The neurosciences service at Medanta has started using advanced Brain Suite system in Asia-Pacific. This system permits the neurosurgeon to have an MRI study on the patient during surgery, and if tumour has remained which was hidden to the human eye, can be detected by special MRI sequences, and can be targeted using neuronavigation (which works on the same principle as the GPS system). Further, tumour fluorescence can help detect small bits and pieces of tumour that may otherwise be likely to be left behind. All this while, the microscope display digitally outlines the critical brain areas, critical nerve fibers, and also the outline of the tumour. This has permitted an aggressive removal of highly malignant brain tumours, which will enhance the survival.
Modern medicine is rapidly moving away from standardised approaches, basically the 'one size fits all' approach. The revolutionary concept of personalised medicine is here to stay. There are two important aspects, as far as brain tumours are concerned.
First, molecular medicine has shown that any two tumours looking the same on imaging do not look the same at surgery or even under the microscope when being examined by a pathologist. Further, two tumours looking similar on the microscope do not look alike, when examined for their molecular signatures. Some of these molecular signatures have the potential to indicate the likely response a tumour would have to radiation and chemotherapy.
Second, there is general agreement in medical literature that the attempt has to be to remove the brain tumour totally, or almost totally, within limits of preserving important brain functions like movements of limbs, speech, language and vision. This requires a quantum leap in surgical technology that enables the neurosurgeon to peel away the entire tumour, while not damaging critical brain areas. Such a technology is being unveiled at Medanta Medicity in Gurgaon.
Dr AN Jha, who is a pioneer in the MRI guided brain tumour surgery in the country, said, "The surgical methods have themselves undergone a silent revolution. At Medanta, a team approach helps us neurosurgeons and oncologists working together to determine the best approach for a particular patient. For example, some patients may require microsurgery for removal of the tumour. Others may require an endoscopic approach, or a stereotactic biopsy. Certain tumours can be treated with single session precisely delivered radiation, called as radio surgery. We are privileged to have a multi-disciplinary team with several neurosurgeons who are known experts in all these approaches."
The success stories are many. Take the case of a patient who developed a large tumour in his pituitary gland. This tumour was removed by a team comprising of an ENT surgeon and two neurosurgeons. Using a combination of approaches, the tumour was thought to have been removed. An intraoperative MRI revealed a part remaining on the right side, which was removed, resulting in total removal of the tumour.
Another patient, a 60-year old gentleman, developed forgetfulness and headache. MRI showed a large malignant brain tumour. He was subsequently operated, and BrainSuite helped in the total removal of the tumour. He looks forward to an extended survival, and is currently on appropriate chemotherapy and radiation therapy guided by a molecular analysis of his tumour specimen.
Dr Jha said, "We want to emphasise that true team-based use of appropriate technology is the only way to achieve world-class patient outcomes, and we are glad that Medanta provides us with the means of pursuing this dream."
The key advances in the Miyabi Brain Suite:
* Two-room concept enables us to do scan one day before and do detailed planning (in earlier machine patient would need to come inside OT, compromising sterility) as this is in separate but adjoining room.
* Latest MR scanner, enabling high-resolution images in as little as 5 minutes, helping saving time and reducing infection.
* Larger bore magnet allowing intraoperative MRI in different positions of the patient.
* Ability to perform a complete range of MRI sequences.
* Advanced patient head rest allowing larger variety of surgical procedures.
* Digital projection of tumour and nerve fibre tracks onto microscope view.
* Advanced Pentero microscope with tumour fluorescence capability.
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