New Hi-Tech Images Guide Surgeons' Hands
There are some worries surgeons don't share with patients before an operation. That they are going into the body blind, while carrying a sharp knife, is one of them. "It's kind of like a labyrinth. You can only see right in front of you, but not around the next bend," says Alexandra Golby, a neurosurgeon at Brigham and Women's Hospital in Boston. Adds Christopher Moir, a pediatric surgeon at the Mayo Clinic in Rochester, Minn., "You hope the structures look like what you've seen before, but you really don't know."
How can this be, in an era where high-tech scans with fancy names like computed tomography and magnetic resonance imaging give unprecedented views of the inner human body? The big reason, surgeons say, is that most scans omit crucial information. MRI and CT images that show the shape of body parts, for instance, don't capture unhealthy electrical activity or blood flow there; the section of a heart causing a dangerous rhythm, for instance, can look just like normal heart muscle. And because most scans are done before surgery, they don't provide the real-time detail that would allow Golby, say, to shift a cut left or right by a millimeter or two–a move that can make the difference between safely removing a brain tumor or stealing a patient's speech.
Now, however, imaging is getting a whole new look. New and powerful computer programs can meld detailed images of anatomical structure with vibrant views of the structures in action, making the invisible visible–and treatable. "Matching these images to one another accurately is the key. It's making a lot of impossible things possible," says Richard Robb, a pioneer in the field who runs Mayo's biomedical imaging lab. Robb has developed scans that reveal abnormal spots of electrical activity causing epileptic seizures in the brain, allowing surgeons to zero in on those points and remove them from patients for whom, previously, surgery would have posed too great a risk. In experiments, combining multiple scans into one easy-to-read image has pinpointed deadly, rapid heart rhythms, too–and may turn a dangerous six-hour repair procedure, much of it spent poking around looking for the abnormal activity, into a relatively simple one- to two-hour job.
Doctors have also moved MRI from pre-op to the surgical table, where real time scanning gives ongoing views as the operation progresses. Already, the technique is making brain surgery and prostate cancer surgery more precise and leading to better treatment. "This really is the dawn of a new surgical era," says Michael Schulder, a neurosurgeon at New Jersey Medical School University Hospital in Newark who uses MRI during tumor surgery. "We're taking a lot of the guesswork away."
An Epileptic's Story
Michael Hutton certainly hoped for better than guesswork when surgeons cut into his brain in 2004 to battle his disabling epileptic seizures. "I told the doctors that I didn't have a lot of extra brain," says the 45-year-old from Chippewa Falls, Wis. "So I couldn't afford for them to take out the wrong spot."
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