Neuralink competitor Precision Neuroscience testing human brain implant

As the lights dimmed in the operating room at Mount Sinai Hospital in New York City, Dr. Joshua Bederson was preparing to make history.

Bedeson, system chief of neurosurgery at the Mount Sinai Health System, is no stranger to long hours in the operating room. A former gymnast who has performed more than 6,500 surgeries in her career, she visualizes each procedure as if she were rehearsing a routine.

On this April morning, Bederson was preparing to undergo surgery to remove a meningioma — a benign brain tumor. Bederson said his primary focus will always be on treating patients, but that sometimes he’ll contribute to scientific advances.

This procedure is one such case.

A small crowd gathered as Bederson sat down in the operating room, his silhouette glowing in the bright white lights that shone on the patient before him. Medical workers, scientists and CNBC reported that some peered through the windows to watch Bederson attach the first of four Precision Neuroscience electrode arrays to the surface of a patient’s brain.

Electrodes are tiny sensors that can detect and transmit electrical signals, and an array is a grid of electrodes. Neurosurgeons use electrodes during some surgeries to monitor or avoid important parts of the brain, such as the areas that control speech and movement.

Precision is a three-year-old startup developing brain-computer interfaces (BCIs) – systems that decode neural signals and translate them into commands for external technology. The best-known company in this field is probably Neuralink. Tesla And Elon Musk, CEO of SpaceX.

Other companies, including Syncron and Paradromics, are also developing BCI systems, but with different goals and designs. Precision’s website says that the first use for its system is to help severely paralyzed patients recover functions such as speech and movement.

Precision’s flagship BCI is called the Layer 7 Cortical Interface. It’s a microelectrode array thinner than a human hair and shaped like a yellow scotch tape. Each array is made up of 1,024 electrodes, and Precision says it fits over the surface of the brain without damaging tissue.

Precision says that when Bederson used four of its arrays during his April surgery, it set a new record for the most electrodes placed on the brain in real time, but perhaps more importantly, the array was able to detect signals from the patient’s individual fingers, providing far more detailed information than standard electrodes can capture.

Using Precision’s electrode array is like turning a pixelated, low-resolution image into a 4K image, says Ignacio Sáez, an associate professor of neuroscience, neurosurgery and neurology at the Icahn School of Medicine at Mount Sinai, who and his team oversee Precision’s work at Mount Sinai.

“Instead of 10 electrodes, you’re going to have 1,000 electrodes,” Saez told CNBC in an interview. “Even though they’re reflecting the same underlying neural activity, the depth, resolution and level of detail you get is completely different.”

Bederson said having access to this level of detail could help doctors perform surgeries and other interventions more carefully in the future. For Precision, the ability to record and decipher signals from individual fingers will be crucial in helping the company eventually restore fine motor control to patients.

While this data marks a milestone for Precision, the company has a long way to go before it can reach its loftier goals: The company is still working toward obtaining U.S. Food and Drug Administration approval and has yet to implant a more permanent version of its technology in patients.

“I think this is a small step toward the ultimate goal of brain-computer interfaces,” Bederson said in an interview with CNBC.

In the operating room

Bederson’s surgery in April was not Precision’s first — in fact, it was the 14th time the company has implanted an array in a human patient’s brain.

Precision is partnering with academic medical centers and health systems to conduct a series of first-in-human clinical trials, each with different goals, and the company announced a partnership with Mount Sinai in March.

At Mount Sinai, Precision is exploring various clinical uses for the array, including helping to monitor the brain during surgery, a procedure in which surgeons like Bederson would temporarily attach a Precision array to patients who have already undergone brain surgery for medical reasons.

Patients consent in advance to participate.

Neurosurgeons routinely use electrodes to map brain signals when performing this type of surgery, but Bedeson said current approved methods use anywhere from four to nearly 100 electrodes — a far cry from the 4,096 electrodes he was prepared to test.

Precision’s arrays are being used in some of these surgeries, so CNBC joined them in the operating room in April as the procedures began.

The patient, who asked not to be named, was asleep. Bederson and his team had already removed part of his skull, leaving a hole the size of a credit card. Four Precision arrays were carefully arranged on a table nearby.

