Although the brain is the most complicated organ in the human body, for years physicians have had a rough map of what each area does. However, each individuals brain is unique, leading to variations in the map. This, along with the complexity of the brain itself, has challenged neurosurgeons in the past as they seek to remove tumors or lesions without damaging parts of the brain unaffected by the tumor.
Physicians at the U-M Medical School are using three-dimensional images of the brain and a technique called awake brain mapping to operate with greater confidence to successfully remove brain tumors without affecting nearby portions of the brain necessary for vital functions.
The marriage of image guidance and brain mapping is one of the most monumental changes in neurosurgery in the last five years, says Oren Sagher, assistant professor of neurosurgery and of anesthesiology.
According to Sagher, the three-dimensional imaging tells surgeons where the borders of the tumor are, but it is the patientawake during the surgerywho helps provide an understanding of the functional areas of the brain near the tumor.
Together, imaging and brain mapping allow surgeons to be more aggressive in tumor removal while maintaining excellent patient safety.
Brain mapping provides assurance to the neurosurgeon that he or she can remove the whole tumor, or a large part of it, without producing any permanent neurologic deficit in the patient, says Erasmo Passaro, clinical assistant professor of neurology, and director of the Adult Epilepsy Laboratory. Sagher and Passaro are part of a surgical team that also includes Karen Kluin, speech pathologist.
The patient [who is sedated but awake] interacts with us as we stimulate areas of the brain near the tumor. The team tests the patient to see if the stimulation has interrupted brain function, Passaro says. For example, stimulating the brain where it controls feeling in the gums may cause the patient to experience a tingling in the gums or a tongue twitch. Language testing also is performed during brain mapping. The team looks for errors in the patients reading or naming ability. Those types of errors give us an indication that were within critical language areas, Passaro says.
Beth Pancost is a recent neurosurgery patient at the U-M. She remembers her brain mapping experience. My speech therapist was in surgery with me. I looked at pictures, repeated things and did spelling. The questions were really easy to answer, Pancost says. Pancost says she is grateful for the high-tech approach to brain surgery.