Wolfson Children’s Hospital in Jacksonville, FL, performs pediatric iMRI real-time during child’s brain surgery
Technology allows pediatric neurosurgeons to perform MRI tests and surgery in one OR for enhanced patient safety and better outcomes
February 5, 2013
At the age of five, Rafael Arias was diagnosed with a medulloblastoma, the most common type of brain tumor experienced by children. Fortunately, pediatric neurosurgeons with Wolfson Children’s Hospital and the University of Florida College of Medicine—Jacksonville were able to treat his tumor successfully with brain surgery, a long course of chemotherapy at Nemours Children’s Clinic, Jacksonville, and an advanced type of radiation treatment called proton beam therapy at the University of Florida Proton Therapy Institute, available in only a few cities in the United States. Proton therapy allows pediatric neurosurgeons and radiation oncologists to treat the tumor without damaging the healthy tissue around it.
During a recent follow-up visit, Nemours hematologist/oncologist Eric Sandler, MD, discovered that Rafael’s brain tumor had returned. Although only an inch in diameter, the cancerous cells were in a place near the medulla and the brainstem, making it difficult to reach via surgery.
On January 17, 2013, Rafael (now 8 years old) was able to take advantage of new technology in a brand new neurosurgical suite at Wolfson Children’s Hospital. This technology, called iMRI (or intraoperative MRI), is available at just a few children’s hospitals nationwide, and was recently installed in the new neurosurgical suite. This was the first iMRI procedure to be done on a child in the region.
What makes the iMRI unique is that it allows doctors to take an MRI image of the brain immediately before surgery, in the same sterile OR, instead of doing the procedure ahead of time in a separate area. The pediatric neurosurgeon and surgical staff stabilize the child’s head and the child is “shuttled” on the operating table into the MRI machine, which takes the image, returns the child to surgical area. The images from the MRI are then downloaded into the image guidance system, enabling the neurosurgeon to navigate in the patient’s brain with the latest and the incision is placed. Following surgery to remove the tumor, the child is shuttled, while still under anesthesia, to the MRI for a second imaging procedure before he leaves the operating room.
“In Rafael’s case, there was a direct benefit of having an intraoperative MRI in the neurosurgical suite,” says UF--Jacksonville pediatric neurosurgeon Philipp Aldana, MD, chief of the Lucy Gooding Children’s Neurosurgery Center at Wolfson Children’s Hospital. “During his first MRI in the OR, we found that the tumor had grown larger in only a month. After removing the tumor tissue we could see in the first MRI, and while he was still in the neurosurgical suite, we did a second MRI scan to ensure we had removed the tumor. We saw a questionable area on the scan that indicated there might be more tumor cells remaining, so we brought him back on the OR table in the same procedure and resected the remaining suspicious tissue.”
Dr. Aldana adds, “I was able to give Rafael’s parents the hopeful news that I had been able to remove the entire tumor, giving him the best chance for a cure.”
Following his surgery and a brief hospitalization at Wolfson Children’s Hospital, Rafael is recovering at home with his family: father Rafael III, his mother Dottie, and his four sisters. Although he still has further treatment ahead of him, his family is hopeful.
New technology like the iMRI will give him the best chance for a longer life and a return to school and his busy life.