HealthFirst

HealthFirst-Mapping the brain

Monday, July 27, 2009

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Leslie Toldo
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UNDATED (WJRT) -- (07/27/09)-- There is a new roadmap for the brain that allows doctors to go where they have not been able to before and save move lives.

HealthFirst reporter Leslie Toldo shows us how doctors are combining some of the best screening techniques to battle brain cancer.

The woman you are about to meet was told that her tumor was inoperable, but a new plan of attack gave her a second chance.

Newlyweds Stacy and Jeff Buzzard quickly learned the meaning of in sickness and in health. "It was just a few days after we were married that it got to the point that I couldn't do anything. I remember saying to my husband that I know I'm dying," Stacy remembered.

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She had a fist-sized brain tumor covering a quarter of her brain. "I remember screaming at home and telling him that it felt like someone was stabbing my eyes out."

Doctors designed a computer program specifically for Stacy using four different imaging technologies -- MRI, functional MRI, diffusion tensor imaging and CT angiography. Surgeons mapped out a 3-D image of the tumor and brain.

With this clear picture, the tumor went from inoperable to treatable because doctors could see vital vessels and maneuver around them.

Dr. John Tew is a neurosurgery professor at the University of Cincinnati Neuroscience Institute. "The size of the tumor was so large that I needed to know where the arteries and veins were located."

"This allows you to do basically sort of a virtual surgery before actually going in and doing the surgery on the patient," explained Dr. James Leach, an associate professor of radiology at the Neuroscience Institute.

Doctors removed 90 percent of Stacy's tumor without harming healthy brain tissue. She was talking and walking the same night. "It was a blessing. There's no question I saw it as a blessing," Tew said.

She had radiation and chemo to treat the remaining tumor, and has now undergone her final treatment.

"I'm really excited about the future and I feel really optimistic and positive," she said.

Having the images in the operating room allowed Stacy to be asleep for the procedure. Patients are often awake for brain surgeries.

Stacy will continue maintenance chemo treatments.

BACKGROUND: About 22,000 people are diagnosed with a malignant brain tumor each year, according to the American Brain Tumor Association. Although the very term "brain tumor" is scary to most, the American Cancer Society reports deaths caused by malignant brain tumors decreased by over 14 percent between 1991 and 2004. Researchers are still trying to identify risk factors linked to brain tumors. The only risk factor consistently associated with increased risk for brain tumors is exposure to ionizing radiation.

TREATMENT: Most adult brain tumors are diagnosed and removed through surgery. Initial surgery to diagnose a brain tumor is called a biopsy, and it's done by removing part of the skull and using a needle to remove tissue from the tumor. If cancer cells are identified in the tissue sample, surgery is usually the next step. Patients are usually given chemotherapy or radiation therapy following surgery to kill any remaining cancer cells.

RISKS: Despite advances in medicine, the brain will always be a risky place to operate. Risks of brain surgery include problems with speech, memory, muscle weakness, balance, vision and coordination; blood clots or bleeding in the brain; seizures; stroke; coma; infection; and brain swelling, or edema. One of the obstacles neurosurgeons deal with in brain surgery is avoiding blood vessels, which becomes more difficult in larger tumors. "If you don't know where the blood vessels are, you're in danger of damaging one," John Tew, M.D., Professor of Neurosurgery at the University of Cincinnati Neuroscience Institute in Cincinnati, Ohio, told Ivanhoe. "In this critical area, you could cause a complete paralysis, or certainly a major paralysis on the opposite side."

MAPPING THE BRAIN: To more carefully maneuver around vessels and other critical components of the brain, scientists and doctors have developed and adapted imaging technologies to create "maps" to prepare them for and guide them through surgery. Doctors at the University of Cincinnati recently combined images from magnetic resonance imaging (MRI), functional MRI (fMRI), diffusion tensor imaging (DTI) and computed tomography angiography (CTA) to create a 3D image of a patient's brain. They entered the 3D image into a surgical guidance computer, which surgeons could then use as a "GPS" to map out a safe route to the tumor. The image enabled the surgeons to see the tumor's relationship to the brain's functional centers, electrical pathways, arteries and veins to avoid damaging them.

For more information:
UC Neuroscience Institute
Cincinnati, OH
1-866-941-UCNI (8264)