Over The Edge

Bringing High-Tech Solutions to Neurosurgery with Dr. Lawton, President and CEO of Barrow Neurological Institute

Episode Summary

How is technology shaping the future of neurosurgery? In this episode, Bill sits down with Dr. Lawton, President and CEO of Barrow Neurological Institute. Dr. Lawton discusses how he is bringing new technologies and innovation to neurosurgery, as well as how it could improve patient outcomes and broaden the field’s scope of impact.

Episode Notes

How is technology shaping the future of neurosurgery? In this episode, Bill sits down with Dr. Lawton, President and CEO of Barrow Neurological Institute, Robert F. Spetzler Endowed Chair for Neurosciences, and Chair of the Department of Neurosurgery. Dr. Lawton discusses the ways he is bringing new technologies and innovation to neurosurgery, as well as how it could improve patients outcomes and broaden the field’s scope of impact.

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Key Quotes:

“If we're able to have these huge datasets where we can take all the brain tumor patients and then go back 10 years before they were ever diagnosed and see what was abnormal then, it might open up these ways to predict or diagnose or even prevent some of these diseases before they get started.” 

“It's a technological revolution that has all of a sudden allowed us to envision things in neurosurgery that incorporate this tech in ways that we never had 20 years ago… I think probably the best example of that is the brain computer interface. There's the perfect example  of how technology and engineering brought into neurosurgery is going to change the world.”

“Instead of taking just six variables, we can take a hundred variables and we can feed them into the black box of AI, and we can look at way more than just those six. And maybe our decision making will be better. Maybe our predictive powers will be different.”

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Timestamps: 

(02:26) Integrating technology in neurosurgery

(06:37) Brain-Computer Interfaces 

(09:56) Expanding neurosurgical training

(19:09) AI in neurosurgery: Diagnostics and beyond

(29:16) Mysteries of the Mind and understanding the mind

(34:35) Future of neurosurgery in emotional and cognitive interventions

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Sponsor:

Edge solutions are unlocking data-driven insights for leading organizations. With Dell Technologies, you can capitalize on your edge by leveraging the broadest portfolio of purpose-built edge hardware, software and services. Leverage AI where you need it; simplify your edge; and protect your edge to generate competitive advantage within your industry. Capitalize on your edge today with Dell Technologies.

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Credits:

Over the Edge is hosted by Bill Pfeifer, and was created by Matt Trifiro and Ian Faison. Executive producers are Matt Trifiro, Ian Faison, Jon Libbey and Kyle Rusca. The show producer is Erin Stenhouse. The audio engineer is Brian Thomas. Additional production support from Elisabeth Plutko.

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Links:

Watch Dr. Lawton share his vision for how AI and edge solutions can be used to transform neurosurgery

Follow Dr. Lawton on X and Instagram

Learn more about Barrow Neurological Institute and neurosurgery

Get to know Barrow President and CEO Michael T. Lawton, MD

Discover more about Barrow Neurological Institute's newest research quest to solve the mysteries of the mind

Watch Dr. Lawton operate in this collection of neurosurgical operative videos

Find out what it's like to be a neurosurgeon by watching three seasons of Barrow Neurosurgery Base Camp

Follow Barrow Neurological Institute on YouTube, Instagram, LinkedIn, X and Facebook

Follow Bill on LinkedIn

Episode Transcription

Producer: [00:00:00] Hello and welcome to Over the Edge. This episode features an interview between Bill Pfeiffer and Dr. Lawton, the president and CEO of Barrow Neurological Institute. Dr. Lawton has completed thousands of brain surgeries, he's removed over 5, 000 aneurysms, he's operated on over 1, 200 arteriovenous malformations and over 1, 200 cavernous malformations, he's completed over 800 bypasses, and he's been published in 900 publications.

Over the Edge In this episode, Dr. Lawton discusses the ways he's bringing new technologies and innovations to neurosurgery, as well as how this could improve outcomes for patients and broaden the field scope of impact. But before we get into it, here's a brief word from our sponsor.

Ad read: Edge solutions are unlocking data driven insights for leading organizations.

With Dell technologies, you can capitalize on your edge by leveraging the broadest portfolio of purpose built edge hardware, software, and services. Leverage AI where you [00:01:00] need it. Simplify your edge and protect your edge to generate competitive advantage within your industry. Capitalize on your edge today with Dell Technologies.

