A new direction in neuroscience

Neurosurgeon Webster Pilcher, M.D., has spent decades collaborating with peers to understand how brain surgery affects function. He is now testing a new approach that helps teams measure and track those changes across the course of care.

“When you operate on an awake patient in the operating room, No. 1, it’s an overwhelming and wonderful experience to have the patient on the table and to engage with that patient, to take that patient through that journey of awake brain surgery. That’s a great privilege,” says Pilcher, chair of neurosurgery at the University of Rochester Medical Center. “But beyond that, there’s an amazing opportunity to learn something about the brain.”

Pilcher and his team are using MindTrace, whose origins lie in URochester research. The technology helps map and measure neurocognitive ability, protecting brain functions such as memory and movement before, during, and after surgery. It integrates real-time imaging and cognitive data to guide decisions, whether for tumor or tissue removal.

MindTrace, a Carnegie Mellon University spinoff, is part of a broader shift in neurosurgery navigation from mapping the brain to predicting, using machine learning, how surgical decisions will affect individual patients. MindTrace is being used at six medical centers in the U.S.

The company employs 10 people, of whom four are located in Rochester. The region is expected to continue to play a role in MindTrace’s future, especially given the access to talent, says CEO Maxwell Sims.

He hopes the company will add a few more clinical sites—no more than 10—and raise $2 million to $3 million in its journey to build out its tool.

“We don’t want to get over our skis with sites,” Sims says of its growth plans. “It’s very time-intensive and labor-intensive to support a site, because we want to make sure we’re doing things the right way.

“In 2026, we really want to focus on the sites that we have,” he adds, “and make sure they’re really happy using this and helping us make this a better product and a better experience for everybody involved.”

Mapping minds

Around 2011, Pilcher and Brad Mahon, co-founder of MindTrace and formerly at URochester, established the Translational Brain Mapping Program. (Mahon is a cognitive neuroscientist and chief science officer at MindTrace. The researchers built a multidisciplinary team, drawing in other surgeons, scientists, oncologists and ophthalmologists.

“(MindTrace is) the result of a very organic process … by Dr. Mahon and myself, asking basic questions and sort of imagining how we could operationalize these questions into something of value,” says Pilcher. (His curiosity as a medical resident took him to Seattle to learn under George Ojemann M.D., who was performing awake brain surgeries in epilepsy patients.)

The Translational Brain Mapping Program studied surgery patients—including those with lesions and those suffering from epilepsy—to learn more about brain function and better understand which parts of the brain are tied to which function.

“Everybody’s brain is organized somewhat differently. Where language is in my brain is probably two centimeters different than where it is in your brain,“ says Sims. “Under Dr. Pilcher’s leadership, they were really trying to push hard on the marriage of neuroimaging and cognitive science to essentially bring that into the operating room.”

The research was backed by federal grants from the National Institutes of Health and the National Science Foundation. The team was focused on enhancing complex neurosurgical procedures.

“Every brain surgery is an opportunity to learn something new about how the mind is organized,” says Pilcher. “MindTrace grew directly out of that philosophy. It turns what we’ve learned in the lab into practical tools that improve patient care in the (operating theater).”

At the time, Sims, a URochester student, worked in Mahon’s lab. He worked with the brain mapping program and patients and facilitated cognitive testing. (Sims went on to earn a STEM-focused MBA from the Simon Business School.)

“Then we started asking the question, OK, if you took this process, which was helping 20 to 30 patients a year in Rochester, what technology would you really need to build and stand up to allow this to go from helping tens of patients a year to hundreds to thousands to tens of thousands?” Sims says. “So asking that question really is what led us down the path of MindTrace because you just can’t scale … without sort of building it inside of a company.”

Jim Senall, president of NextCorps, who is rooting for MindTrace’s success, recalls learning about the technology at a Mark Ain Business Model Competition. 

“(It) was amazing to me the first time I heard about it,” he says, recalling when MindTrace joined the NextCorps incubator through the URochester student incubation program.

“As I got to know Max Sims, I was extremely impressed,” Senall adds. “As investors often say, they would always invest in an A+ person with a B-quality idea versus the other way around. In this case, it seemed to me that Max and his team were definitely A+ people, and their idea and technology were also A+.”

MindTrace launched in 2020. It has raised $4.5 million through grant dollars, programs and business contests. While it works closely with URochester, it was Mahon’s move to Carnegie Mellon that shifted the company’s “center of gravity” to Pittsburgh, Sims says.

