Dariusz Szarek, MD, PhD from Wrocław Tech’s Faculty of Medicine works in the Neurosurgery Ward at Wrocław’s Marciniak Hospital, our partner facility. Dr Szarek is one of the few neurosurgeons in Lower Silesia to perform the procedures for the implantation of bypasses into cerebral vessels, e.g. in moyamoya disease, which require extreme precision and experience. Patients come from all over Poland for consultations at the Wrocław-based centre.

Research into brain structure

When the idea of establishing a Faculty of Medicine at Wrocław Tech was conceived, Dr Szarek approached Prof. Marcin Magdziarz, Dean of the university's Faculty of Mathematics, with an offer of joint research.“I was looking for scientists to help with research into the;structure of the brain and with some calculations I needed to optimally perform cerebral artery bypasses during neurosurgery,” says Dr Dariusz Szarek. “That's how I come across the mathematicians, at which point I knew immediately that our collaboration would be fruitful.” Bypasses are the method most commonly used for conditions causing the narrowing or obstruction of cerebral arteries. The main indications for bypasses are moyamoya disease, brain tumours, and arterial damage occurring after radiotherapy), as well as atherosclerosis (which leads to cerebral ischaemia).

Looking for the perfect angle

The collaboration between mathematicians and a neurosurgeon has been going on for almost two years. The beginning mainly involved arduous and rather complicated mathematical calculations. The project, which Dr Dariusz Szarek, Prof. Marcin Magdziarz, and Assoc. Prof. Łukasz Płociniczak, PhD, Dsc are now working on, is a 3D mathematical model of the brain that will allow the condition of each patient to be assessed individually. Prof. Marcin Magdziarz, Dean of Wrocław Tech’s Faculty of Mathematics explains: “Complicated bypass surgery is, of course, Dr Szarek’s domain. We mathematicians are supposed to suggest various solutions to the operating surgeon. For example, we’re studying aspects such as at what angle, at what distance, and where to place the bypasses so that the blood to the brain flows optimally. As far as I’m concerned, these are typical mathematical problems and issues,” he adds. In their studies of the brain, the researchers used differential equations, mathematical models, data analysis, and subtractive angiography studies, among other methods. As a result of the analysis, the
neurosurgeon obtains a set of relevant information before the operation. Dr Szarek talks about how it works: “We first make a 3D model of the cerebral circulation in a specific patient. Then, virtually, using computer software, we introduce a 'dry' mathematical, i.e. artificial bypass. In this way, we can immediately observe, by trial and error, which segment of the cerebral
vessel will best;accept; the bypass.

Virtual treatment scenarios

Currently, Dr Szarek and Prof. Magdziarz are analysing the case of a teenager who has pathological changes in brain arteries. The illness brings about very severe headaches and dizziness, as well as nausea. The researchers joined their efforts to develop a model of the patient's brain based on CT scans. “For now, I’m virtually testing different treatment scenarios for the patient,” says Dr Szarek. Based on the data I got from the mathematicians, I added a bypass, and it turns out that if I place it in the indicated spot, the patient will start recovering. And this is precisely the focus of our research.” The neurosurgeon also collaborates with Sapporo Medical University in Japan and the Lower Silesian Centre for Oncology, Pulmonology and Haematology (which is also our partner). The study looks at genetic variants in patients. Genetic trait typing can identify patients with individual traits predisposing them to a favourable (or unfavourable) outcome from brain bypass surgery.