Image guided brain tumour surgery Surgery for BRAIN TUMOURS is always surrounded by an aura of fear owing to the risks involved. Removing as much tumour as possible is very important, as in some types of brain tumour this can help patients to live longer and have a good quality of life. However, removing a brain tumour may in some cases be difficult because the tumour either looks like normal brain tissue or is near brain tissue that is needed for normal functioning.
Over the years, Neurosurgery has gone through several changes in terms of technique and technology, today, we are able to remove brain tumours that were once considered inoperable due to their size and/or location by the use of computer technologies and other imaging advances in the operating room which has helped doctors perform safer and less invasive procedures. Like Global Positioning System (GPS), image guided surgery systems use infrared cameras or electromagnetic fields to capture patient’s anatomy and the surgeon’s precise movements in relation to the patient, and relays them to computer monitors in the operating room. This helps the surgeon to orient himself with three-dimensional images of the patient’s anatomy including the tumour.
Advantages of image guided surgery:
- Measure the position, size and location of a patient’s brain tumour in relationship to the structures in the brain and plan the desired access.
- Plan the location of the craniotomy (area of bone to be removed) in relationship to the brain tumour.
- Track the surgical instruments in relationship to the patient’s brain and tumour itself Improve extent of tumour removal, improving survivability and quality of life.
- Avoid redo surgeries.
- Early detection of complications occurring during surgery.
Imaging interventions used during surgery included:
- Intra op Magnetic resonance imaging (iMRI): Intra op MRI is a useful tool to access the amount of residual tumour. To use MRI technology, the patient is moved from the operating room to an adjacent room, where MRI is performed. The images are transferred concurrently to the navigation system which enables the surgeon during surgery to assess the amount of remaining tumour, if any. This helps the surgeon to perform total resection of the brain tumour, which gives a better survival and prevents redo surgeries. Aster RV is only one of the very few centres in INDIA to have this technology.
- Neuro navigation guided resection: Neuronavigation helps neurosurgeons to precisely localize different intracerebral pathological processes by using a set of preoperative images to map out the location of a tumour, which was then used at the time of surgery to guide the surgery.
- Fluorescence guided surgery: Fluorescein is a dye which when injected into the blood is taken up by few brain tumours especially high-grade gliomas, metastasis, meningiomas etc. and when these brain tumours are viewed under specific light conditions (yellow filter), using a microscope the tumour glows in relation to the surrounding normal tissue, guiding the surgeon to differentiate between normal brain tissue and tumour during surgery.
- Intra op ultrasound: Ultrasound is a useful, cost effective tool that can be used during surgery, to obtain real time images of brain tumours during surgery to assess the extent of removal of tumour and to detect any residual tumour during surgery. This helps the surgeon to remove the tumour maximally and safely