Gathering data

Currently, MindTrace is a research tool at a consortium of academic medical centers. In addition to URochester, Massachusetts General Hospital, University of California San Francisco, the University of Pennsylvania, Rush University Medical Center in Chicago and University of Texas Health are sites where the technology is being used. Its use is under Institutional Review Board oversight, meaning it is still being studied in a controlled clinical setting to ensure its safety and effectiveness.

“It’s being used primarily for awake brain surgery patients who have brain cancer, but also drug-resistant epilepsy patients,” Sims says.

In brain tumor cases, the lesion or tumor is removed, while in epilepsy cases, surgeons are trying to get to the tissue that’s generating the seizure in a way that won’t result in a lasting neurocognitive deficit.

“You’re trying to manage the seizure, but they’re also going to live longer, so (it’s a) similar kind of brain mapping, translational brain mapping problem, but the technology is a little bit applied differently there,” Sims says.

MindTrace is also pursuing a Food and Drug Administration-registered device strategy, where its tool would be used as a neurocognitive assessment aid. 

“There’s a whole FDA regulatory reimbursement strategy that’s underpinning all of this as well,” Sims says. “We’ve had on-the-record discussions with the FDA. Our ultimate goal at MindTrace is to get towards prediction. If you took this piece of brain tissue, what is the probability that the patient is going to have a language deficit after surgery, a motor deficit, a memory deficit?”

“That is ultimately … our true north,” he says.

To get there, he adds, the company needs a data set with relevant variables to make those predictions with confidence.

“It can’t be black box prediction,” Sims says, referring to internal decision-making logic that remains hidden. It needs to be interpretable, allowing surgeons to see how surgical decisions could impact function.

The grant funding is helping MindTrace get to that goal and build the initial dataset. Adding machine learning to datasets then gives the company another edge. Sims says the company is also looking to apply for the FDA’s Breakthrough Device designation. (The FDA defines it as a  voluntary program for certain medical devices and device-led combination products that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions.)

“Part of (the) work that we’re doing right now is to really unpack that health care economic story, as well as collecting all of this clinical data, because it’s really important to build the health care economic story in lockstep with the centers with their data, as opposed to working with some outside consulting firm that has this data set that they think is relevant, that isn’t really relevant,” Sims says. “So we very much have taken (a) ‘let’s build it together with our sites’ approach to this.”

There are several success stories, like Dan Fabbio’s, who played the saxophone while undergoing brain surgery. Data collected during that case helped define the relationship between parts of the brain responsible for music and language processing. It was also an example of the multidisciplinary nature of the work.

“As I think back about Dan’s case and about the incredible outcome and what we were able to achieve, it reminds me of how far we have come,” said Pilcher at the time. “Ten years ago, we mapped the brain using very simple tools—electrical stimulation and image guidance. But now, we have all the tools of cognitive science. We have brought the cognitive science laboratory into the operating room and now almost as a matter of course with every single patient.”

Looking ahead

Competition for MindTrace isn’t easy to define. The company straddles traditional neuronavigation systems and newer AI tools that aim to predict surgical outcomes.

“There’s a lot of market-taking behavior,” Sims observes. “It’s like, who’s got the new widget right now, whereas we’re (not) trying to be a better mousetrap, we’re trying to help create a new translational brain mapping category. So, to be a market maker, not a market taker. That’s hard to do.”

The global neuronavigation systems market is expected to reach $5 billion by 2030, according to industry estimates, driven by the rise in neurological conditions requiring precise intervention. There is also a market for brain-mapping instruments that could be another space for MindTrace. At the same time, these systems are integrating artificial intelligence and advanced imaging. Together, these trends point to a broader shift: from tools that simply map the brain to systems that help interpret function and guide clinical decisions.

As Sims looks ahead, he views MindTrace as a way to layer information into existing workflows without disrupting processes, which can be challenging.

“It’s not the technology that’s not working; it’s the fact that you’re disrupting very entrenched and well-oiled clinical processes across hospitals,” Sims says. “So, we very intentionally have designed this to not disrupt workflow and to more or less fit like an invisible glove over that existing process at the sites.”

Sims hopes the system adds value to all those involved in managing and supporting a patient’s journey.

Rochester is likely to continue to play a key role in MindTrace’s growth. URMC is a driving force in the six-center consortium, Pilcher says.

“MindTrace is definitely a strong positive for our region. We’d love to see many more companies like this one, tapping into the talent and expertise here, and creating jobs over time,” says Senall, who also points to the growth of the life sciences sector as a whole. MindTrace’s presence, he says, “makes me optimistic we can see more medical and life sciences startups take root here over time.”

Smriti Jacob is Rochester Beacon managing editor. 

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