Producer: And now please enjoy this interview between Bill Pfeiffer and Dr. Lawton, President and CEO of Barrow Neurological Institute.

Bill: Dr. Lawton, thanks so much for joining us today. This will be a slight departure from our regular sort of series going on here, because in addition to being a technologist, you're a practicing neurosurgeon, which is going to be a lot of fun.

So our standard intro question, just to kind of get The person behind the story is how did you come to be in technology, but you're not exactly in technology. So let's start with what brought you to neurosurgery and how did you get so involved in the technology side of it?

Dr. Lawton: So when I was in college, I was a biomedical engineer.

I was at Brown University. Brown at the time was noted for artificial organs. And so this was back in the 80s [00:02:00] when the Jarvik 7 artificial heart was on the front page of Time Magazine and William DeVries was implanting this device in the first patients. And so I really got excited about the combination of engineering and medicine.

And I saw myself as wanting to go into cardiac surgery and do exactly that. I was interested in engineering because I thought it would be a great segue to whatever came next in life. And I just sort of found this medical application and I was off to the races.

Bill: Very cool. So you were thinking about cardiac, but then you ended up in neuro.

What made that jump?

Dr. Lawton: Yeah, so that's serendipity in action. So as life always has it, you just have curveballs. I, I knocked on the door of William Reitz. He was the chair of cardiac surgery at Johns Hopkins where I was in medical school. And I thought, surely, you know, I I'll volunteer myself for the summer and get a great project in cardiac surgery and this will sort of set my career path.

And he said, thank you very [00:03:00] much, but we're full. We can't accommodate you. So I was very dejected and down spirited. I picked up the Johns Hopkins magazine and there on the cover was an article about spinal cord stimulation for patients with pain. So I looked at the characters in the story, I knocked on their doors and they said yes.

So that's what swayed me from cardiac to neuro.

Bill: Wow. And a star was born.

Dr. Lawton: Serendipity.

Bill: Yeah, I love it. I love it. So adding the tech into the neurosurgery, you're, you're focused on helping patients. That's why you go into medical practice in general, of course, but can you talk about how you're applying technology and local computing to improve The field of neurosurgery and how that changes the outcomes for your patients.

Dr. Lawton: Yeah. So when I continued my journey into neurosurgery, I actually found that it was not really a very techie sort of craft. It was more like this art form and it was [00:04:00] an artisan craft where. The, the people that were inspiring me that I was seeing do the best work were actually these amazing virtuosos and what differentiated them was how good they were with their hands.

And I kind of got veered away from tech because I just saw that this was a manual craft that the really cool things that were happening in the operating room were sewing blood vessels together or clipping giant aneurysms or. Tackling these monstrous malformations of blood vessels. That was very low tech.

There's some tech. We have these high powered microscopes that allow us to magnify the surgical field by about tenfold, to bring in intense light into these dark corners of the cranium. And that's very technological. But the crux of these procedures were very craftsy or manual. And, and then I, I really got sort of pulled in that direction and I became focused on making [00:05:00] myself the best manual technician, developing my dexterity, practicing my bypass skills, learning anatomy so that I could navigate through these corridors to these dark corners, all of that stuff that was really not so techie.

So That took me down this path for another, probably two decades. And in the meantime, I think there's been this technological revolution that has all of a sudden allowed us to envision things. in neurosurgery that incorporate this tech in ways that we never had 20 years ago. And that's where we are today.

Like I think probably the best example of that is brain computer interface. You know, there, there's the perfect example of how technology and engineering brought into neurosurgery is going to change the world. And the neurosurgery that we practice today by clipping aneurysms, doing bypasses, resecting brain tumors, it's going to be expanded dramatically by all of these new frontiers where we [00:06:00] put in technology, brain computer interfaces that allow us to impact other diseases that today we don't even treat as neurosurgeons.

So my view is that our day has finally come. I had to wait a long time for it to get here, and I took a little detour along the way. But now I see them as coming together finally, so that we can really make some progress.

Bill: I love the connection to the biomedical engineering, and it's an interesting point.

I mean, the brain seems like such a nuanced, unforgiving place to be, that not using all the technology available is a little scary, a little bit scary. You mentioned brain computer interface a couple times. Can you talk a little bit about what that is?

Dr. Lawton: Yeah, so brain computer interface is basically taking technology And connecting it directly to brain tissue.

