Focused Brain Surgery
Brain tumors can damage speech, memory or gait depending on where it is. When a patient goes in for surgery, the doctor has to carefully remove the tumor while avoiding those same areas of function. A new tool helps them see their target better
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2002 Was a year of highlights for Chris and Tracy Schoettelkotte. Tracy graduated from law school. They were married.
Tracy Schoettelkotte
"We went on our honeymoon. It was great."
Then Tracy began to get severe headaches.
Chris Schoettelkotte
Tracy's husband
"I guess, I feel like December 24th, our life was basically perfect."
On Christmas Day, they went to the emergency room.
Tracy Schoettelkotte
Had brain tumor
"An hour and a half later, they were coming down and telling us that I actually had a tumor."
Neurosurgeon Raymond Sawaya says Tracy's brain tumor was two inches across.
Raymond Sawaya, M.D.
Neurosurgeon
M.D. Anderson Cancer Center
Houston, TX
"It is a tumor that originates from within the brain substance. So when this tumor grows, it is growing surrounded by brain tissue."
His challenge was to remove the tumor without damaging other areas. He used this new tool called a surgiscope. It combines medical images with images from a microscope.
Raymond Sawaya, M.D.
"I want to be focused on this point and just to be able to tell that to the microscope, and the microscope, which is hanging on the ceiling, to be able to rotate and focus on that point."
Patients recover more quickly and go home sooner than with standard surgery. Tracy's tumor was removed on New Year's Eve. Now her focus is not on cancer, but on their baby-to-be.
Tracy Schoettelkotte
"It happened to me at this time and there's a reason. And we just go forward with it and that's what we do."
Tracy will have her baby and then start chemotherapy. Doctor Sawaya says there are two keys with surgery when removing tumors, removing the entire mass and avoid causing any damage.
BRAIN TUMORS: According to the American Cancer Society, more than 100,000 cases of brain cancer are diagnosed each year. Although brain tumors may originate in the brain and spinal cord, they more commonly develop from cells spreading from a primary cancer elsewhere in the body. Doctors say the most important factor influencing treatment and prognosis is the biology of the tumor. Another factor is the location of the tumor. The brain is made up of areas of function. The ability to get to the tumor and to remove it while preserving the brain tissue around it depends in great part on the function of the brain immediately adjacent to the cancer.
Surgery followed by radiation is the standard treatment for brain tumors. Chemotherapy is also commonly used for primary brain tumors. "The current literature and our research show that prognosis is based on the amount of the tumor that is removed. Surgeons must reach a certain extent of resection, perhaps in excess of 90 percent, to make a significant impact on a patient's outcome, both in terms of length of survival and quality of life," says Raymond Sawaya, M.D., a neurosurgeon at M.D. Anderson Cancer Center in Houston.
SURGISCOPE: This new highly sophisticated navigational device allows doctors to perform image-
guided surgery. Prior to surgery, patients undergo an MRI scan, which locates the tumor and determines the function of the brain immediately adjacent to the tumor. Using the visual feedback from the scans, the SurgiScope helps surgeons navigate to that target without damaging critical areas of the brain. The goal of surgeons is to remove the tumor without damaging the area around the tumor.
M.D. Anderson is one of only six medical centers in the nation using the SurgiScope. The tool, which combines computer technology with a microscope to magnify the target for surgery in relation to the patient's anatomy, is mounted in the operating room. In some cases, simpler versions of the SurgiScope can be used without the robotically controlled microscope. In other cases, the surgeon may use only a Freehand Viewing Wand, a pen-like pointing instrument that provides 3-D computerized images of any portion of the brain, using scanned MRI or other images. Like the SurgiScope, the wand assists with preoperative planning and guidance during surgery.
Dr. Sawaya says, "It benefits patients by keeping them in good shape and providing them with the best results, and at the same time, removes the whole mass." If doctors can remove the mass only and leave surrounding rain tissue unharmed, he says the patient will have less swelling, fewer complications and recover more quickly.
The University of Texas
M.D. Anderson Cancer Center
Brain and Spine Center
1515 Holcombe Blvd., Unit 339
Houston, TX 77030
(713) 792-7728
http://www.mdanderson.org
Copyright © 2003 Ivanhoe Broadcast News, Inc.
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