Brain Surgery's GPS
Judy F. Minkove
Date: February 4, 2010
New technology at Johns Hopkins Bayview Medical Center gives neurosurgeons--and patients--an edge
More than a century ago at Hopkins, Harvey Cushing, widely regarded as the greatest neurosurgeon of the 20th century, performed the first successful operation for brain tumors. Seventy years later, CT scans would revolutionize brain surgery again. Still, brain tumor patients needed postsurgical scans to see if all the growth had been removed. If not, the patient had to schedule additional surgeries, raising risks for infection and other complications.
Now, Johns Hopkins Bayview Medical Center has found a better way. Since last November, the hospital’s two new neurosurgical operating rooms have been sharing a coveted “intraoperative” CT scanner that gauges a surgery’s progress with razor-sharp precision during and immediately following procedures—while the patient is still prepped for surgery. This eliminates the need to move the patient out of the OR and into the radiology department. If a correction is needed, the patient is ready to be moved right back into surgery.
Hopkins Bayview is the first hospital on the East Coast and the second in the United States to offer this hardware and software working together in connected operating rooms. “There’s a lot of excitement among our neurosurgeons about this,” says lead CT tech Patrick Tyler. “We used to be able to get 60 percent to 70 percent of tumors out during surgery. With this new technology, the doctors project capturing 98 percent of all tumors.”
“Intraoperative CT will make us more effective and provide more safety to patients in the OR,” says Alessandro Olivi, Hopkins Bayview’s neurosurgery chair. “It will be useful when we place catheters into the brain or screws in the spine. It will help to verify their position and make sure that bleeding from the brain has been completely stopped before we take the patient away from the OR.”
Learning this technology was no small feat. Months earlier, the hospital sent a multidisciplinary team to Carondelet Neurological Institute in Tucson, where the only other iCT in the country is housed. Led by former Hopkins Bayview neurosurgery resident Eric Sipos, who is now medical director at the Arizona Institute, the training has also built professional relationships. As time goes on, teams at both hospitals will be able to merge outcomes data to evaluate the effect of the new technology on patients’ experiences.
Brand new technology also debuted recently at Hopkins Bayview’s adjoining new endovascular operating room, aiding surgeons as they treat a wide range of complex vascular conditions. The fixed, ceiling-mounted system in a sterile surgical environment means combination cases can be performed at one time, which is better for the patient—instead of using an interventional radiology suite and then having another procedure in the operating room.
The only drawback to these new developments, says Tyler, is that it puts additional pressure on his staff of about a dozen techs to work longer hours—a small price to pay, he adds, for better outcomes.
—Judy F. Minkove