Once the patient was stabilized, Precision employees trickled into the operating room. They helped secure the array in an arc around an opening in the patient’s head, then connected a long bundle of blue wires on the other end to a cart packed with equipment and monitors.

Dr. Benjamin Rapoport, Precision’s co-founder and chief scientific officer, watched quietly. Though all major surgery carries some risk, the quiet neurosurgeon’s calm demeanor never faltered. He told CNBC that each new case is as exciting as the last, in part because the company is still learning.

As Precision’s preparations neared the end, Bederson entered the operating room, helped make final adjustments to the setup, and the overhead lights were turned off.

The ongoing chatter had turned to hushed whispers. Bederson was ready to begin.

He first carefully peeled back a fibrous membrane called the dura mater to expose the surface of the brain, then placed standard electrode strips on the tissue for a few minutes before testing Precision’s technology.

Using a pair of yellow tweezers called long bayonet tweezers, Bederson began placing all four of Precision’s electrode arrays into the patient’s brain. The first two arrays were easy to place, but the last two proved a bit more difficult.

Because Bederson was working with a tiny piece of brain tissue, he needed to get the angle just right to lay the array flat. For perspective, imagine lining up the ends of four tape measures on a surface area the size of a rubber band. It took a bit of reconfiguration, but after a few minutes, Bederson had it.

A real-time rendering of the patient’s brain activity was displayed on a Precision monitor in the operating room, with all four arrays operational.

In an interview after the procedure, Bederson said that deploying all four arrays at once was “complicated” and “a bit inconvenient.” From a design standpoint, he said, two arrays with twice as many contact points, or a longer array with wider spacing, would have been better.

Bederson likened the sequences to spaghetti, and that description was spot on: From where CNBC was watching, it was hard to tell where one sequence ended and the next began.

Once all the arrays were in place and detecting signals, Precision’s Rapoport stood at the monitor with his team, helping to oversee data collection. He said the study was a true team effort between the company, the health care system and the patients, who often don’t see the technology’s benefits at this stage.

“It takes a village to move something like this forward,” Rapoport said.

CNBC left the operating room as Bederson began removing the tumor, which he said went smoothly. Because the surgery was performed in that part of the brain, the patient woke up with some weakness in his leg after the procedure, but Bederson said he expects the leg to recover in three to four weeks.

Rapoport was present for this particular surgery because of his role at Precision, but he is familiar with Mount Sinai’s operating rooms.

Rapoport, a practicing surgeon and assistant professor of neurosurgery at the Icahn School of Medicine at Mount Sinai, reports to Bederson, who said the two have known each other since Rapoport was a medical resident at Weill Cornell Medicine.

Dr. Thomas Oxley, CEO of rival BCI company Syncron, is also Bederson’s professor. Syncron is developing a stent-like BCI that can be inserted into a patient’s blood vessels. As of early February, the company had implanted the system in 10 patients and is also pursuing FDA approval.

Bederson holds stock in Syncron but told CNBC he didn’t realize how that would prevent him from participating in research with the Syncron team. He has no financial investment in Precision.

“I didn’t want to have a financial stake in Precision because I thought it had a promising future as well and wanted to advance the science as quickly as possible,” Bederson said.

Rapoport also co-founded Musk’s Neuralink in 2017 but left the company the following year. Neuralink is developing a BCI designed to be inserted directly into brain tissue, and the company recently received approval for a second patient implant, it said. The Wall Street Journal on monday.

As the BCI industry heats up, Bederson says scientists’ understanding of the brain will “explode” over the next few years, and companies like Precision are just getting started.

“Really, I feel like the future is what’s exciting,” Bederson said.

Rapoport said Precision expects to receive FDA clearance for a wired version of its system “within the next few months.” The version, which CNBC saw in an operating room, will be used in hospitals and monitored care units for up to 30 days, he said.

Precision’s permanent implant transmits signals wirelessly and will go through a separate FDA approval process.

Rapoport said Precision plans to implant its wired version in “several dozen” patients by the end of the year. This data collection gives the company a “very high level of confidence” in its ability to decipher movement and speech signals in real time, he said.

“We’ll see more advanced versions of this technology in the next few years,” Rapoport said.