her fear and anxiety. “She knew that we were well prepared,” he said. “Often, surgeons, including myself, speak in abstract terms with our patients about their procedures. This type of video preview enables us to show our patients exactly what will happen during their surgery. Seeing that the surgery is well planned and individually tailored for them brings a lot of comfort to our patients and their loved ones.”

Better surgery
The rehearsal also helped Chen and his surgical team achieve a better surgery. When he got close to the dura – the brain’s covering – Chen already had a sense of where he was thanks to the video rehearsal. “Nearing that depth, I slowed down,” he said. “In Paget’s disease, the bone is bloodier than normal bone tissue. It requires taking extra time to ensure we control the bleeding, especially as we get close to the dura.”

Because Kathleen was a transplant patient, one key precaution that was taken for her was to specially type antibodies in any blood she might have needed so the transfusion wouldn’t attack her body. Thanks to the preparation of her surgical team, however, a transfusion wasn’t required.

Recovered as expected
After the procedure on December 21, 2022, Kathleen noted that her recovery went exactly the way her care team had explained it would. “Right after the surgery, I discovered I couldn’t be bounced around,” she said. “I was in my daughter’s car during the holidays, and we hit a couple of potholes. It made me nauseous, and I arrived for Christmas throwing up.” The recovery wasn’t as painful as she expected, however, and Kathleen only had to take painkillers a few times. She feels that everything is now back to normal.

Chen believes that having access to tools such as Surgical Theater addresses a gap in healthcare. “In general, we have limited technologies that address the anxiety patients feel prior to surgery; using Surgical Theater helps us address this gap,” said Chen. “The technology also allows surgeons to better rehearse procedures in advance, achieve better outcomes, and better educate the next generation of surgeons and physicians. The Department of Neurosurgery will continue to advance these technologies to better serve our core mission of clinical service, medical education, and innovative research.”