Pioneers in computer-assisted techniques for brain tumor surgery since the mid-1980s, the Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center's surgeons have extended the scope of operable brain tumors by using techniques such as:
- frame of frameless stereotaxy (to provide a fixed frame of reference to assist with computerized navigation for locating brain tumors)
- Skull base techniques
- Endoscopic surgery
- Computer-assisted brain tumor surgery
- Radiation implants
The precision surgical navigation systems by Cleveland Clinic's Center for Computer-Assisted Neurosurgery has resulted in substantial reduction of wound and neurologic morbidity, length of surgery, hospital costs, and length of stay for much benign and malignant tumor surgery. The brain tumor surgeons, who are interested in surgical navigation, work with the Department of Neurosurgery to use navigation equipment from several manufacturers.
In recent years, Cleveland Clinic neurosurgeons have continued the pursuit of cutting-edge brain tumor surgery technology with the advance use of intraoperative MRI. The newly upgraded device weighs only 1,300 pounds - a fraction of the weight of conventional units. During brain surgery for tumor removal the MRI is stowed below the operative field, or in a side room allowing many conventional surgical instruments to be used. When imaging is required, the magnets are raised into position, or roll in through embedded ceiling rails to surround the patient's head for up-to-the-minute scans. When not required during brain surgery, the imager is placed in a magnetically shielded cage in the corner of the room, or the unit rolls back into a shielded side room, allowing for the room to be fully used for conventional procedures. The systems have their own integrated navigation system, allowing the brain tumor surgeon to track and manage changes in the brain's shape during the actual surgical procedure, making more complete tumor removal possible in some cases than with navigation alone.
Our nationally renowned Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center was first in the world to test a new device known as NeuroBlate™ in humans that uses a specially designed laser probe to heat and destroy brain tumors. Based largely on favorable results from this trial, the NeuroBlate system earned Food and Drug Administration clearance for use in neurosurgery in May 2009.
In addition to piloting the testing of the NeuroBlate device, Burkhardt Brain Tumor Center physicians wanted to ensure that patients receive the highest-quality imaging available during brain surgery. The center was among the first worldwide to integrate the NeuroBlate system with advanced intraoperative magnetic resonance imaging (MRI) technology.
MRI scans produce detailed images of internal organs without the use of ionizing radiation. Our leading-edge MRI unit generates high-resolution images in real time in a neurosurgical operating room that incorporates the NeuroBlate system. This innovation allows physicians to see and direct the progress of tumor destruction as it happens, thereby increasing the likelihood that tumors will be completely treated.
Laser interstitial thermal therapy (LITT) transmits heat to coagulate, or “cook,” brain tumors from the inside out. This technology is not new in cancer treatment, but early approaches in the brain posed challenges which limited control and therefore benefit of the laser energy for tumors. With Monteris Medical Inc.’s NeuroBlate system, the surgeon can “steer” and monitor the effects of the laser beam, thus maximizing tumor cell kill while sparing surrounding healthy tissue.
Unlike conventional open surgery, this therapy is minimally invasive. It takes place with the patient in an MRI machine because the laser system is guided, positioned and monitored with MRI.
If NeuroBlate is appropriate for you, here is what will happen during the procedure:
- You will be placed under general anesthesia. With great precision, a thin, high-intensity laser probe will be inserted through a small hole in your skull, deep into your brain. The tip of the probe emits laser energy sideways, heating and destroying brain tumor tissue in one direction while cooling to remove heat and protect normal tissue in neighboring areas.
- Each burst of laser energy lasts from 30 seconds to several minutes or more. The laser generates heat up to 160 degrees Fahrenheit, which is sufficient to coagulate and kill the tumor cells.
- On a computer screen, your surgeon will monitor the tumor destruction as it occurs. He or she can remotely plan and control the procedure, steering heat directly to tumor tissue. An advance known as MRI thermometry measures temperature in and around the tumor, which, in conjunction with special software, provides valuable feedback to the surgeon throughout the procedure.
- After surgery, you will remain in the hospital for one or two days, which is typically half the time you would have been hospitalized after conventional surgery.
- Any type of brain surgery poses some risk. The most common risk with NeuroBlate is some temporary swelling around the treated area, which usually is managed with medication.
Why Choose NeuroBlate?
In the hands of the Burkhardt Brain Tumor Center’s skilled, experienced neurosurgeons, the NeuroBlate system offers hope to brain tumor patients whose treatment options were limited. This thermal therapy:
- When compared to even the most minimally invasive open operations
- Is less invasive
- Enhances patient safety
- Promotes quicker recovery
- Has the potential to help some patients whose tumors had been considered too risky to treat, whose tumors did not respond to alternate treatments or who had otherwise been deemed poor candidates for surgery
- May offer a therapeutic option when radiosurgery fails
- Has the potential for multiple treatments
The combination of NeuroBlate with our intraoperative MRI capability streamlines the procedure within a single room. Conversely, at sites without this upgrade, the surgical portion is done in a conventional operating room and the patient must be transported to a diagnostic MRI suite and this may limit the number of penetrations of the laser into the tumor and hence, reduce the success of treatment. At Cleveland Clinic, the integration of technologies represents a significant advance in patient safety and reduced procedure time.
State-of-the-art imaging technology in the operating theater. This portable MRI enables scans to be performed during the operation.
This system will provide the surgeons with more robust capabilities to navigate through the brain, provide more flexibility in patient positioning and selection, and allow us to merge high-resolution preoperative images with those acquired in brain tumor surgery. Also, the advanced design of this brain surgery system produces intraoperative images of great quality.
These technologies allow for brain surgeon leadership in an important new procedure for delivering certain drugs to brain tumors - convection enhanced delivery - where drugs are slowly, continuously pumped through the brain substance over days. Cleveland Clinic brain tumor surgeons work closely with companies such as BrainLab and NeoPharm to develop this new field in terms of safety and efficacy.