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Figure 1. Magnetic resonance images and 3D reconstruction (lower right) used for image-guided surgery show the brain tumor and zones for 1 mm (green sphere/circle) and 2 mm (yellow circle) accuracy. Blue circles surround external skin markers used to register the image space with the actual head of the patient, so that the images can be used to guide the surgeon through the antomy of the brain |
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Iowa City, 6-20-01
UIHC scientists and physicians in Radiology and Neurosurgery recently combined efforts to map brain function for surgical planning in a patient with a brain tumor. Thomas Gallagher, a visiting medical student from Loyola Medical School, working with John Haller, PhD (Adjunct Assistant Professor of Radiology), Timothy Ryken, MD (Assistant Professor of Neurosurgery), and Chris Barry, MD (Neurosurgery resident) helped provide functional magnetic resonance images (fMRI) of brain activity associated with hand movement. Functional MRI scans were used in the operating room to avoid damage to the motor areas in the brain responsible for control of movement.
The functional MRI mapping of motor activity in the brain was confirmed by electrical stimulation of the brain in the patient while he was awake during the surgical procedure. The motor region of the brain, which controls movement, was estimated by fMRI and electrical stimulation to be 1.5 centimeters away from the tumor, which was removed under image-guidance (Figure 1) . In addition, the images of brain activity were fused with anatomic views provided by MRI, CT and ultrasound (Figure 2). Ultrasound images were acquired during surgery to determine brain shift.
The surgical procedure was a complete success, and the patient's ability to move his limbs and appendages was spared with the help of functional imaging, while the bulk of the tumor was removed. Drs. Haller, Ryken and Tom Gallagher continue to work together along with MRI physicist Lizann Bolinger, PhD and others at UIHC to improve the techniques used to create maps of brain function used in image-guided surgery.
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