Intra-operative MRI at Montreal
MONTREAL – On any ordinary day, six
year old Émilie Gagnon gets up and heads off to grade one at her
elementary school in la Chaudière- Appalaches. But October 19 was no
ordinary day. Instead of taking the bus to school Émilie was wheeled in
to a new operating room at The Montreal Children’s Hospital where she
underwent brain surgery.
Émilie suffers from epilepsy caused by a tumour located on her occipital
lobe, the rear most portion of the brain which houses the visual cortex,
the part of the brain that interprets what our eyes see. Émilie’s tumour
was the size of a large egg. The roots of the tumour penetrated deep
into her brain. These roots bear a striking resemblance to grey matter,
making it difficult for surgeons to detect the direction they are
growing and where they end.
Émilie was the first child to undergo brain surgery in The Montreal
Children’s Hospital of the MUHC’s new Pediatric Interventional Brain
Suite, home to the first intraoperative magnetic resonance (MRI) in a
Canadian pediatric hospital.
“We’re incredibly pleased to be the first pediatric hospital in the
country to be able to offer our patients the benefit of this remarkable new
technology,” says Dr. Harvey Guyda, Associate Executive Director of The
Montreal Children’s Hospital. “Equipment like this is helping us
transform how we care for our patients - a transformation that will take
another major step forward when shovels hit the ground later this year
for the new Montreal Children’s Hospital at the Glen Campus.”
This new technology gives the three neurosurgeons at The Montreal
Children’s Hospital unprecedented views of the brain before and during
surgery, thus improving the accuracy of procedures.
“The new intraoperative MRI gives us a tremendous advantage as we
navigate through the brain to remove tumours,” says Dr. Jean-Pierre
Farmer, Chief-of-surgery and a member of the neurosurgery team. “
“Traditionally, during brain surgery, we are guided by MRI images taken
prior to the procedure. But during brain surgery, the brain can actually
shift as a result of a slight movement of the head, retraction of the
brain, or the draining of cerebrospinal fluid. Thus the images the
neurosurgeon is relying on are no longer as precise as the surgery
proceeds. With the new MRI, we will have access to images of the brain
in real time. This will allow us to be much more accurate at determining
where the tumour begins and ends. Furthermore the three Tesla technology
of the new magnet allows us to identify eloquent areas that we need to
avoid entering as we resect tumours or epileptic tissue.”
During Émilie’s 11-hour surgery, Dr. Farmer removed all visible traces
of her tumour. Normally, this is when the surgery ends. However, thanks
to the new intraoperative MRI, Emilie was wheeled out of operating room
and in to the adjacent MRI room. The child was still under anesthesia,
was still in the same position as on the operating table. In fact, the
portion of her skull removed to conduct the surgery was still missing.
The MRI indicated that roots of the tumour remained. So, Émilie was
rolled back in to the OR and Dr. Farmer continued the surgery removing
still more of the tumour with enhanced accuracy from updated
Basically, the new equipment prevented Emilie from having to undergo a
second surgery. Also, the strength of the 3T MRI gave Dr. Farmer much
clearer images of eloquent areas of her brain.
“Having to operate a second time on Émilie would have been extremely
traumatic for her and her parents,” says Dr. Farmer. “In most cases,
with the new MRI, we’ll be able to avoid second surgeries. In the case
of Émilie, by removing more of the tumour we stand a much greater chance
of stopping her epileptic seizures.”
Installing the new MRI
To accommodate the new piece of machinery, the MCH built what is called
a two-room solution. An operating room and new MRI suite were built
side-by-side on the hospital’s third floor. This design allows the MRI
to be used during surgery, but also makes it available for traditional
imaging when the OR isn’t in use. This will enable The Montreal
Children’s Hospital to reduce patient wait times for an MRI.
Currently, the MCH has 600 to 700 patients waiting for an MRI. Some can
wait up to a year for the scan.
Thanks to the two-room approach, the new MRI will also be made available
to MCH researchers studying the brain. The new operating room and
intraoperative MRI will also be used to perform epilepsy surgery,
movement disorder surgery and some orthopedic procedures.
It is also important to note The Montreal Children’s Hospital will be
able to move about 75% to 80% of the equipment to its new hospital which
will open in four years on the Glen Campus.
This project cost more than $10 million and was made possible thanks to
generous donors of The Montreal Children’s Hospital Foundation,
including donations from Opération Enfant Soleil, The Sarah Cook Fund
Posted November 12, 2009