Paediatrics - Cook Children's Hospital


iMRI for precision brain surgery

Intraoperative Magnetic Resonance Imaging or iMRI is a process through which images of the brain are created while the surgery is being performed. Images generated by iMRI come to a surgeon’s aid while removing a brain tumour or such abnormalities.

The iMRI technology was implemented at Cook Children’s Hospital in 2007. Since then, the iMRI has aided Cook Children’s to revolutionize neurological surgery for patients from all over the world. The intraoperative MRI (iMRI) has been used to perform over 1,000 diagnostic scans in stereotactic procedures like deep brain stimulation (DBS), laser ablation, and tumour biopsies during surgery that have dramatically changed the lives of so many families.

For ease of convenience, an iMRI suite comprising of a surgical suite and an MRI scanner is available at the hospital. During a surgical procedure the MRI scanner can be moved over a patient and an MRI procedure can be performed during surgery without moving the patient. Surgeons are able to utilize special software that accurately maps areas of the brain to help them remove tumours, seizure spots, and other lesions. By providing timely information, the technology allows better-informed decisions and greater precision, reducing risk and the need for a second surgery.

Treating dystonia
Several milestones have been achieved by Cook Children’s with the help of iMRI technology. For instance, in September 2007, Cook Children’s Medical Center became the first free-standing children’s hospital to perform DBS in children with dystonia. Since the first implant, Cook Children’s has established itself as one of the elite paediatric DBS programs in United States with more than 113 patients to date. DBS is used to restore normal function in patients with physiological and movement disorders such as essential tremor, Parkinson’s disease and dystonia. DBS often provides phenomenal results in reducing muscle tone, improving function and preventing the progression of movement disorders to other areas of the body. It involves two parts: implanting electrodes into the brain and a pacemaker under the skin of the chest. Surgeons connect these two devices, and the pacemaker sends electrical impulses to the electrodes to disrupt the abnormal signals of the movement disorder. The two surgeries take place about a week apart. Following both procedures, the child is able to return home the next day.

In 2013, Cook Children’s Medical Center was declared as the first U.S. children’s hospital to offer asleep deep brain stimulation surgery to children suffering from dystonia. Now, intraoperative MRI and real-time intraoperative image guidance technology helps with procedure visualization so patients can remain asleep during surgery. The procedure works by first generating high-resolution images by the MRI scanner and sending them to a guidance workstation for review by the physician. Image guidance software allows the physician to find an optimal path from the surface of the skull down to the neurological target in the brain, identifying specific areas of entry and critical areas to avoid. As the surgeon inserts the interventional device, real-time images ensure no undesirable events take place and the target is reached.

There are less than 30 hospitals worldwide that offer real-time neurosurgical image guidance and procedure visualization technology. While not painful, the procedure has traditionally been performed while the patient is awake to test responses to impulses. However, the idea of being awake during brain surgery is understandingly troubling for some patients, and physically impossible for others. Asleep DBS increases patient comfort and decreases patient anxiety during surgery, and also facilitates treatment for patients who would otherwise not make good neurosurgery candidates, such as those with physical restrictions. Now, thanks to enhanced technology, patients can be under anaesthesia and asleep. This change in the treatment’s technique came with the addition of an iMRI. The iMRI allows neurosurgeons to have pinpoint accuracy while performing delicate brain surgery.

“With all the technology we have, I know I am in the exact spot I want to be,” said John Honeycutt, M.D., medical director of Neurosurgery at Cook Children’s “My accuracy for DBS is 0.5 millimetres.”

Laser ablation brain surgery
In May 2013, Cook Children’s Medical Center became the first children’s hospital in North Texas and surrounding states to perform minimally invasive laser ablation brain surgery in an iMRI suite. For many patients, this advanced surgical procedure means that doctors can treat certain areas of the brain that were once considered inoperable. Laser ablation surgery is an iMRI-guided, minimally invasive procedure that allows abnormal tissue to be thermally destroyed in real time. In fact, doctors can target problem brain tissue within a single millimetre, greatly reducing risk to surrounding tissue. Performing this surgery in the iMRI suite, helps doctors see the tumour or lesion and remove all of it in a single surgery. Most patients can go home within 24 hours and with only one stitch.

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Date of upload: 8th Jul 2016


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