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Image courtesy Henrico Doctors' Hospital
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Neurosurgeon Peter Alexander (right) works with neuro-radiologist John Kuta, who reads scans during surgery. Jay Paul photo
An MRI (magnetic resonance imaging) scan reveals the problem area inside your head to your doctors. They begin the operation, opening your skull and removing the visible tumor. With pressure relieved, your brain inevitably shifts — as much as an inch — rendering that pre-surgery scan obsolete.
New technology at Henrico Doctors' Hospital allows MRI scans to be taken during an operation. The scans help surgeons reorient themselves with the shifted brain and check the completion of their work.
"This will allow us to do the maximum resection [removal] with the least amount of damage to functional brain tissue," says Dr. Peter Alexander, a neurosurgeon with Neurosurgical Associates in Henrico County.
"Oftentimes these patients continue to radiation," says Esther Desimini, director of The Cancer Center at Henrico Doctors' Hospital. "The smaller the tumor, the less there is to shrink," she says.
In some tumors, particularly benign ones, the edges are not easily visible to the human eye, but they can be seen on an MRI. The intraoperative imaging machine, called iMRI, will aid in removal of benign tumors and low-grade cancers, which can morph into more aggressive, high-grade cancers.
Virginia medical centers treat about 450 brain-tumor patients a year. Nearly 200 of them get treatment at one of the three health-care systems around Richmond.
The state's first surgical use of the intraoperative MRI occurred at Henrico Doctors' on March 8. (The next closest iMRI system is 325 miles away in Wilkes-Barre, Pa.) "It went smoothly," Alexander says, adding that the patient is doing well. After the initial resection, the iMRI found some tumor residue, which the surgeon removed, deeper in the brain.
The hospital spent $8.5 million to build and install the connecting, copper-lined operating and radiology rooms, the MRI and control center, air-flow systems, 3-D navigational software, ceiling-mounted lighting and anesthesia carts, and X-ray light boxes on a wall. To make the greatest use of the iMRI, the scanner will also be used in outpatient radiology on nonsurgical days.