So the best use case that now people are quite familiar with, it would be the analogy to my Jarvik 7 case when I was back in college. This [00:07:00] is, you know, the Nolan Arbaugh's of the world, the first patient who got the Neuralink device here at the Barrow Neurological Institute. You know, this is a device where a thousand electrodes got implanted by a robot into his hand motor cortex.

And just by this patient thinking about how he wants to move his hand, which is paralyzed by the way from an accident that broke his neck and transected his spinal cord. Just by thinking those thoughts, he can then control a cursor in ways that allow him to regain his autonomy. But now, with a brain computer interface device, the simple thought of how they would want to move a joystick or a mouse, Allows them to surf the net.

They're just endless expansions of what those debilitated patients can now do with those kinds of devices. And it's really getting technology to interface directly with the neurons, so that those signals that the brain normally produces in all of us to do what we do that makes us human, gets [00:08:00] harvested, sent out to a computer, decoded, and then translated to a computer, so that it can do what the person wants it to do.

Bill: Wow. And that's really mixing the science with the art form. And fortunately you spent a while developing skills in the art form and you have a history with the science. So you can blend the two. That's pretty amazing. Definitely gives your patients some, some different outcomes that probably weren't even possible a couple of years ago.

Dr. Lawton: For sure. And as we get better as neurosurgeons and neuroscientists, we'll understand the circuitry better. The hand motor cortex literally is a tiny little knob. We call it the hand knob because it's, it's one little lobule of all of the hundreds of gyrations and infolds of the brain. That's just one of them.

And if we, if we have the ability to understand all of them or just a larger percentage of those, then that unlocks potential to do all kinds of things. The more we, we can unravel that [00:09:00] circuitry of the brain. The more possibility we have. And then, you know, as we go deeper into the brain and we start to get to things like behaviors and motivations and feelings, we can start treating all kinds of psychiatric disorders like people with depression, people with drug abuse, people with post traumatic stress, and on and on.

And this is where I think neurosurgery gets really interesting. It goes from taking out brain tumors to truly impacting the way we live as human beings.

Bill: Kind of an aside, but that, that connects to a couple folks that I've talked to relatively recently about artificial intelligence and, you know, the next revolution in artificial intelligence is likely going to be, Driven by better understanding of how our brains work, you know, what makes us curious, but you know, understanding the brain better is likely to have massive implications.

You've also been talking about expanding [00:10:00] access to neurosurgical training to more surgeons, to other hospitals, to other parts of the world. Maybe to places where you otherwise wouldn't be able to get this level of training. Can you talk some about what you're doing in that space or what you envision?

Dr. Lawton: Yes. It's a real passion project of, of mine and of ours here at Barrow. You know, what we do in neurosurgery is very complex. It takes seven years after medical school, which by the way, It requires four years of college and four years of medical school, and then you get to your seven years of training.

And it's incredibly complex to learn the intricacies of the brain, the, the, all the various techniques that are required to do these various operations for the different diseases that we see in patients. So it's, it's a really challenging area and in and of itself, that's a big mountain to climb. But then we're facing issues now where there's sometimes not enough.

Patients out there for us to really gain the expertise that we need to be really [00:11:00] good. I mean when patients come into a hospital, they want their surgeon to be flawless. They want perfect outcomes and to get a surgeon to that level requires a lot of cases, a lot of experience. And, you know, what we're seeing now on the surgical side of things is that a lot of the cases that we used to do, at least in my specialty in vascular neurosurgery, where we would operate on brain aneurysms, that's being diluted by alternative technologies like endovascular coils and stents and devices that we call flow diverters.

These are placed with catheters inside the arteries. So what happens is that there's less cases for the surgeons to learn on. And yet The cases that they're seeing are ever increasingly complicated because we're getting the cases where the simple treatments with the catheters fail. So you run into this conundrum where the surgeons have to be even better and they have fewer and fewer cases to train on.

And so you've got this unrealistic expectation that can't be met. So this is the problem. And our [00:12:00] solution is that, well, maybe we can. Maybe we can do for surgery what has been done for pilots in that, you know, pilots have simulation systems that allow them to log hours on a computer and develop those reflexes and develop those skills.

Surgery is not just pure cognition. It's not just, you know, thinking your way through a case. It's the combination of manual dexterity, cognitive ability, and then all sorts of other things that are more emotional as you go through that frustration and fear and all this other stuff. And so we need a better training environment that is digitally based.

