Dr. Richard Bucholz and the origins of modern brain surgery

If you or your loved one had successful brain surgery, you can probably thank my colleague, Dr. Richard Bucholz, Professor of Neurosurgery at Saint Louis University School of Medicine. Dr. Bucholz pioneered and invented the image-guided surgery navigational system marketed by Medtronic as the “Stealth Station.” It is standard equipment in nearly every neurosurgical suite in the world.

When Dr. Bucholz was first trained in intracranial surgery, the positioning of surgical instruments in the skull was done by approximation, a word that no surgical patient wants to hear. Dr. Bucholz decided it was time to exploit the rapidly advancing laptop computers to design a kind of GPS for real-time intracranial instrument placement. His initial strategy was to place three spark generators at the base of an instrument and microphones in the surgical light array. In lab experiments, this worked well, but when he tried it in the operating room, the hard tile floors and walls caused too much echo for accurate microphone tracking.

Fortunately, LED technology had recently been commercialized, so he replaced the spark generators with infrared LEDs and replaced the microphones with infrared detectors. Voila! As time went on, computers became faster and more powerful, so images of cranial MRIs and contrast imaging for blood vessels could be fused with the image of the instrument tip, all aligned by the use of fiducials attached to the patient’s scalp as reference points.

Dr. Bucholz holds over 30 US patents for this technology, which is used to treat brain tumors, strokes and embolisms. Recently, it is being used to position electrodes in the brain for deep brain stimulation to alleviate severe tremors. He is a fellow of the National Academy of Inventors, for which I nominated him. I’ve nominated him for several other national awards, but unfortunately, he lacks the long list of publications and funded research grants that are valorized by the judging panels. Dr. Bucholz funded his research using income from his surgeries, and he prefers patents to published papers. Ultimately, he derives most of his personal satisfaction from helping his patients live more normal lives.

Dr. Richard Bucholz and deep brain stimulation therapy for tremors