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Highly Advanced Imaging Lets Capital Health Surgeons ‘Map’ Brain and Safely Reach Deep-Seated Tumors

Highly advanced imaging technology at the Capital Institute for Neurosciences is enabling neurosurgeons to “map” the brains of cancer patients as never before and surgically remove tumors once considered inoperable.

Dr. Arlan H. Mintz, director of Neurosurgical Oncology and Surgical Director of CyberKnife® at Capital Health, said planned, pre-operative trajectories that steer clear of critical brain tissue are allowing surgeons to now safely remove tumors deep within the brain.

“Our goal is to maximally resect tumors while preventing injuries to the brain,” Dr. Mintz said. “Up until most recently, we were not able to see important parts of the brain in a way that was helpful to the surgeon in the operating room.”

Advances in magnetic resonance imaging (MRI) on several fronts are giving neurosurgeons new insight into the brain.

Using functional MRI (fMRI), surgeons can map the brain’s so-called gray matter, which includes regions involved in muscle control, sensory perception, vision and speech.

Another type of MRI advancement is called diffusion tensor imaging (DTI). This allows surgeons to visualize the white matter tracts, or pathways that create neural connections between different parts of the brain.

In addition, High Definition Fiber Tractography (HDFT) estimates the pathways used by white matter tracts as they travel from one part of the brain to another. Dr. Mintz was among the first in the world to use HDFT images during an operative brain tumor resection.

“Before, the brain’s white matter looked like tapioca pudding. We are now able to identify neural tracts within the white matter that send messages to different parts of the brain. If you cut those tracks, you can lose function. These are very specific bundles we can see now,” Dr. Mintz said.

He operates using endoscopic and microscopic port surgery, guided by the new imaging technologies available at the Capital Institute for Neurosciences.

Advances to fight brain tumors are much needed. More than 600,000 people in the United States are living with a primary brain tumor —one that begins and stays in the brain — and more than 60,000 adults and children will be diagnosed with a brain tumor this year. Evidence indicates that patients live longer when more of the tumor is removed.

“This is not a cure for malignant brain cancer, but an important step to improve quality and quantity of life,” said Dr. Mintz.

He recalled a woman with a non-malignant tumor who was transferred from another hospital to Capital Health because the original surgeon did not believe he could operate without risking significant visual loss.

“We used our advanced technology to remove the tumor without disrupting the vision pathways. The woman’s vision is fine now, and she is doing great,” Dr. Mintz said.

Dr. Mintz joined Capital Health in 2012 from the University of Pittsburgh, where he was director of the University of Pittsburgh Medical Center’s Adult Neurosurgical Oncology program, one of the leading neurosurgery programs in the country.

He is also among the select group of neurosurgeons nationwide performing “awake brain surgery.” During “awake brain surgery” the neurosurgeon stimulates the area around the brain with small electrodes. The surgeon asks the patient to perform tasks, such as talking or looking at pictures to determine what critical areas of the brain must be avoided while removing the tumor.

Capital Health also plans clinical trials testing another pioneer brain tumor therapy, one that injects chemotherapy directly into the arteries that feed a brain tumor.

“The 90s were the ‘Decade of the Brain’,” Dr. Mintz said. “That decade set off research and started the flame that is still growing. Our efforts to fight brain tumors has benefitted from this explosion of research, interest and understanding of the brain.”

Appointments can be scheduled with Dr. Mintz by calling 609-537-7300.


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