#363 ‒ A new frontier in neurosurgery: restoring brain function with brain-computer interfaces, advancing glioblastoma care, and new hope for devastating brain diseases | Edward Chang, M.D.

What It Covers

Dr. Edward Chang discusses revolutionary brain-computer interfaces restoring speech to paralyzed patients, achieving 80 words per minute through 253-sensor arrays. He covers awake brain surgery techniques, glioblastoma treatment advances, and engineering solutions for ALS, stroke, and neurodegenerative diseases through neural decoding.

Key Questions Answered

• •Brain-Computer Interface Performance: Patient Anne, paralyzed 18 years from brainstem stroke, achieved 80 words per minute speech output using 253 eCOG sensors on brain surface. System translates motor cortex signals to text with under one second latency, reaching 95-100% accuracy after one week of training on NATO phonetic alphabet.
• •Awake Brain Surgery Safety: Brain tissue contains no pain receptors, enabling awake craniotomies using only local anesthesia on scalp and dura. Surgeons map language and motor functions in real-time using electrical stimulation while patients speak, protecting critical areas during tumor resection to maximize removal while preventing paralysis or aphasia.
• •Glioblastoma Treatment Evolution: Extensive surgical resection remains most effective treatment, with survival directly correlating to removal percentage. Molecular profiling now identifies specific genetic mutations in each tumor, enabling targeted chemotherapy. Focused ultrasound temporarily opens blood-brain barrier for drug delivery without invasive catheters or direct brain penetration.
• •Neural Recording Resolution: Moving from scalp EEG to brain surface eCOG provides 1000x better signal resolution. Skull and scalp cause major signal loss and diffusion. Further moving to intracortical electrodes adds only 5x more resolution but creates immune reactions and scarring, making surface recording optimal for chronic implants.
• •Functional Electrical Stimulation Future: Bypassing damaged nervous system requires coupling brain signal decoders with muscle stimulators. For ALS patients, electrodes placed directly in diaphragm and chest muscles could restore breathing without relying on degenerating motor neurons. Technology exists now; challenge is integrating neurosurgeons, engineers, and neurologists for implementation.