Preserving Eloquence
Preserving Eloquence | Steven Abram, Paul Rosenblatt, Saint Thomas Health, Saint Thomas Hospital, Unity System, Novalis BrainLAB, BrainSuite, Varian TrueBeam STx, Brain Tumor, Neurosurgery

Dr. Paul Rosenblatt (L) and Dr. Steven Abram (R) discuss the exciting capabilities of the new BrainSuite hybrid neurosurgical OR, which is debuting this month at Saint Thomas Hospital.
Saint Thomas Debuts Fully-Integrated Neurosurgical Center

Saint Thomas Hospital is in the process of unveiling the Unity System, the first fully-integrated neurosurgical center in North America. Currently, the only other system similar to this one is in Singapore.

The Unity System, Saint Thomas Health’s proprietary program for treating brain tumors, builds on the advanced neurological technology Saint Thomas Hospital (STH) began implementing in 2004 with the debut of BrainLAB by Novalis. Over the past eight years, STH has continued to invest in increasingly sophisticated software, equipment and diagnostics all building to the spring 2012 premiere of the Unity System, which seamlessly creates a virtual OR where physicians across disciplines work collaboratively in real-time to determine optimal treatment for patients.

The technology behind the Unity System includes surgical capabilities through BrainSuite, a hybrid, neurosurgical OR with integrated high field magnetic resonance imaging, computer assisted planning, stereotactic image-guided navigation, video conferencing and data networking. The integrated system also includes functional brain mapping diffusion tensor imaging, identifying axonal pathways or communicating fiber tracks, and functional MRI in the surgical planning and navigation process to help preserve eloquent brain tissue. Currently, Saint Thomas Hospital is the only site in Tennessee to utilize this type of multimodal functional brain mapping.

Additionally, STH is one of the first in the nation to install IMRI — intraoperative MRI. The 1.5 tesla, open bore, mobile imaging magnet is ‘garaged’ in the operating room and can be easily rolled out on a track during surgery to update preoperative brain maps.

It isn’t uncommon for surgical margins to become indistinct, brain tissue to move or important structures to migrate during a procedure. With IMRI, the neurosurgeon can retrieve new images in the OR, which can be accessed remotely throughout the Neuroscience Center via high-definition medical grade visualization and streaming audio and video conferencing for real time collaboration. The entire medical team can then fine-tune the surgical plan, adding a level of preciseness that wasn’t possible before in the brain tumor removal.

“While we’re doing an operation, the intraoperative MRI and its integration package allows us to communicate with radiation oncology, with medical oncology, with neuropathology, while we’re doing the surgery,” explained Steven Abram, MD, director of the Brain & Spinal Tumor Center at STH. “I’m in the OR, virtually,” added Paul Rosenblatt, MD, the hospital’s chief of Radiation Oncology. Abram noted he is able to be in direct communication and consultation with Rosenblatt while working. “Now I have my team at the OR table.”

A final piece of the system, coming online in April, is the Varian TrueBeam™ STx Linear Accelerator powered by BrainLAB Novalis. Enhancing current radiation oncology capabilities, TrueBeam delivers a more precise dose in about one-third the time of current procedures to target the tumor while preserving brain function. The equipment also has the ability to create images using 25 percent less x-ray dose.

With the advanced technology, Abram said it has made it possible to use data sets in planning a patient’s operation to preserve as much eloquent … or functional … brain as possible, thereby maximizing quality of life. The integration and upgrades in radiation oncology also allow those same data sets to be used to deliver TruBeam’s very focused, shaped, precise beams of radiation in consideration of that same functional status.

For all the Unity System’s high-tech capabilities, the essence of the Neuroscience Center is the collaborative spirit among oncologists, surgeons, pathologists, medical physicists, researchers, nurses and social workers.

“It’s been shown by numerous studies and centers that a patient managed in a multidisciplinary … or interdisciplinary … way does better. That’s been data proven,” said Abram. What the new enhanced technology does, he continued, is take that collaboration and metaphorically put it on steroids and deliver it in real time.

Saint Thomas Hospital has hosted a weekly brain tumor board for a number of years. Unlike many tumor boards, however, that discuss cases retrospectively, Rosenblatt stressed the technology Saint Thomas has in place allows their tumor board to take a prospective approach to planning treatment for each individual case. He said the tumor board routinely discusses 12-15 cases each week.

“Sometimes in retrospect, you would have wished a different order to things,” Rosenblatt noted. “What’s really been the change here is a patient presents to Dr. Abram, comes in on referral, and we’re discussing it before anything is done.”

He said it wasn’t unusual for a radiologist to suggest a different test outside the standard as a result of that discussion. “So even from the initial evaluation, it’s a team effort,” Rosenblatt continued.

In fact, he said, the tumor board allows the team to collaboratively discuss what part of the tumor should be surgically removed and what should be attacked via radiation or chemotherapy to retain as much functionality as possible. “With radiation, it’s not just what you treat, but it’s what you can avoid,” Rosenblatt noted of the goal to limit the radiation field to the tightest margins possible.

“That’s what we’ve been able to do … this prospective, integrated approach,” said Abram. “Now, we’re going to be able to do that same interdisciplinary approach every time the patient is touched in our program.”

Rosenblatt added something he and Abram foresee is that the new equipment will allow them to confer, in real time, on how to proceed with an operation if something unexpected comes up. Going forward, the two specialists will have the luxury of discussing what is the safest method … cutting or radiation … to attack a tumor extending near the ocular nerves, for example, to preserve sight. “We’ll have an interactive discussion … who can do better at that spot at that time,” Rosenblatt said.

The bottom line for patients is improved outcomes and functionality when faced with the very frightening diagnosis of a brain tumor. “There were some cases before where there wasn’t a good surgical answer or a good radiation answer. For some of those now, there is a good combined answer,” Rosenblatt said.

“You can’t downplay that avoidance of hurting somebody,” he continued.

Abram agreed, “Quality of life is more than a catchphrase.”