When you hear the word “stealth”, you probably think of stealth bombers and their ability to hone in on a target without detection.
While it's a different technology, Stealth is also being used in operating rooms, allowing doctors to pinpoint precise areas of the brain during surgery.
In years past, treating brain tumors was often like shooting in the dark, with doctors making their best guess on where and how much to cut.
But now doctors in Michiana are using Stealth technology to target tumors.
Years ago, most people assumed that a diagnosis of a brain tumor was the worst possible news that you could get.
The reality is that a large number of people with brain tumors have a good outcome following treatment and are able to return to a good quality of life, thanks to technology and skilled surgeons.
In this Special Medical Moment, Maureen, along with photojournalist Don Schoenfeld takes us inside the O.R. at Memorial to watch a technology that targets tumors with precision.
Part One: Preparation
68-year-old Carol Butgereit of Bremen is at Memorial Hospital about to undergo surgery to have a malignant brain tumor removed.
Neurosurgeon Dr. Robert Yount talks to Carol and her husband, Carl, before surgery gets underway.
“It will be a relatively small incision kind of shaped like a horseshoe,” says Dr. Yount.
Carol originally had lung cancer, which is now in complete remission, but seven months later, doctors found the brain tumor that started affecting Carol's speech and memory.
Dr. Yount is confident he can remove the tumor.
Before surgery, Dr. Yount is in the OR, reviewing images of Carol's brain on a highly sophisticated computer system called “Stealth.”
“What the computer does is tells us exactly where the tumor is, how deep it is, where to go in and so forth, and that minimizes the amount of incision we have to make in the surface of the brain,” says Dr. Yount.
Before surgery, Dr. Yount arbitrarily defined 10 points on Carol’s head he will use as markers, along with the computer, to direct him to the precise location of the tumor.
“That red dot, I've told the computer that's my target. That's where I want to be, so I'm going to identify that as my set target,” he says.
With that done, Carol is wheeled in and prepped for anesthesia.
Nearly an hour after Dr. Yount starts reviewing his calculations, Carol is asleep and a helmet is put on her head to keep it rigidly immobile.
Pins will be screwed into the outer part of Carol's skull, but will not penetrate.
More like science fiction than the medieval pins, this balled device is the reference frame which establishes a fixed relationship with Carol's head.
Putting on his barber hat, Dr. Yount trims up Carol’s hair.
After a 10-minute antiseptic scrub, Dr. Yount straps on his headlight and is ready to get Carol's surgery underway, replacing the balled testing device with a sterile reference frame.
With another check on the three dimensional image of Carol's brain, Dr. Yount is ready to go.
With technology guiding him, Dr. Yount makes an incision into Carol's brain, starting delicate surgery to remove her cancer and give her back her life.
Part Two: Procedure
With the recent death of Ted Kennedy, we heard a lot about brain tumors.
There are basically two types: those that start in the brain, like Senator Kennedy's, and secondary brain tumors that spread from another part of the body.
Both can have a profound and deadly impact.
Senator Kennedy's brain cancer is harder to treat, because it starts in the brain it often spreads throughout the brain.
But when the tumor spreads from another part of the body the brain recognizes it doesn't belong there and forms a sort of capsule around it. Newer technology often allows doctors to get to those tumors and remove them.
Neurosurgeon Dr. Robert Yount is making an incision into Carol Butgereit's skull.
The Bremen woman has a malignant brain tumor that spread from cancer in her lungs. By the time she met Dr. Yount she had some memory and speech problems.
“Her primary tumor is in remission and as far as we can tell from scanning her whole body, this is the only other tumor she has,” says Dr. Yount.
With computer technology called Stealth, doctors can see tumors like Carol's like never before.
“What the computer does for us in reconstructs a three-dimensional image of her head, which is right here,” says Dr. Yount.
Dr. Yount makes a horseshoe-like incision in Carol's scalp.
“These clips just squeeze the scalp and stop bleeding,” says Dr. Yount.
Putting the scalpel down, Dr. Yount picks up the tools of his trade, explaining this ominous drill will disengage when it gets to the last layer of the skull.
“A nice little device which is intended to keep us from plunging into the brain which is considered bad form,” he says.
And sometimes doctors need to go back to the old-fashioned way of opening the skull.
With a small circle of Carol's skull bone removed, Dr. Yount puts it in a solution so he can put it back once the tumor is removed. Now it's time to begin the journey into Carol's brain.
”So far I have done nothing to her brain to hurt her,” says Dr. Yount, checking his Stealth computer images one more time.
By again watching the computer imaging Dr. Yount minimizes the amount of cutting and possible damage to Carol's brain.
“I'm right on the surface of the tumor. Right there. Right there. That's our tumor and my red dot, which is my probe, so I am indeed at the surface of the tumor,” says Dr. Yount. “Now what I am going to do is gently work my way around the tumor.”
Dr. Yount then works the cancerous tumor out of Carol's brain.
This little mass, no larger than a kidney bean would have killed Carol without surgery.
“I've verified that I am completely around the edge of the tumor so this tumor is gone,” says Dr. Yount.
A call from pathology confirms it's malignant.
Knowing that he got all of the tumor, it's time to close and put the piece of Carol's skull removed earlier back in.
“It's like a jigsaw puzzle,” says Dr. Young. “I got to make sure I get it back in the right direction.”
He then reattaches the piece with a few titanium screws. With the scalp back in place Dr. Yount is confident Carol will make a full recovery.
“This lady, I can cure her of her brain cancer,” he says.
And with Stealth technology, there is less cutting, more precision and a lower risk of brain damage.
“If she complains about her haircut, if that's her biggest complaint, I'll be happy with that,” says Dr. Yount. “I’ll consider it a good result.
After bandaging Carol up Dr. Yount is pleased with the outcome.
“Everything went very smoothly. I like to have cases with no surprises,” he says.
And just five minutes after Carol's brain surgery is over, almost unbelievably, the anesthesiologist awakens her.
Less than a week later we saw Carol and her husband Carl at home happily showing us pictures of their seven children and great grandchildren.
On Dr. Yount's orders, Carol was still using a walker, just for safety, but she and Carl are counting their blessings.
“We're still young kids, we'd like to see 100 years together,” says Carl.
“I am going to have the biggest and best garden ever,” says Carol. “That's in the works.”
And despite battling two cancers, Carol’s life is given back to her by a surgeon's skilled hands, technology, and a profound faith in the untapped power of the human brain, even one under assault.
Carol will undergo some radiation as a precaution.
While Stealth technology is now being widely used by many surgeons, Memorial was the first hospital in Indiana to use the technology and is getting ready to upgrade for the third time.
Click on the clips to watch either the on-air video of the preparation and procedure, or the full-length versions. We do warn you: this video is graphic, especially the full-length versions.