MindTrace Is Improving Brain Surgery Outcomes Through Behavioral Mapping
Co-founders Brad Mahon, Max Sims, and Hugo Angulo are building tools that help brain surgeons understand how procedures will impact a patient’s core functions, like speech and memory. It’s a new approach that bridges cognition and anatomy at the point of care.
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The Challenge
Imagine going to the doctor because your right hand has been tingling and receiving the scariest news of your life. It’s cancer. In your brain. And they need to operate as soon as possible.
As if that wasn’t bad enough, there’s more. You learn that since the surgeons will be operating in an area of the brain that supports core functions like the abilities to skillfully use your hands and produce language (they call these “eloquent” areas), there is a risk that removing the tumor could damage parts of your brain that help you function. The ordeal could cause a cognitive deficit that makes you less, well, YOU.
Now, there have been tools and strategies in existence for decades to try to work this problem, to protect people’s minds during surgery so that they can walk out of the hospital the same person they walked in. One approach involves “awake surgery” and it goes something like this: Local anesthetic is applied to the scalp in the location where the surgery will occur. The patient is put under general anesthesia and their skull carefully opened, exposing the brain. Then the person is woken up. Because the scalp has been numbed and the brain has no feeling, they can remain awake and aware without pain or discomfort, for hours. The surgeon then begins a process of electrically stimulating specific parts of the brain while evaluating the real-time performance of the patient on sensory, motor and cognitive tests.For instance, while a specific point in the brain is temporarily “turned off” through electrical stimulation, another member of the clinical team might show the patient a word or picture on a notecard and see if they can recognize it. By doing so, they’re able to pinpoint where certain functions exist in that patient’s brain. No two brains are exactly alike in their geography; in fact there can be up to a two centimeter difference in where certain cognitive functions are located in the brain, from one patient to the next.
Here’s where the modern challenge comes into play. How can clinical teams plan a route to remove the most tumor while at the same time ensuring the highest possible quality of life post-surgery? To tackle that problem, surgeons need new tools to integrate data and translate information into evidence that can be used during clinical decision making. Today, brain surgeons rely heavily on a suite of brain mapping techniques that provide high-resolution information about the functional and structural organization of each specific patient’s brain. Those data are collected pre-operatively, whenever possible, at all major medical centers as part of standard of care. Those pre-operative images give the surgeons a very clear picture of the patient’s brain and where a tumor sits within it. What’s needed now is an upgraded suite of tools that helps translate all of that information into evidence at the point of care in the surgical suite. It is the difference between knowing where something is in the brain (the status quo) and having an evidence-based prediction about how removing a given area of the brain will affect a patient’s future language or motor function — a sort of Google directions for brain surgery. Making this happen means mapping an individual’s cognitive function in a way that can be brought right into the surgical suite, and that utilizes data from other patients in real-time. No more holding up flashcards, no more lost data.
And that is where MindTrace comes in.
Origin Story
Brad Mahon was working at the University of Rochester when he first witnessed the opportunities for innovation around the surgical management of brain tumor and epilepsy patients. As a psychology professor specializing in neuroscience, he built his academic career on a research program that involved pre-, intra- and post-operative cognitive testing in brain tumor and epilepsy patients. Throughout his time in Rochester, Mahon worked closely with Dr. Webster H. Pilcher, Chairman of the Department of Neurosurgery. Mahon and Pilcher had shared NIH and NSF grants to support their academic research, and collaborated on building a Translational Brain Mapping program to foster innovations that lead to better patient outcomes. “Every time we do an operation, we have an opportunity to learn something new about the brain,” says Dr. Pilcher, who specializes in the care of patients requiring complex brain mapping and awake surgery. “We want to deliver the best care to our patients and to ensure they have the best possible outcomes. This means treating the person and not just the disease–and in neurosurgery, this means doing everything we can to protect each patient’s mind while addressing their specific surgical needs.”
Through his experience as a basic scientist working with surgeons such as Dr. Pilcher, Mahon came to recognize two core needs. The first was that there was no established technology or system for the cognitive and brain imaging data his team was collecting before surgery to be most effectively utilized by surgeons at the point of care. The second involved the opportunity to innovate the way that data was collected and accessed in real time during awake brain surgery.
The pieces began to come together when Mahon met Max Sims, who was double majoring in business and neuroscience at Rochester. Sims worked with Mahon in the lab for two years as a full-time researcher, testing brain tumor and epilepsy patients before, during, and after surgery. As they studied each brain, they became more convinced that they could improve how cognitive functions are mapped in the brain in a neurosurgical context and help bring a more nuanced picture of the brain into the surgery suite.
