UCLA ushers in new era of neurosurgery

Monday, November 16, 1998

UCLA ushers in new era of neurosurgery

INNOVATION: Viewing brain during operation gives doctors best
way to evaluate progress

By Teresa Jun

Daily Bruin Contributor

Until about a month ago, Patricia Ullrich had no idea a
cancerous tumor was developing in her brain.

When doctors finally located it, they told her the tumor was
inoperable because it was so close to the brain’s primary motor
area.

The risk of disturbing the motor strip while removing the tumor
– which potentially could paralyze the right side of Ullrich’s body
– was too high, doctors said.

But just three weeks ago, Ullrich came to the UCLA Medical
Center to undergo surgery in the new interventional magnetic
resonance (iMR) surgical suite and came out with her brain tumor
successfully removed.

UCLA’s new iMR suite – one of only three in the nation, and the
only available in the western United States – makes it possible for
surgeons to remove a complete tumor during a single operation,
while protecting areas adjacent to the tumor.

Traditionally, surgeons would perform follow-up operations to
remove traces of a brain tumor, missed during the first operation,
that would show up on the magnetic resonance imaging (MRI) images
taken the next day.

With iMR technology, doctors no longer have to wait until after
the surgery to assess tissue status and degree of removal.

A screen next to the operating table shows real-time MRI images
throughout the surgery. This allows the surgeon to see and remove
more of the diseased tissue without disturbing healthy areas of the
brain.

This makes the risk of additional operations virtually
unnecessary, and in the case of Ullrich and her tumor, allows
doctors to operate safely in sensitive areas of the brain.

"He could see where there was still tissue before he closed me
up, instead of having to go back in (to surgery) the next day,"
Ullrich said.

"It’s really amazing. It saved me another surgery," she added.
"And it’s going to save a lot of other lives and unnecessary
surgeries."

According to Dr. Gregory Rubino, the UCLA neurosurgeon who
organized the iMR project and performed Ullrich’s surgery, "This
new method is safer because we can constantly check the patient’s
brain while taking out the tumor."

During an operation, both the tumor and brain tissue is
"reassessed every 15 minutes, and before we close the patient, we
can verify complete removal," Rubino added.

This technology involves more than just placing a million-dollar
MRI scanner in an operating room. The entire room is specifically
designed to be compatible with the magnetic field of the
scanner.

Due to the sensitivity of the MRI machine, lead and iron-based
equipment are not allowed in the room, meaning most of the
instruments and furniture must be made from plastic and
titanium.

Despite the expense and excruciating care and detail that went
into creating the iMR surgical room, the project (funded primarily
by research grants) is worth it because it represents a "big step
in neurosurgery," said Anna Wang-Mathieson, neurosurgery specialty
coordinator in the operating room.

"It’s a big advancement," she said. "An MR is a picture of
what’s going on inside (the patient). If something happens, we’ll
know right away."

This breakthrough was the next natural step in the evolution of
MR-involved surgeries, according to Rubino.

Previous methods involved imperfect resolution and a two-room
model, Rubino said.

The current model, involving new instruments and a "fringe
field," or low magnetic field, allows the patient to be operated on
just a few feet away from the MRI machine and then periodically
slid into the magnetic field for images as necessary, Rubino
explained.

Typically, an MR image is produced on the eve of a surgery to
provide a map of the tissue and affected area during the
operation.

"But there can be problems because when you’re operating, stuff
moves around and changes," Rubino said.

The iMR suite avoids these kinds of problems by providing a
minute-by-minute assessment of what’s going on.

Though the room was designed mainly to accommodate brain
surgeries, Rubino thinks the technology will appeal to surgeons of
other specialties as well.

"Other surgeons would want the added safety factor," he said,
citing vascular surgery as an example.

"It’s the next step in seeing because you can see beyond the
surface. It’s like you can see into the brain," he said.

Two other such surgical setups currently exist in the United
States at the University of Minnesota and Case Western Reserve
University in Cleveland, Ohio.

It may be a while before this new technology becomes more
universal, however.

"It would be an expensive dream to have it at all hospitals, but
maybe they could be introduced at major academic institutions
located strategically throughout the United States," Wang-Mathieson
said.

"With it, we can always see what’s going on during the actual
surgery," she added. "It’s a dynamic process. That’s the beauty of
it."CHARLES KUO/Daily Bruin

Patricia Ullrich, front left, and Oswaldo Favero had brain
lesions that were successfully removed, thanks to the iMR suite, a
futuristic operating room whose development was spearheaded by UCLA
neurosurgeon Dr. Gregory Rubino (background).

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