And that's really where This comes in like we, my belief is that we can create a surgical, an artificial surgical environment where surgeons can immerse themselves in and they can develop all the components of good surgical skill, the cognitive, the technical, the manual. All in that environment. And we'll do that through AI, through the combination and the integration of surgical video, [00:13:00] of radiomics, which is all the imaging that allows us to visualize the brain in, for example, MRI, CT scan, angiography.

And it'll also bring in tracking of the instruments, how the surgeon is not just seeing the field, but moving his or her hands and holding instruments. All of these different elements are, in my view, can be integrated to build this digital environment that becomes like a training workshop. And that doesn't exist right now.

It requires the same kind of vision that Elon Musk had with Tesla, you know, by putting cameras on millions of Tesla automobiles on the roads and gathering visual data. That becomes the grist for enhancing these algorithms that drive the cars. And I think the same is true in our world. We can tap all of this digital data that comes from the cameras, from the, the radiomics, from tracking surgeon movements and integrating that so that we can self drive, if you will.

We can show the budding surgeon. Next [00:14:00] moves, better strategies, different ways to hold the instruments, different ways to attack a particular pathology. This can all be, I think, built out through big data. You know, if all of my cases get entered into this, the AI engine. In the same way that the entire internet gets absorbed into chat GPT, then, you know, we have, I think, the, the grist to create the surgical digital training ground.

Bill: That's, wow. I, my dad was a trauma surgeon and we had talked about how he became one and he was talking about his fellowship and it was, you know, 20 hours a day in a hospital because you have to be there. When that, that one in a hundred, one in a thousand case comes in, if you're not there, you don't get to see it.

You don't get to learn on it. And it sounds like the challenge that, that you're seeing now is the opposite, that you don't get those easy cases. You don't get the training wheels. You don't get the basics. You get the one in a thousand cases. And they say, Hey, here's this super challenging thing. Go. And [00:15:00] wow.

Dr. Lawton: Well, we like your father, my residency, we used to do 120 hour work weeks. I would literally go into the hospital on Friday mornings, we would have a call structure where I wouldn't leave the hospital until Monday night, I would take the entire weekend and that would allow me to get my next weekend free so that I could have a, have a weekend to myself.

But you would pay these incredible prices to, to gain a little piece of freedom down the road. And, and that's how I think the training was built then. Now we've gone from 120 hours to a maximum of 80. So there's been a dramatic reduction in the work hours. So not only are there less cases, there are less hours that surgeons spend in the training process.

It's a lot more gentle. It's probably better. Honestly, you know, we were maybe beaten a little bit back in the day by that kind of training regimen. Yeah, it's a lot healthier now. So it's, I'm not knocking it. It's good. But it's less. And so it just makes it harder for the newer generations of surgeons to reach that [00:16:00] same level that the people that train them had reached.

Bill: Sure. But then if you can start to build really good simulations and you can home in on exactly what skills they're great at, what skills they're not great at, and then beat those skills until they're all great, that would be, that would be amazing. And a lot more. dependable than, well, you just didn't see that kind of case before.

Dr. Lawton: Yeah. I mean, today, today we have digital videos that are so plentiful. In fact, I've created an archive of probably close to 500 surgical videos. I, I post two videos a week. They're on Twitter. They're on Instagram. And so people who follow me get a regular diet of really complicated cases that I do week after week.

That didn't exist. Like when I was in my training, surgical videos were impossible to get to. A surgeon might put them on a VCR cassette and they might show them in a meeting, but they weren't accessible to the student, the residents who were trying to learn. So [00:17:00] you just didn't get that grist. And so to learn you would have to go to journal articles and look at pictures or look at illustrators renditions of a surgical case.

And so, so we've, we've created things digitally now that are really so invaluable. And I think that does help this generation immeasurably. They can climb that learning curve by watching videos. They can see so much in a video, how a surgeon handles the tissue, how they respond to a ruptured aneurysm under duress.

How they place the suture to sew a bypass together. I mean, there's so much benefit in that. And, and that's why we've invested in that. We've made that a priority to produce that content. I think that what we've been talking about in this AI space. It just takes that to another level. And so like when, when we finally achieve this, that next iteration of a digital training tool will be even better for these younger neurosurgeons.

Bill: Yeah, that's, that's fantastic. And I would, I would imagine they'd still need a lot of training just to be able to understand what they're [00:18:00] seeing and, you know, understand where the pressure is.

Dr. Lawton: Training is no shorter today than it was. Yeah, in terms of years, it's still seven years and yeah, they still need all of it.