They decided to take their idea on the road to test whether the opportunities for innovation they were seeing at one academic center were generalizable across the country. They traveled the United States and had hundreds of conversations with brain surgery teams at 15 different medical centers. The answer was a resounding yes, which gave them the confidence to pursue MindTrace as a business.
“It’s a space that is ripe for innovation,” says Mahon, “because even at the top facilities for cancer and epilepsy treatment, in the context of incredibly advanced methods for non-invasive and invasive brain mapping, it is not uncommon for someone to be holding up a piece of paper with words or pictures and doing the test completely manually. And, even if the testing is digital, that data remains siloed from other information about the patient, and siloed from informing the care of future patients. All of that information is being used in the moment, but then it’s disappearing.” Mahon and Sims realized that MindTrace could develop the tools to digitize this entire process. By doing so, the data generated from one patient can inform care decisions about future patients, and in potentially any operating room in the world.
Core to their challenge was how to scale. They knew they could improve cognitive mapping for 50–60 patients a year, but how could they grow to help thousands of neurosurgery patients a year? For that they’d need a new platform driven by artificial intelligence and machine learning. So they moved to Pittsburgh and started building out a tech team at Carnegie Mellon.
Today, they’re building up their medical advisory board and prepping for their first meeting with the FDA. They raised about $600K in their pre-seed stage and are looking ahead to a seed round.
Under the Hood
MindTrace is a SaaS platform that organizes all of the behavioral and neuro-imaging data that is collected before, during, and after a brain surgery. Put another way, they’re combining the knowledge gained from pre-operative neuropsychology assessments with anatomical scans like MRI and CT. That allows MindTrace to overlay — and fuse in 3D — all of the relevant neuroimaging and behavioral data into a single 3D visualization. That image can then be used by the surgeon to evaluate their surgical options, both before the first incision and in real time as the surgery unfolds.
Once it “co-registers” the neuroimaging and behavioral information into one platform, MindTrace will be able to simulate surgical plans and actually predict postoperative cognitive outcomes. That means a new type of evidence-based planning about how to surgically treat brain cancer and medically refractory epilepsy, while optimizing the post-operative quality of life of the patient.
To explain how this added data helps the surgeon, Sims extends the analogy to navigation. Imagine a Google Map. For the last couple decades, we’ve had anatomical navigation for brain surgery. That status quo is like using a two dimensional map of roads and highways and then manually charting one’s planned course. Of course, for geographical navigation we now have google maps, which tells you the implications of taking one route over another. Mind Tracing, says Sims, will tell clinical teams the implications for a patient’s future mental function of taking one approach in a surgery compared to another. “We want to be able to tell the brain surgeon how a decision could change the expected neurocognitive performance of the patient, in real time, during surgery so that the surgical team can use that information in real time as new type of evidence.”
Why We’re Proud to Invest
Some innovations in health are more technical and specialized than others. MindTrace’s product is highly technical and their initial market of awake brain surgeries is in the low thousands per year. But that’s part of the strength of what they’re doing. We’re incredibly proud to back this team because they’re patiently and carefully laying the groundwork for massive future impact. The first step is to hone the algorithm in awake brain surgery where they can get direct causal feedback. Then they can build a tool for a broader population and help hundreds of thousands of people with brain injuries, like stroke patients just as one example. Mahon’s got one word to describe this approach.
“If there’s one core value to MindTrace, it’s integrity,” says Mahon. “In the space in which we’re working, we understand the need that every step of our journey must be based in scientific validity, because that is our lived experience in the academic work out of which MindTrace grew. We want to build and scale MindTrace as quickly as we can, but no quicker and without haste. We must proceed carefully, so that our clinician collaborators understand and recognize that our products and features will work exactly as intended.”
The industry has already responded positively. For their work helping make sure people walk out of surgery the same person they walked in as, MindTrace won the first-place prize of LifeX Labs at Pittsburgh Life Science Greenhouse’s Accelerator program. As Mahon’s longtime collaborator Dr. Pilcher put it, “What is inspiring about this technology is the ability to harness the insights gained from the care of today’s patient to inform the care of tomorrow’s patient, and to do this at scale, across clinicians, medical centers, and time”
Finally, we’re proud to support the team at MindTrace because they understand that it’s not enough to simply live longer. It’s how we live that defines our humanity. Their tools change the focus away from a simple calculation of life years to protecting the things that matter most. It’s about thriving as we age and protecting the parts of ourselves that make us who we are. That’s a health moonshot mission we can get behind. Join us in welcoming Brad Mahon, Max Sims, Hugo Angulo, and the rest of the MindTrace team to the StartUp Health family.
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