India’s first 3T Intraoperative iMRI at Yashoda Hospitals

A revolution in brain surgeries has begun in India. The Yashoda Hospitals Group has installed India’s first 3T Intraoperative MRI which has made brain surgeries unprecedentedly accurate, safe and avoided the need for multiple resurgeries recently. This most advanced iMRI helps to change the way current brain tumour surgery is performed and emerged as an important support for CNS tumour treatment. Furthermore, the ability of MRI to successfully couple with functional imaging (Perfusion and DTI Fibre track Imaging) neuroendoscopy and therapeutic devices, such as focused ultrasound is improving brain tumour therapy and outcomes. Taking advantage of iMRI facility surgeons at Yashoda Group of Hospitals have completed 100 complicated Brain surgeries during the last couple of months.   

Neurosurgery has always been feared for risks involved to life and function of body parts as the brain controls the whole body. Microscopes in Neurosurgery made it safer and effective to do delicate surgeries on the minute brain structures.  However, watching under a microscope surgeon could only visualise a part of the brain and to plan and reach deep structures was difficult and filled with risks. Neuronavigation was a big help with the ability to plan on preop 3-D images on the patient. It also helped in locating the surgeon’s position in the brain while operating, like a modern GPS system. Navigation gives only anatomical location and not functional information of the visualised brain. Using Intraoperative Electrophysiological Monitoring like NIM Eclipse monitor, one could also map the functional areas of the brain and preserve them from damage during surgery.

Yashoda Hospital already has state of the art PENTERO D900 high-end microscope, Fully equipped advanced Medtronic Navigation system, and NIM Eclipse Neuromonitoring for safe and effective neurosurgery. However, there are problems due to limitations in all these modalities. Microscope not only provides good lighting and visualisation but can also be integrated with Navigation providing the precise location of the site of surgery. However, the microscope cannot help differentiate between normal and abnormal tumour areas easily, as some tumours appear like normal brain under the microscope. In a blood-filled area, it becomes even more difficult to make the differentiation. Navigation could help here but brain being a soft structure is subject to “shifts” once we start the operation, This makes navigating with preop images not very useful. This makes it necessary to have some form of intra Op imaging to accurately guide the surgeon to make the surgery safe and effective by revealing the remaining tumour or normal margins correctly.

Traditionally the patient who underwent an MRI scan before the surgery and based on these images the surgery is performed. Post op MRI is again done the next day. If found incomplete, the patient may need a repeat surgery. With intra op MRI (iMRI) the MRI scan is done during the surgery itself before closure, confirm if the surgery was performed as planned. In case any residue is found the patient is subject to further surgery to completion.

Mr.Ravin Kapadia(34) a Software Engineer from UP state is among first to get surgery for a brain tumour (Left frontotemporal craniotomy) with the assistance of iMRI. He was operated on 4th October last and was discharged on the 5th day after surgery. Mr Kapadia has completely recovered and now leading totally normal life. Mrs.Vajramma(72) came to the hospital with a chronic headache and was operated on 9th October iMRI has shown that there was a residual tumour and surgeons continued the operation and it completely removed. Even at this advanced age she could recover quickly and was able to get discharged within a few days and now completely relieved of a headache. Yashoda surgeons could handle a very complicated tumour for Mr MK Gandhi (65) successfully.He was suffering from Progressive loss of peripheral vision because of a brain tumour. At the end of the surgery, he was scanned with iMRI which has revealed residue of a tumour and with operation continued to remove even that small residue tumour. He was discharged and totally recovered now. Mrs Paly Banerjee(59) from Ranchi (Jharkhand state) who was suffering from a cancerous brain tumour (Left Frontal Recurrent Gloma) came to Hyderabad for removal of a tumour. With assistance iMRI, brain surgeons at YGH could successfully remove the tumour completely. She was operated on 29th of Dec. and discharged within five days.

The iMRI gave neurosurgeons real-time views of the brain during surgery. It was used by the neurosurgeons to visualize the patient’s brain during surgery without the need to move the patient out of the operation theatre area.This cutting-edge technology helped to create accurate pictures of the brain that guided the neurosurgeons. Allowed them to detect abnormal tissues and remove brain tumours safely and effectively in a single setting. “The brain often shifts during a surgery, which makes pre-surgical imaging inaccurate. Intraoperative MRI gives us the most accurate real-time images of the brain,” said Dr.Anandh Balasubramaniam, Senior Neurosurgeon at Yashoda Hospitals. This will distinguish normal brain tissue from abnormal brain tissue. Differentiating the edges of a brain tumour and separating the normal tissue from abnormal tissue is a difficult task. Intraoperative MRI helps to confirm that the entire brain tumour is removed completely and safely.

The operating theatre at Yashoda Hospitals Neurosurgery department is specially designed and equipped with the most technically advanced iMRI, which uses the highest quality scanning sequences for up-to-the-minute images. “We at Yashoda Hospitals give the highest priority to acquire latest, state of the art technology which can give patients faster, longlasting relief from their ailments. Our surgeons who have trained and have worked with prestigious international & national medical centres are making the best use of these facilities to give best of the best results to patients,” said Dr G. S. Rao, Managing Director, Yashoda Group of Hospitals.

Who can benefit with iMRI? The Intraoperative MRI can benefit greatly Patients with a Brain tumour, Parkinson’s disease and movement disorders- (deep brain stimulation surgery) Pituitary tumours, Pediatric brain tumours, Epilepsy surgery etc. Greater precision is provided to the surgeon by integrating the MRI imaging and the operating room navigation to ensure that a complete tumour is removed without damaging any healthy tissues. Real-time imaging is possible so the patient does not need to undergo multiple operations or treatments to control if any tumour has not been removed completely.Neurosurgeons Dr B.J. Rajesh, Dr.Savitr Sastri, Dr Venugopal, Dr Srinivas Botla who were also present and explained features of iMRI.

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