Bill: Yeah, for good reasons. Brains have not gotten simpler, but, but they certainly have access to much more amazing stuff than ever before. Yeah. You don't have to be in exactly the right place at exactly the right time to see a thing. You can, Catch it after the fact on replay, which is pretty incredible. So the tech advances that you're working on now, I would imagine could apply to a number of other medical disciplines as well as neurosurgery.

What do you imagine Will come of it. Do you see this applying to, for instance, cardiac surgery and other disciplines, or is this very specific to neurological?

Dr. Lawton: Yeah, I'll answer that in two ways. The first is that, yes, what we develop in neurosurgery, I think, could be applied to any, Other surgical subspecialty.

And one of the [00:19:00] things I've always liked about neurosurgery is that it's sort of at the top of the pyramid in terms of complexity and technology.

Bill: And also the body. Yeah.

Dr. Lawton: Yeah. We're just a lot more technologically, uh, up there when you compare us to, let's say, plastic surgery or some of these other things.

So whatever we can develop in our field, I think can infiltrate all of surgical specialty. So I think our challenges are a bit daunting, but if we can solve them. In our sphere, then they will be applicable quite broadly. Now, the second answer is that AI is not just about bringing this technology into the operating room.

I think it will apply in. A lot of different areas, specifically the diagnostic fields, it'll apply to surgical decision making fields, and it also applied to the electronic medical record or the tools that we use to record our, our work. So, you know, for, for diagnostics and decision making, I'll give you an example.

For a vascular malformation, which is a [00:20:00] abnormality of the blood vessels in the brain, what we've spent a lot of time doing is to. Take that complex decision on how to manage that particular malformation and reducing it down to a fixed number of variables. Like my mentor, Dr. Spetzler, came up with three variables, the size of the malformation, how deep it was, and whether it was in brain that was eloquent or not.

And those three variables are the foundation of how we grade an AVM, you know, we, like a tumor that's graded from one to four, from more benign to more malignant, we can grade an AVM from one to five and one is easy and five is really hard. And that's just based on three variables. I have my own grading system that I added on to the Spetzler grading system that has three more variables.

So we're up to six. And mine has to do with the patient's age, whether the AVM ruptured and whether the tangle of vessels is tightly compacted or whether it's sort of pulled apart. But the idea is that, you know, you take a complex [00:21:00] decision and you reduce it down so that it's very simple so that everybody gets the right decision.

But what AI has done is it's flipped everything, and it's basically telling us we don't have to be reductionist anymore. We can be expansile in how we think about these decisions. We can, instead of taking just six variables, we can take a hundred variables, and we can feed them into the black box of AI, and we can look at way more than just those six, and maybe our decision making will be better.

Maybe, Our predictive powers will be different. That's the idea of AI and what's, what excites me is that we can just really change the course of everything we've been doing for the last 30 years and, and turn it in the other direction and say, how, how good can we get at creating that crystal wall that predicts outcome, that predicts patient medical course over time, et cetera.

So that's one on the diagnostic side. On just the EMR side, you know, we, we spend a lot of time in medicine doing tasks that are. Really mundane. You know, [00:22:00] for example, doing a discharge summary becomes very important for how we get compensated for the work we've done. It's like, you know, your bill at the end of the meal, it has all the things that you ordered and it has the price and you know exactly what to pay or in our case, to get paid as a health system.

Doing a discharge summary is mundane. AI can come along and do a much better job of that. And it's also a better way to do the economics of medicine. So I think AI can really change that part of it. And then just as a research tool, think of what we would be able to do if we could get all of the medical data on millions of patients and be able to study that data set.

You know, we could essentially, reverse time. For example, if a patient comes in with a brain tumor, we're forced to just do imaging studies and see what we can dig out of their blood tests and their, their scans and what have you at that moment. But if we're able to have these huge data sets where we can take all the brain tumor patients and then go back 10 years before they were ever [00:23:00] diagnosed and see what was abnormal then, it might open up these ways to predict or diagnose or even prevent.

some of these diseases before they get started. And so to me, that that's another really exciting part of, of what AI brings to the table. It, it defies time. It defies our, our reality of medicine and might open huge new insights.

Bill: It massively changes the game. That's for sure. It lets you keep track of all sorts of things that then you don't have to learn how to keep track of individually or too many things for a person to keep track of.

