The brain is responsible for our essential functions – including movement, language, and sight – and many of the areas that help define us – such as our thoughts and emotions. Because of this, there can be high risks for surgical procedures involving the brain. For patients with brain tumors, however, surgical removal of the tumor is typically the first line of treatment.
“Nearly 80,000 people this year will be diagnosed with a primary brain tumor, affecting people from childhood to the last years of their lives,” said Dr. Alexandra Golby, Director of Image-Guided Neurosurgery at Brigham and Women’s Hospital. “Advances in image guidance have changed the landscape of neurosurgery and have enabled us to address some of the key challenges that we face during surgical treatment of brain tumors.”
Navigating Critical Areas
Because it is important to preserve as much normal brain tissue as possible while removing the tumor, precision is vital. One of the biggest obstacles is distinguishing normal brain tissue from brain tumor. With the naked eye, these appear almost identical. Brain tumors can also infiltrate normal brain tissue, making it even more difficult to ascertain clear margins during surgery.
In the Advanced Multimodality Image Guided Operating (AMIGO) suite at BWH, Dr. Golby uses advanced imaging techniques, including MRI, CT, PET, and other technologies to plan surgical procedures and guide the removal of brain tumors. Fusing images from different technologies aids in identifying and navigating structural and functional areas of the brain, making a clear map of where critical parts of the brain are located. Functional areas of the brain can be determined with the patient awake in the operating room, performing tasks such as speech and movement.
The position of the brain also can change as brain tumor tissue is removed during surgery. The phenomenon is called brain shift. Even a few millimeters of movement can make a big difference. Dr. Golby and her colleagues are studying ways to measure brain shift as it is happening. For example, by using a handheld ultrasound probe, Dr. Golby can obtain an updated image of the brain and how it is shifting during surgery.
“Together, these advances help us provide the most precise treatment and deliver the best possible outcomes for each patient,” said Dr. Golby.