Contact: Ellen Bank


June 30, 2000

MUSC Using Functional MRI for Brain Surgery

CHARLESTON, S.C. -- Brain surgeons at the Medical University of South Carolina can now be more aggressive in removing tumors thanks to new imaging procedures that help the surgeon locate parts of the brain that control vital functions.

MUSC is the only facility in South Carolina, and one of only about 15 in the country using functional MRI in conjunction with tumor surgery.

"Before we started using this technique, brain tumor removal posed a perilous balancing act," said Sunil Patel, M.D., an MUSC neurological surgeon. "Our goal is to remove as much of the tumor as possible to prevent regrowth. But our problem has been that the tumor is sometimes too close to regions of the brain controlling vital functions. If we take out too much tumor, we could paralyze the patient, impair his ability to speak or destroy other critical functions. If we don't take out enough tumor, we risk regrowth."

In the past, the surgeon was limited by the use of conventional MRI images of the brain, combined with his knowledge of what area of the brain controlled what function. Unfortunately, there are small but important variations in the localization of these functions, and in some cases the tumor may have juxtaposed brain matter obscuring the relationship between anatomical location and function. But the use of functional MRI has revolutionized this procedure, giving the surgeon a "map" of the brain by function.

Functional MRI involves no radiation, allowing for repeated, rapid images. Hundreds of images of the patient's brain can be taken prior to surgery, generating a map that shows the location of functions such as movement or language. Diana Vincent, Ph.D., an MUSC researcher, works with the patient prior to the surgery. "Using a conventional MRI, the patient lies passively while we take pictures," said Vincent. "During a functional MRI, I instruct the patient to talk, think, and move body parts during the imaging. By following my instructions, the patient activates the region of the brain that controls that specific function I ask them to perform. The blood contains oxygen which acts as a marker, highlighting on the scans which areas of the brain are at work, during a specific activity. This enables me to produce a computer-generated map for the surgeon, telling him what parts of the particular patient's brain control what functions."

Patel views real-time three dimensional conventional MRI scans while operating. This allows him to see the patient's brain in relationship to his nose mouth, and other body parts. He can compare these images with the maps Vincent has developed based on the preoperative functional MRI. This allows him to determine which areas of the brain control vital functions, and which areas of the brain can be safely removed. Vincent is right alongside of him in the operating room, helping to interpret the maps.