Dr. Lawton: This is another mind blowing thought. You know, you think of the medical literature, it's enormous. I, I have journals and journals stacked on my bookshelf that I can't possibly keep up with, but AI consumes that in no time. The power of supercomputing just exceeds what the human brain can ever accomplish.

You know, I may be able to read 200 articles in the course of a year and AI can read, 200, [00:24:00] 000 articles. And so that's a tool that's just so much more powerful than our brains will ever be. And so we, we need to find a way to use that because we, we can't replicate that.

Bill: And then you still have to perform the treatment, which takes you back to the art.

So now we're back to, you're using the science to get back to doing the art. Exactly.

Dr. Lawton: At the end of the day, the, my view of AI is it's, it's a really powerful tool, but like you said earlier, it's not curious. It's not synthetic, it doesn't like, it's not able to synthesize all the different pieces of a puzzle and put them together in the same way that a good diagnostician can.

And so it has to be used by the diagnostician as a tool to help him or her do the diagnosis.

Bill: Yeah. You have to understand your area even better, arguably, because it will give you the answer and you have to understand. What factors were weighed in there and where the judgment call was made and be able to decide if that was the right one.

So [00:25:00] within the actual, within the actual neurosurgery, what sorts of technologies are you currently using to push that forward? You were talking about using AI as a crystal ball and the diagnostics and some of the treatment, but then in terms of the actual Hands on the art of neurosurgery. Where do you see technology playing in that?

And what's cutting edge and what's not yet even made it that far, but that you're starting to think about?

Dr. Lawton: Yeah, I would say that right now we're just beginning to see the future. And the things that are in place are pretty thin. We record all of our operative cases. So we have surgical video. We're one of the biggest neurosurgical centers in the world.

We have 12 operating rooms. And you know, if we capture all of the cases that happen in those 12 operating rooms, we have a really nice, good data set to work with. But I think we have the capacity with platforms that exist today that are coming online to [00:26:00] capture every neurosurgical operating room that uses that platform around the world.

So we can. multiply the amount of data that's coming in by huge orders of magnitude. And I think surgical video is one. I think tracking our microscope in space, how it moves and allows us to see is a way to sort of follow our progress through an operation. The radiomics of a patient's brain MRI and all the imaging that they've had.

That's another data set. These really are isolated data sets at present. And you know, the, the radiomics exists in a whole separate database that's in a radiology department, separate from the surgical videos, which are in an operating room. And then, you know, things like how the surgeon is moving his hands and holding instruments.

That's not something we collect right now. We don't put cameras on the surgeon. We put them on the operative field. That's a data stream that simply doesn't exist today. So I think we're at the [00:27:00] very beginning stage of building this out. We need the platforms. We need more cameras. We need to integrate these data sets.

They may exist, but they don't communicate. It's the connection and the overlay. that is ultimately going to get us to the goal.

Bill: It almost sounds like you're talking about those remote robotic surgeries that have started making the news here and there in bits and pieces, but doing that locally. So that you have real time 3D scans of where you are in the patient and exactly what's going on with the instruments and, and really fully, fully digitizing what's going on.

Dr. Lawton: Yeah. Well, I think the, the ultimate kind of use case for this would be if we, if we succeed in this and we can bring all this to bear, then a surgeon who's, let's say in Tanzania at a very small hospital who has a tough case, Who's really struggling, they could hit the panic button on their, on their microscope and all of a sudden some new information might [00:28:00] flash into their, into their ocular in the same way that in your glasses you might see, you know, this little clue that says, okay, this is the situation that you're in based upon all of the data input that we see here.

Based on all of these data troves, all of these data sets that we have, we think this is your next best move is to go a little bit to the left here. Your aneurysm sits over here. You need to move this artery aside. And all of a sudden, that surgeon who might have been in trouble, a little bit lost, a little bit afraid, finds their way through a tough situation.

And, you know, that, that can be an instantaneous, instant death. Entirely digital solution for someone who's under resourced, who doesn't have a mentor, who doesn't have maybe the kind of experience that a surgeon like myself has in a big, busy, uh, American institute. We can then raise the level of care globally so that, you know, this technology helps patients worldwide.[00:29:00]

Bill: I love it. Exactly. It's, it's always good to have someone who can give you a hand when you get stuck. And many people in such a specialized field wouldn't have that. So that would be really cool. Now you set up a research facility that you're calling right now, Mysteries of the Mind, looking into how the brain functions as a mind.

Where's the line between The, the mind, the cognition, the you and the physical brain. Can you tell us a little bit about that project and what you're doing with that?

