Spring/Summer 2002, Volume 15, Number 1
Hopkins is in the midst of installing a high-end intraoperative MRI scanner in the OR because "we've stopped believing surgeons," says Neurosurgeon in Chief, Henry Brem, M.D. At one time, surgeons said, "We got it all" after resecting a brain tumor. They'd close the patient's skull and hope for the best. A day later, the woozy recoveree would be wheeled into radiology for a shadowy CT scan that might or might not reveal a very real residual tumor. Three months later, the growth would return.
The new MRI flanks
neurosurgeon Jon Weingart.
MRI has changed much of that, with its soft-tissue capabilities, but the inability to scan patients until they're long off the surgical table has remained a major drawback. By August that should change when a new, roughly 3 foot-by-3 foot intraoperative MRI is in situ in OR-5. "We'll be able to get instant feedback on an operation," says Jon Weingart, M.D., neurosurgery's point person in the endeavor. "We'll be able to tell if we've missed a sliver of tumor and can go back and clean it up."
Moreover, surgeons will be able to get constant, real-time updates during surgery, to compensate for small shifts the brain may make during an operation.
In addition, he says, the new system can swing into place just before the start of a craniotomy or biopsy to help plan the best approach to the target tumor. Surgeons use a specialized pointer, touching it to the skull at spots of potential entry, then eyeing a nearby monitor to view brain structures on the proposed surgical path. All of this occurs in real time.
Few institutions in this country have intraoperative MRI, though the system is more common in Israel, where it was developed. The company manufacturing Hopkins' $1,134,000 version says it's most valuable in tackling oligodendrogliomas, pituitary tumors, low-grade astrocytomas, intraventricular or skull-base tumors and subdural bleeding.
"We'll be selective in choosing patients," Weingart explains. "Those with tumors in certain locations would more likely see maximal removal. We believe we're talking about major differences in outcome." The MRI is a joint venture of the neurosurgery and neuroradiology departments.