Photograph by Frank Di Piazza
“The brain is the most complex structure in the universe,” says Richard D. Bucholz, chief of neurosurgery at Saint Louis University Hospital. “Our knowledge of it is rudimentary. It’s a mass of nerve cells connected by fibers—but where is memory? Where is speech? How does the brain provide consciousness? What structure contains what you learned in fourth grade?”
Nobody’s sure. So when brain surgeons open a patient’s skull to remove a tumor, they want to get to it by the shortest, least risky route. They don’t want to blunder around in the dark, knocking over the furniture. “This is not an operation to remove your gallbladder,” Bucholz says. “It’s your personality and ability to think that’s at stake.”
When Bucholz was a resident at Yale University in the late 1970s, the best available method of navigating inside the skull was stereotaxis: You took X-rays and used them to plot a system of three-dimensional coordinates. Bucholz learned to use these 3-D maps to implant electrodes in the brains of patients with epilepsy, alleviating their seizures. It worked, but it was such a slow, inflexible, laborious method, involving the use of such cumbersome equipment, that only a small percentage of neurosurgeons were willing to perform procedures that required its use. “It was a 19th-century instrument,” Bucholz recalls. “I thought, ‘This is something technology could help with.’”
The technology wasn’t available yet, but the young resident’s guess was right, and he would turn out to be the man responsible for making it happen.
Bucholz grew up in Omaha, where his father was a general practitioner, but, as a boy, Bucholz swore that he wouldn’t follow in his father’s footsteps. The routine nature of family practice, conducting the same physical examinations every day, struck Bucholz as monotonous. He was much more interested in computers. He got hold of a book called How to Build a Working Digital Computer, which offered instructions for doing so with nothing more than wire, screws and paper clips. “I can still remember that mass of paper clips in the closet,” he recalls ruefully. But as he got older, his expertise increased. As a student at Phillips Exeter Academy in New Hampshire, he was able to work on an advanced (for the time) computer at nearby Dartmouth College and do a summer internship at Xerox.
Bucholz was using computers mostly to work out problems in physics. He intended to be a physicist but, as a Yale undergrad, he found the subject matter too dry and abstract, so he changed his major to molecular biochemistry and biophysics. To satisfy a course requirement, he took neurophysiology. Early in the course, he realized that neurons communicated just like basic computer language: through the use of simple digital signals (0 or 1). Later he was to learn that this interpretation was a bit simplistic, but in that first flush of excitement, it struck him that the human brain and nervous system were like the computers he loved—just infinitely more complex.
“The nervous system was a fascination for a lifetime,” he says.
After completing his medical training at Yale, Bucholz joined the faculty at Saint Louis University in the mid-’80s. He was still using the stereotactic method he had been introduced to during his residency, but he was obsessed with finding a better way. In 1988, he got hold of a personal computer capable of depicting computed tomographic—or CT—scans, which provide far more detail about internal body structure than ordinary X-rays can. Finally, he thought, the moment for innovation had arrived.
The technology was ready. People, unfortunately, were not. “I was told by the great minds of neurosurgery, ‘This doesn’t seem useful,’” he recalls. “Instrument firms said, ‘Why do you want to do that?’ No one wanted to develop it. No one saw its value.”
Even though he had support at SLU, Bucholz was mostly on his own, begging for funds or borrowing components. He sought out unlikely collaborators. A key partner was Kurt Smith, who had invented a computerized sound mixing board used for recording songs. He had given it a name to appeal to young rockers: Stealth-Station. Bucholz persuaded Smith to drop the music application and concentrate on the surgical one, but the name stuck. “People thought it was cool,” says Bucholz.
The StealthStation is a computer that uses CT scans of the patient’s brain to create a 3-D image and display it on a monitor. Setting up the lesion or other target, the Stealth- Station figures out the most risk-free point of incision and path to the target. “It’s like MapQuest,” Bucholz explains. Instead of exposing a large area of the brain, only a very small incision is necessary. The computer performs its calculations quickly, giving the surgical team flexibility. If they should find a large vein in the way, they can ask the computer for an alternate path. Throughout the procedure, the surgeon can see exactly where his instrument is in relation to the patient’s anatomy. An emitter on the forceps or other surgical instrument shows up as crosshairs on the screen when the surgeon steps on a footswitch.
Even after he had the first StealthStation in working order, Bucholz found that no amount of explaining could overcome skepticism. He had to take his product on the road. Once surgeons had the forceps in hand and were looking at the screen, they understood what the tool could do—and they wanted one of their own.
Between 1994 and 2002, the StealthStation generated more than $2 million in licensing fees and royalties for SLU. In 2004, Bucholz was named Inventor of the Year by the Bar Association of Metropolitan St. Louis. Today, 20 gold plaques from the U.S. Patent Office hang on his office walls, and the Stealth-Station is the standard of care. Hospitals across the United States and Europe use it. It is manufactured and distributed by Medtronic Navigation, now a $90 million division of Medtronic Inc. Last fall, the company won a lawsuit against a German firm that had infringed on Bucholz’s and others’ patents. A jury awarded Medtronic $51 million in damages.
Income from the StealthStation is divided among Saint Louis University, Bucholz and his department. The steady revenue stream has enabled the neurosurgery division to acquire the latest equipment and pursue novel research projects.
“Anything you want to do inside the skull, this technology can help you with it,” Bucholz says. Investigators conducting trials of powerful new toxins for chemotherapy are using the StealthStation to implant catheters for precise delivery of the toxins so they can attack the tumor powerfully and precisely while causing the least possible damage to healthy tissue. Bucholz’s invention also allows physicians to place electrodes where they can reduce the effects of Parkinson’s disease or depression. In the future, the StealthStation may play a role in gene or stem-cell therapy.
The next challenge for Bucholz is seeking more maneuverability for the instrument in the brain. Surgeons operate through pathways as narrow as one-third of an inch. In such close quarters, it’s difficult to turn a corner, which they often have to do upon reaching the tumor. “We need to project our control to where we make the turn,” Bucholz explains. “I would be delighted to be able to both ‘see’ around a corner and manipulate tissue around a corner from a distance.”
Bucholz is married to Kathleen Keenan Bucholz, a professor of psychiatry at Washington University. They have two daughters and a son and live in West St. Louis County. The two met when they were members of the Yale Glee Club. Bucholz recalls riding the bus with her after a concert: “I wanted to impress her, so I spent two-and-a-half hours telling her how to do a frontal lobotomy on a snail. She could have gone one of two ways: either ‘He’s crazy’ or ‘He’s passionate about his work.’ Fortunately, her reaction was the latter.”
Looking back on his career, Bucholz remembers many patients who have come to him because they’d been told that their tumors were inoperable. Bucholz and his team were able to remove them. “The patients come back for checkups year after year. The tumor is still gone. This problem could have changed their lives, even brought their lives to an end. Instead, it was dealt with. I can’t imagine a more rewarding career.”