Dr. Lawton: Yeah. Well, I think it's always been one of our biggest fascinations is what makes us human? What is it about our brain that allows us to have a mind where we can think and we can feel?

And we can have these emotions. We can be creative. These are all of the things that the brain states that make us who we are. And ironically, it's sort of the [00:30:00] realm of neurosciences. The neurosurgeon is actually the person or the group that's best positioned to figure this out because we have access to people's brains.

You know, we, we open the cranium every day, many times a day. And so the best way to figure out this puzzle and unravel these mysteries is through a neurosurgical portal. And so my belief is that it's going to take a neurosurgical center like ours to tap into this portal and turn operating rooms into laboratories where we can actually understand how the brain is functioning as the mind.

We have this unique access where so many critical parts of the brain can be measured. They can be listened to with electrodes. They can be studied visually. We can gather this data and figure out how the circuits started talking to one another, how these different parcels of brain communicate from one area to the next, how we go from thinking of an idea to actually executing a [00:31:00] movement.

These are the things that ultimately depend on a neurosurgical window of opportunity. So, my fundamental belief is that we need to build out this place where we try to understand the mind. We have to build that out from a neurosurgeon's point of view. And then, we can't stop there. It's not possible for neurosurgeons to do this alone because we, we get bogged down by the diseases that we treat and the patients that depend on us.

We need computer scientists. We need engineers. We need neuroscientists who understand the mind. neuronal signals at this single cell level. And that kind of integration of all of these different entities doesn't exist in the world. In many places, they're, they're exceptionally rare. You would think that big research universities would be really, they would all have them, but, but to bring together this collection of silos all dedicated to this mission of understanding the brain as it functions as the mind using that neurosurgical portal, that take portal, that, that takes a very unique [00:32:00] environment.

And that's. What we're trying to build here, you know, we, we have the neurosurgical suite. We have tremendous engineers through our collaborations with Arizona State University and the Fulton School of Engineering, one of the largest in the country. And we have industry partners like Neuralink, who, you know, are trying to make those devices that allow us to make these leaps forward.

This is what the mind engineering lab that we're building is all about is to try and bring these different entities together. to tackle these big questions. It gets back to that statement earlier that I made about if we can understand the circuitry of the brain better, we'll unlock all these future therapies.

I believe neurosurgery in 2050 won't just be about brain tumors and brain aneurysms and strokes. It's going to be about treating obsessive compulsive disorder and obesity and even diabetes. Things that have a basis in neural function. And with our engineering and our technology, we [00:33:00] can modulate that neural function in ways that allow us to correct things that aren't quite right.

You know, if right now, obesity is a great example, you know, we have medications and it's a pharmacological solution that we pursue or one of diet and exercise. But if in the extreme cases, it's a question of a patient's hypothalamic dysfunction or another circuit in the brain that's Relating to reward activity, then, then we can modulate that and we can help patients in that other electrical way.

Bill: Wow. I have a couple of friends who are data scientists and I may have them listen to this just because I can, I can really see them. They're spending so much time now trying to understand how the brain works from the outside. So that they can build better AI that mimics how we think, how we learn, how we function, how we have judgment and make judgment calls and things like that.

And I could easily see that being an interesting feedback loop. [00:34:00] If you're not careful, you may find yourself as a center for AI research too, which would be an interesting shift. You're learning the brain from the inside. They're trying to figure it out from the outside and you're both using AI to do it.

Dr. Lawton: It's this integration of different perspectives. You know, we have our medical perspective, but we need that outside kind of engineering perspective. And one of the reasons that we haven't made as much progress to date is that we haven't brought these diverse groups together in the ways that would be beneficial.

Bill: Pretty incredible stuff. So that takes us to looking forward. Given everything you're doing to push the art of the possible forward, what do you most hope to see? as the future of neurosurgery. You mentioned doing, getting into behavioral problems and medical problems that are other places in the body and the body follows the brain.

Makes sense. But in terms of the art of the possible, what do [00:35:00] you see coming in the relatively near term?

Dr. Lawton: Yeah, well, I, I think it boils down to systematically going through these different pieces of the brain. The way I think about it is some of the easy stuff is how we move and how we feel. So the motor system and the sensory system are relatively simple.

And we've seen things like what I described with Neuralink, with the cursor control. We've seen things like speech prosthetics where patients who've had strokes, who've not spoken in decades, and all of a sudden have the thought of what they want to say decoded by. A device and then turned into, into speech sound that allows them to communicate.

