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Neurosurgeons at Cincinnati Children’s have the opportunity to use advanced and unique technology such as the BrainSUITE operating room with intraoperative MRI that allows for the removal of certain deep-seated tumors and other lesions of the brain previously thought to be inoperable.
One of these techniques that involves minimal blood loss, pain and scarring in combination with special computer guided navigation is called SMART (Stereotactic Minimal Access Resection Technique) surgery. SMART surgery, which was pioneered by Kerry Crone, director of the division of neurosurgery, allows our neurosurgeons to implant special temporary balloon catheters into the brain using stereotactic computer guidance to create a small tunnel to allow for safe removal of tumors and other lesions in areas of the brain that were previously though t to be inoperable. This is one of the major areas of focus of the minimally invasive neurosurgery division (MIND), also led by Crone, which seeks to explore new techniques for removing tumors, blood clots and other lesions by minimizing trauma to the surrounding tissues.
The entire minimally invasive neurosurgery division (MIND) evolved as a result of years of groundbreaking research by Crone and colleagues from around the world as they explored the use of an endoscope to treat a variety of neurosurgical disorders that, at the time, required doing “major” surgery. These techniques of minimal access surgery have also been utilized to operate on blood clots, abscesses, hydrocephalus and congenital cysts, such as arachnoid cysts, of the brain. They are becoming a standard part of the approach to surgical treatment of craniosynostosis, whereby early fusion of the plates of the skull can now be corrected with very small incisions and implantation of small metallic springs to guide the skull to as it grows into a more normal, cosmetically acceptable shape. Thus, we are able to offer our patients an alternative to what may have been considered “standard” surgery 10 or 20 years ago for many neurosurgical conditions.
The neurosurgical operating suite at Cincinnati Children’s was the first of its kind in a pediatric institution in the United States. It features an intraoperative MRI with an integrated neurosurgical microscope and stereotactic guidance system as well as a specialized bed that allows for safe intraoperative imaging of the patient while maintaining sterility of the operative field. Multimodality intraoperative imaging and monitoring of normal neural pathways is used to optimize safety of surgical manipulation and tissue resection during treatment of such lesions as Chiari malformations and brain and spinal cord tumors.
Our pediatric intensive care units provide access to the latest technology for monitoring and treating the critically ill patient, including portable bedside CT scanning, along with family-centered, team-oriented care coordinated by a critical care specialist working closely with our neurosurgeons. Patients of the Comprehensive Epilepsy Center can undergo perioperative continuous video EEG monitoring in the intensive care unit as well as on our neuroscience unit, in addition to metabolic, anatomic and neurophysiologic multimodality studies that supplement surgical localization for resection of seizure foci in patients with intractable epilepsy.
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