New MRI helps surgeons operate on shifting brain
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By MARK ANDERSEN / Lincoln Journal Star
LaVonna Baehr pulled into a Beatrice driveway, shifted her car into park and lapsed into a seizure.
She looked at her shaking hand. Thought, why are you doing that?
And then, I’m having a stroke.
She turned toward her 3-year-old grandson, Kai Mayfield, in the car seat behind her, and then she bit her tongue hard and passed out.
She awoke in a Beatrice emergency room to news she had an egg-sized tumor beneath her right temple. And no, she insisted, she had never experienced blurry vision or headaches. Nothing.
The seizure hit the retired 70-year-old long-distance phone operator Aug. 20.
Surgery to take out the tumor came Sept. 20 at BryanLGH Medical Center West, where Baehr became one of the first Nebraska patients to undergo brain surgery with the aid of an intraoperative MRI.
Neurosurgeons say it’s not just cool and expensive technology, but useful — one that will improve results for the 40 or 50 patients who need it each year.
“For the people who need it,” said Dr. Christopher Kent, “it should help to extend lives.”
People tend to consider their brain a link to Aristotle, to reason. Neurosurgeons view it as 3 pounds of gray tofu.
In the unhealthy parts, its consistency is sometimes closer to that of toothpaste.
It squishes around inside the skull. Pop a brain cyst or take out an egg-sized tumor, and the tofu shifts.
The iMRI, as surgeons call it, creates real-time, 3-D images during surgery, so the doctor’s road map shifts with the shifting brain.
The $1.6 million device is the first of its kind in the state and among the first 50 in the nation, Kent said.
It was bought for BryanLGH’s Gogela Neuroscience Institute with $1.2 million from funds donated to the Lincoln General Hospital Foundation, now merged with the BryanLGH Foundation.
One of the largest gifts ever given to the hospital, the money was earmarked for use at the hospital’s west campus, the former Lincoln General, said BryanLGH spokeswoman Suzanne McMasters.
When the device arrived mid-summer, the iMRI required a complete change in surgical tools because of its strong magnetic field.
Unlike traditional MRIs with large electromagnets, Medtronic’s Pole Star iMRI uses permanent magnets. Not as powerful, they’re still capable of erasing credit card and iPod data from a yard away.
Kent said surgeons use more traditional imaging technology to plan their surgical approach. They then use technology developed about a decade ago to orient that road map to the patient.
The iMRI takes surgical precision to the next level.
The device is used primarily in the removal of brain tumors.
The goal there, Kent said, is to remove as much tumor as possible while leaving as much healthy brain as possible. Sometimes, he said, there’s a clear border between tumor and brain. It’s like a yoke in a hardboiled egg.
At other times, tumor and brain mix like scrambled eggs, with maybe a greater concentration of yoke at the center.
The best way to determine whether all of a tumor has been removed, he said, is with the iMRI.
Before, a surgeon may have had to close the incision, take the patient elsewhere for a scan, and then return for more surgery, he said.
Dr. Daniel Tomes performed Baehr’s surgery. McMasters said the iMRI enabled Tomes to discover and remove a hidden pocket of tumor before closing.
Baehr’s tumor is cancerous but likely treatable, and she has only a few residual problems related to her procedure. In addition to crediting her surgeon and technology, she also thanked providence.
She was delivering Meals on Wheels, she said, when the seizure hit. As she fell unconscious, grandson Kai climbed out of his car seat and was trying to pry open her eyes when people living at the home came outside.
It was their first time receiving meals, and they didn’t know it was customary for drivers to bring meals to the door.
Baehr was a backup meals driver that day, she said, and by all rights should have been lying helplessly on her kitchen floor.
Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.
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