Bill: That would be life altering.

Dr. Lawton: Yeah. These are, these are simple motor or sensory type prosthetics that, that are now coming online. But the next level is to dive into the emotional side of the brain. And by that, I mean, you know, all the things we've been talking about with depression or anxiety or obsessive compulsive [00:36:00] disorder, these are getting into the realm of, more psychiatric illnesses, but these are all subtle variations, aberrations in human emotion.

And by understanding that circuitry, we can impact a patient population that's orders of magnitude bigger than what we treat now with say brain tumors and aneurysm patients. And think of, when you think of the 8 billion people on this planet, There may be 100, 000 with brain tumors every year, but there are going to be millions and millions of people with these emotional disorders that would benefit from some intervention that would allow.

them to elevate their mood and get through a depressive episode. And so that second tier of the emotional side of the brain opens up an incredible horizon for us to intervene in just totally different types of patients. Next, we go down to the level of, you know, what, what makes human higher function like intelligence and creativity.

You know, think about if, if we [00:37:00] could understand what intelligence is and how that actually works, we, we could change the world. You know, one person like an Einstein who comes around once in a hundred years was sort of this aberration or this virtuoso out of nowhere and changed the world in how we think about.

Quantum physics and nuclear power and, and on and on. If what we understood about the brain could allow a hundred people in a hundred years to achieve that same kind of insight and advancement in science, then the world would be a different and potentially better place. If we can understand that. way that the brain makes us intelligent.

Then the next level I think of is, is plasticity, you know, and, and by that, I mean like how we as human beings learn and gather new information. That's a whole side of what the brain does, how it processes our day to day experiences and makes us different or better or smarter. That plasticity is an incredible feature of, of the [00:38:00] brain.

And If we could unlock that, it would allow us to, you know, potentially treat patients who have had strokes, who need the reparative aspect of plasticity. It might help those who have had trouble learning to do better in school. That whole plasticity side is really exciting. Memory is, is the next pillar.

The human mind was not meant to live to 75 or 80, Years of age, which is now what people are living to. We, we were engineered to live to about 40 to 45. And so when people live that long, they have memory problems and dementia has become a major issue for the world. And so understanding the memory circuits and how we can influence that and prevent dementias, help people remember the things that make them who they are.

This is the next pillar. And the last one is, is clarity. Consciousness, you know, I think the biggest question that we all ponder at some point is, you know, What is [00:39:00] it about our brain that allows us to achieve consciousness and we all enjoy our consciousness, we take it for granted, it makes us who we are.

We then see people who, like in our intensive care unit, Lose consciousness and are in comas. And we suddenly realized what a wonder this is. And, and we don't really have a good, even understanding, basic understanding of, of how that happens. And so ultimately we'd like to figure that one out too. So these are sort of our to do lists.

These are the things that we plan to march down. And I think the deeper we get down the list, the more it opens up. You know, in terms of therapies for patients or ways that we can change us as a, as human beings that can influence how we live in the world and ultimately solve these mysteries like consciousness.

Bill: That is a heck of a to do list and taking it from the science to the art form and back to the science and. Back to the art form. And we'll see where that, where that puts us all in the end, but it sounds like you're really pushing [00:40:00] the boundaries forward in ways that are just mind blowing. I can't wait to see with all of the new technologies that are available now, where that takes you in a couple of years.

Dr. Lawton: Yeah, me too. I feel like, you know, it's thanks to people like you and Dell and NVIDIA and supercomputing and GPUs, we can finally start to dream like this. I feel like for so much time, we've been just doing the mundane of neurosurgery and, and now all of a sudden with these incredible tools that are filtering into our operating room, we all of a sudden can see how these things can actually happen.

happen.

Bill: It's pretty incredible time for sure. Dr. Lawton, thanks so much for joining us today. How can people find you, keep track of you, and keep up with the amazing work that you're doing?

Dr. Lawton: Well, I am a very public figure. I have a Twitter account, MT Lawton. I have an Instagram account, Michael underscore T underscore Lawton, and we have a [00:41:00] Barrow website called barrowneuro.

org, where a lot of this material, a lot of my surgical videos, a lot of our beautiful illustrations are all displayed so that your listeners who have interest can find all of it in those sites.

Bill: Fantastic. Thank you so much for joining us. Thank you for having me, Bill.

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