New Imaging Technique Improves Surgical Planning for Brain Tumors

CINCINNATI—Brain specialists at the Neuroscience Institute at the University of Cincinnati (UC) and University Hospital are among the first in United States to use a new technology that allows neurosurgeons to safely remove tumors without harming other areas of the brain.

This high-tech surgical navigation system, known as BrainLAB, can directly utilize images obtained with two advanced brain imaging techniques—functional magnetic resonance imaging (MRI) and diffusion tensor tractography—to outline important areas of brain function and their connections.

Neuroradiologist James Leach, MD, uses functional MRI to identify important areas of the brain linked to speech, movement and vision. This data is transferred into the BrainLab system for surgical planning and in the operating room during brain tumor surgery.

“This is a major advance in what we’re able to do for patients with brain tumors,” says Leach, associate professor of radiology at the UC. “Functional MRI has the potential to significantly affect how neurosurgeons plan their surgeries and how much tumor they can remove, while still avoiding critical areas of brain function.”

The new BrainLAB equipment also enables neurosurgeons to use diffusion tensor imaging to map critical “white-matter tracts” in the brain during surgery. Physicians perform the functional MRI and diffusion tensor tractography scans, which take about one and a half hours to complete, about a week prior to surgery.

“White matter tracts are like electrical connections between different parts of a house,” Leach explains. “If you disrupt the connection, you may lose communication between the various areas of the brain.”

The new technology has already been used successfully in 14 surgical cases at University Hospital.

“Functional MRI is easier and safer for the patient, and it can reduce the length of surgery,” says Christopher McPherson, MD, a neurosurgeon and assistant professor of neurosurgery at UC.

“It’s never been a matter of guessing where critical areas of the brain begin and end,” adds Leach, “but boundaries are not always clear, and the growth of a tumor can cause functional areas to shift from their original locations. Large tumors can cause these critical regions to shift dramatically.”

Neurosurgeons have traditionally applied a small electrical stimulation with a wand-like instrument during surgery to identify functional areas of the brain that should be avoided. If a motor area is stimulated, for example, the patient’s hand will move.

However, McPherson explains, any electrical stimulation involves risk.

“Stimulating the brain with an electrode can cause a seizure,” he says. “And in some cases, to accurately identify language areas we had to keep the patient awake. We also were forced to make a larger opening of the skull and expose more areas of the brain.”

While neurosurgeons transition to the functional MRI–assisted navigation technology, they will continue to use the standard technique to double-check their mapping. So far, McPherson says, brain stimulation has confirmed functional MRI’s accuracy, which suggests the new technology may eventually replace brain stimulation.

The Neuroscience Institute is a regional center of excellence at UC and University Hospital. The collaborative team is dedicated to patient care, research, education, and the development of new treatments for stroke, brain and spinal tumors, epilepsy, multiple sclerosis, trauma, Alzheimer’s disease, and Parkinson’s disease.

Support from this project came from the Neuroscience Institute, UC’s radiology and neurosurgery departments and Mayfield Clinic.

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