More Effective Brain Surgery Using iMRI

A brain tumor is a mass of abnormal cells in your brain. Many different types of brain tumors exist. Some are noncancerous (benign) and some are cancerous (malignant). Brain tumors can begin in your brain (a primary tumor), or cancer can begin in other parts of your body and spread to your brain (secondary or metastatic).

Treatment for a brain tumor depends on the type, size and location of the tumor, as well as your overall health and your preferences. Surgery is the usual treatment for most brain tumors. 

Brain tumors have traditionally been difficult to treat since they occur at the control center for thought, emotion and
physical functioning.  Neurosurgeons must be careful not to damage healthy brain tissue while removing a tumor.  A traditional procedure uses a special operative microscope that provides tremendous detail within a limited field of view.  However, this approach also can make it difficult for the surgeon to see the exact extent and location of all tumor fragments. A tumor sometimes may be hidden behind nerves or arteries.  If any part of a tumor is missed during surgery, the patient may need a second surgery or some form of radiation treatment.

iMRI Benefits

At Boulder Community Health, we’ve minimized the need for follow-up surgery by employing Colorado’s first (and currently only) intraoperative magnetic resonance imaging (iMRI) system. iMRI enables BCH surgeons to obtain detailed images of the brain during and immediately after surgery, while the patient is still in the operating room. These iMRI scans help our surgeons determine more precisely the boundaries between a tumor and healthy tissue.  The scans also alert them to tiny tumor fragments that may not be readily seen with the surgical microscope.  The neurosurgical team carefully evaluates the iMRI images and can adjust the surgical plan as necessary using advanced computer-guided navigation to reach and remove any tumor fragments.

The benefits of iMRI-guided brain surgery include:

• Delicate healthy tissue is preserved during the surgery
• Improved surgical accuracy, which often means quicker recovery
• Neurosurgeons can locate hidden tumor fragments and safely remove them, which lessens the likelihood that a patient will need repeat surgery or radiation treatment
• A patient’s hospital stay is often reduced

Tumor Types

Neurosurgeons at BCH use iMRI-guided brain surgery for most types of tumors, including:

• Acoustic neuroma – slow growing, benign tumor of the nerve that connects the ear to the brain
• Cavernous malformation -- a collection of blood vessels that are enlarged and irregular in structure 
• Chondrosarcoma -- the second most common type of bone cancer, typically occurring in the legs, arms or pelvis
• Chordoma – rare, slow-growing malignant tumor that occurs in the spine and base of the skull
• Intercranial tumor --  located within or on the surface of the brain
• Meningioma --  benign tumor that develops in the thin membranes (meninges) that cover the brain and spinal cord
• Neurofibroma—benign tumor that  usually affects nerves that are close to the surface of the body, such as nerves of the skin or tissue just beneath the skin
• Schwannoma --- benign tumor that develops in the tissue that surrounds nerve fibers that transmit messages from the brain and spinal cord to the rest of the body

Questions and Answers

What are the symptoms of a brain tumor?

The symptoms of brain tumors depend on tumor size, type, and location. The most common symptoms of brain tumors are headaches; nausea or vomiting; changes in speech, vision or hearing; problems balancing or walking; changes in mood or personality; problems with memory or ability to concentrate; muscle jerking or twitching (seizures or convulsions); numbness or tingling in the arms or legs.  These symptoms are not definitive signs of a brain tumor.  Only a doctor can diagnose and treat the problem.

What is the difference between intraoperative MRI and MRI?

Magnetic Resonance Imaging (MRI) is used to visualize the internal structures of the body. MRI scans provide a very clear contrast between the different soft tissues of the body, making that technology especially useful for brain scans. However, MRI scans also have important limitations.  Standard MRI scans obtained before surgery cannot take into account the shifting of brain tissue that typically occurs during an operation.

Our state-of-the-art intraoperative MRI system gives BCH surgeons a real-time look at the patient's brain during all phases of surgery.

The iMRI unit is very different from a typical diagnostic MRI machine.  The latter is large, heavy and stationary. The compact, portable iMRI device is specialized for brain scanning in the operating room. It is positioned below the operating table and then raised and lowered by the surgeon as needed to take MRI scans of the brain during tumor removal.
The surgeon can review these real-time iMRI scans in the operating room, allowing him to determine if the entire tumor has been removed.

Why is iMRI so valuable for brain surgery?

Brain surgery is performed in extremely delicate tissue where surgeons often have a hard time seeing clearly.  A tumor can hide behind membrane folds, nerves or arteries. Brain tissue often shifts once the skull is surgically opened, which can conceal portions of a tumor. When tiny bits of tumor are missed during surgery, a patient may require a second operation or radiation treatments.

At BCH, we’ve minimized the risk of needing follow-up surgery or radiation by utilizing iMRI technology. The neurosurgical team can scan a patient’s brain in real time during an operation to verify that the entire tumor has been removed.
iMRI also helps our surgeons see the boundary between a tumor and normal tissue more accurately, letting the team remove tumors without damaging healthy tissue.  When iMRI is coupled with our advanced image-guided surgery system, our neurosurgeons can use computer guidance to navigate even more precisely through the brain.

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