New procedure gives brain surgeons an edge

A new imaging procedure is giving brain surgeons an edge during a very delicate surgery.

A special scanning system allows doctors to see more accurate views of cancer cells they want to remove and the critical areas they want to save.

This machine may be the key to recovery for some brain tumor patients like 43-year-old April Gillies. In March, doctors removed a tumor from her brain for the third time.

"It's hard to keep your faith, and not wonder why you have to keep going through it,” she said.

The tumor was cancerous and growing near an area that controlled fine motor skills. But this time, doctors at Henry Ford Hospital in Detroit have a new tool by their sides, an intraoperative magnetic resonance imaging machine, or IMRI.

"We've had surgery and MRI for decades. Now, we're putting them together,” Dr. Steven Kalkanis said.

The imaging system is in a special suite connected to the operating room. Patients can be wheeled into the scanner, giving surgeons a real-time snapshot of the brain. Traditionally, surgeons rely on images taken hours before.

With this surgical set-up, doctors also use the IMRI right after the operation. In April's case, the scanner picked up a tiny area of suspicious cells that were hidden during surgery. Dr. Kalkanis went back in and removed them, increasing her chances of kicking the cancer for good. This news made a huge difference to April, her husband, and their 12-year-old son.

Dr. Kalkanis said the IMRI is being used as part of the evaluation of many of Henry Ford Hospital's ongoing brain tumor clinical trials.

It is helping doctors understand which treatments are the most effective for a particular patient suffering from the disease.

Research Summary:

BACKGROUND: The intraoperative Magnetic Resonance Imaging (iMRI) equipment includes a stereotactic targeting device with optimal precision and stability, which allows surgeons to target the exact area of the brain on which they will operate. Once set, the iMRI device projects clear images of the brain to a monitor in the operating room from which the surgeon works. The images function as a map of the brain, and because the map is so precise, the surgeon's work is as accurate as it can possibly be. (SOURCE:

THE MACHINE: The system actually is an MRI machine with a 58-cm vertical gap in the center. It is stationary in a lead-shielded OR. The intraoperative MRI allows surgeons to visualize tumors directly, including those that historically have been labeled as inoperable. It permits smaller incisions and smaller bone flap removals because of its location system. This leads to less invasive neurosurgical procedures. Less invasive surgery can be expected to equate to shorter patient recovery time. (SOURCE:

TUMORS: A recent advancement in treating tumors of the liver is the use of iMRI. Liver tumors often occur next to critical areas of the body, such as the diaphragm, colon, stomach, and gallbladder. Precise, real-time imaging capabilities allow the tumors to be destroyed while the surgeons observe -- literally. The removal of liver tumors had to be done traditionally in open surgery. With the iMRI, the ablation process is carried out using a very thin, minimally-invasive needle instrument. iMRI is especially advantageous in treating recurring liver tumors, including those in patients who have had prior operations. The iMRI can significantly prolong survival. (SOURCE:

Brain tumor tissue is often difficult to distinguish from normal brain tissue. In iMRI-guided neurosurgery, physicians use real-time imaging from the scanner to distinguish between healthy brain tissue and diseased tissue (the tumor) without compromising the patient's safety and care. Intraoperative MRI is used for the removal of low-grade gliomas -- tumors that typically blend into normal brain tissue. It is also used for pituitary tumor removal surgery, which is performed through a small tube with limited visibility. (SOURCE:

Dwight Angell, Media Relations
Henry Ford Hospital
Detroit, MI

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