Cincinnati Children's Neurosurgeon Develops Procedure To Operate on Previously Inoperable Brain Tumors
9-Year-Old Boy Doing Fine After Deep-Seated Tumor Removed
A neurosurgeon at Cincinnati Children's Hospital Medical Center has devised a new, minimally invasive procedure to operate on brain tumors and other abnormalities deep in the brain that were previously thought to be inoperable.
The technique, which uses sophisticated digital imaging and gradual inflation of a balloon catheter to gain access to portions of the brain that are important for vital neurologic functions, such as movement, language, and memory, could save the lives of thousands of children and adults each year.
On Tuesday, March 2, Kerry Crone, MD, director of Neurosurgery at Cincinnati Children's who is internationally renowned for pioneering endoscopic neurosurgery, successfully operated on Caleb Madison, 9, from Crescent Spring, KY, who had a thalamic tumor. The thalamus is located deep within the brain and serves as a relay station for all sensory and motor functions of the brain.
The procedure involved gently creating a pathway to the tumor. First, while the patient was under general anesthesia, Dr. Crone made a one-inch opening in the skull to gain access to the brain. Using computerized targeting, he precisely guided a tiny (1/8 inch diameter) tube, or catheter, to the tumor. The end of the catheter contained a deflated, cylindrical balloon.
Over the course of several days, the balloon was slowly inflated, which spread delicate nerve fibers in the brain and created a safe pathway to the tumor. The child was continuously monitored for any adverse reaction. Once the pathway was of sufficient size to allow for surgical removal, the child was taken to the operating room. Dr. Crone deflated the balloon and, through the small opening, surgically removed the entire tumor. Although the patient was under anesthesia, Dr. Crone believes the procedure can be done in older children and adults while they are awake, which allows for better patient monitoring.
Dr. Crone calls the procedure SMART surgery (Specialized Minimal Access Resection Techniques). This technique is one of many new surgical procedures offered by the Minimally Invasive Neurosurgical Division (The MIND) at Cincinnati Children's.
"The vast majority of surgeons would consider this deep tumor inoperable and would be either unable to operate or unwilling to operate because of the risk involved," says Dr. Crone. "They would have biopsied the tumor and recommended radiation treatments, but the tumor would have enlarged and resulted in this young boy's death. I believe we have surgically cured this child of his brain tumor."
What makes the procedure possible at Cincinnati Children's is the fusion of radiological technology and experience in surgical techniques. Prior to performing SMART surgery, radiologists use functional magnetic resonance imaging (fMRI) to map areas of the brain that control motor function using a new, ultra-high magnetic field strength MRI (3 Tesla) that provides images of the highest possible resolution. These images provide the ability to map nerve fibers and allow Dr. Crone to determine whether he can operate safely, as the potential for permanent paralysis is high.
"Preoperative planning with superior image technology coupled with image directed minimal access surgery allows us to achieve what most other medical centers cannot," says Dr. Crone.
Caleb's family first noticed a problem when he had swelling in one eye and was referred for a CT scan of his sinuses. When Cincinnati Children's radiologists reviewed the scan, they noticed a "low density" area in the thalamus, and, after an MRI, diagnosed the tumor. The actual resection of the tumor took about four hours. Just one day after surgery, Caleb was moving normally and gaining strength. He may or may not need some occupational or physical therapy.
Dr. Crone says the procedure is not only applicable to deep-seated tumors but also to other abnormalities in the brain, such as vascular malformations -- abnormal clusters of blood vessels that occur during fetal development. In fact, Dr. Crone has performed SMART surgery successfully on a few of these patients.
"This is definitely what you want to do," says Dr. Crone. "It's simple and it's conceptually logical. It's all in the planning."
You may view the press conference about this new procedure, which was broadcast live on March 12, 2004.
Contact Information
Jim Feuer, 513-636-4656,
jim.feuer@cchmc.org
