International Physician Update

Now in Place, New Intra-Op MRI Proves Its Worth

Daughters Zarah and Celeste speed Steve Brooks' recovery after brain tumor surgery.

Though slow-growing, the tumors in the brain known as craniopharyngiomas can be exceedingly difficult to remove completely.
The lesions stretch into tissue near the hypothalamus and the skull's sella turcica, the bony niche that houses the pituitary gland. That makes clean removal difficult. As tumors spread, second or third surgeries are not uncommon.

But at Hopkins, a new MRI—a compact, operating-room version of the imaging device—is shifting craniopharyngioma outcomes, and that of other tumors such as low-grade gliomas, to patients' favor. The device essentially delineates what needs removing. “Our intraoperative MRI has been in use less than half a year,” says neurosurgeon Alessandro Olivi, “but we already see tumor removal is far more thorough.”

Take the story of Steve Brooks, 42, a recent patient of Olivi’s. Three years ago, the husband and father had become leaden with fatigue. Endocrinologists at his local medical center said he had low thyroid hormone. “I did,” Brooks says, “but nothing seemed to correct it.”
Scans at a nearby hospital suggested a pituitary tumor, and Brooks underwent surgery via the transsphenoidal approach: through the nose, sinus roof and floor of the skull to the sella. The fact that the tumor turned out to be a craniopharyngioma wasn’t troubling. He still felt fine afterward.

But within months, Brooks had problems driving. “I would head down the road and the painted lines would cross.” Also, his peripheral vision was suspect. It was clear that the regrowing tumor threatened his sight. When Brooks came to Hopkins, Olivi scheduled immediate surgery—a right fronto-temporal craniotomy—to save the man's vision. A second transsphenoidal surgery would have provided total access, Olivi explains, but was risky so soon after Brooks’ earlier operation.

“My goal was to relieve the pressure on the optic nerves,” says Olivi, though he knew some tumor would remain out of reach.

This April, with Brooks’ vision fine and his previous surgeries healed, Olivi went back for the rest. But this time, he had the intra-op MRI at hand. In a newly refitted and shielded OR, the machine’s magnet snapped into place hydraulically from beneath the operating table, cradling Brooks’ head for a pre-op scan.

“Seeing what the MRI enhanced let me evaluate the margins of the tumor and possible residual tissue,” says Olivi. “Before closing, we again raised the magnet and scanned the surgical site. It was clean. And follow-up MRI with the higher-resolution hospital scanner the next day confirmed it.” As for Brooks, who's back at work, the photo above says it all.