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Brain map ups chance of successful surgery

July 24, 2009 12:00:00 AM PDT
The brain is one of the most delicate places to operate, and sometimes surgery to remove brain tumors is too risky. But doctors have created a better roadmap of the brain to guide them with precision through surgery. For one woman it gave her an option when others told her it was too late. 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, 'I know I'm dying,'" said Stacy.

Stacy 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," said Stacy.

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 3D image of the tumor and brain.

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

"The size of the tumor was so large that I needed to know where the arteries and veins were located," said Dr. John Tew, Neurosurgery Professor, University of Cincinnati.

"This allows you to do basically sort of a virtual surgery, before actually going in and doing the surgery on the patient," said Dr. James Leach, Associate Professor of Radiology, University of Cincinnati 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," said Dr. Tew.

Stacy had radiation and chemotherapy to treat the remaining tumor. During her last treatment Stacy says she hopes it will be the beginning of a new life.

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

Stacy is on maintenance chemotherapy five days per month and her doctor says she has responded exceptionally well to treatment.

Web extra information

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," said John Tew, M.D., Professor of Neurosurgery at the University of Cincinnati Neuroscience Institute in Cincinnati, Ohio. "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.

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