M Health Fairview Transforms Neurosurgery Through Advanced, Real-Time Imaging

By Josh Garcia
Wednesday, December 18, 2019

The surgical suite not only provides real-time, 3-Tesla MRI imaging during complex neurosurgical procedures but also paves the way for future surgical methods and a deeper understanding of how the brain functions and responds to actions taken during surgery.

M Health Fairview physicians and leadership in partnership with the Minnesota-based medical technology integration firm IMRIS have launched a groundbreaking neurosurgery suite equipped with a mobile 3-Tesla MRI capable of traveling across specially configured, adjacent diagnostic and operating rooms. Part of a recent $111-million renovation project at M Health Fairview University of Minnesota Medical Center, the project reflects the health system’s dedication to excellence and the University of Minnesota’s role in pioneering advanced technology in intraoperative imaging.

“We actually installed one of the first intraoperative MRIs in the country during the 1980s,” says Charles Dietz, MD, FACR, radiologist with M Health Fairview. “However, technology has advanced significantly since then. This new renovation project is aimed at updating and expanding the capabilities of both the OR and ER.”

The intraoperative 3-Tesla MRI neurosurgery suite offers new surgical and imaging options and also enables future research into the effects of surgery and anesthesia on brain function, research that should lead to safer procedures for patients at M Health Fairview and beyond.

“Being able to image a patient’s brain under anesthesia — that’s a big deal,” says Clark C. Chen, MD, PhD, neurosurgeon with M Health Fairview and Lyle A. French Professor in Neurosurgery and Chair of the Department of Neurosurgery at the University of Minnesota Medical School. “Anesthesia is more than 100 years old, but we still don’t know exactly what happens to the brain when a patient is placed under general anesthesia.”

Touring the T-Suite

The key technological component of the new suite is its 3-Tesla MRI. In addition to anatomical imaging, which helps surgeons visualize structures within the brain and body, the 3-Tesla MRI can perform neuroimaging that helps surgeons recognize brain activity and function taking place during procedures to treat brain tumors, Parkinson’s disease and other neurological disorders.

“The 3-Tesla magnet is capable of performing functional MRIs,” Dr. Chen explains. “Functional MRIs allow us to visualize the connectivity inside the brain, which is different than anatomical imaging. This means we can now begin to understand how our surgery impacts the way parts of the brain communicate with each other as we operate on it.”

Determining the functional consequences of surgical maneuvers in real time is a distinct benefit of the new intraoperative MRI suite.

This capability is made possible thanks to the advanced 3-Tesla MRI technology and the special configuration of the suite — three ORs surround the diagnostic imaging room that contains the MRI, forming a t-shape when viewed from above. This configuration provides the suite with its name: the “T-suite.”

“If you’re standing in the diagnostic imaging room with the MRI, there is an OR to the left, an OR to the right and an OR straight ahead,” Dr. Dietz describes.

Surgeons and imaging technologists in any of the three ORs can pause midprocedure and use the 3-Tesla MRI to gauge results and determine whether continued surgery — or a different type of surgery altogether — is necessary.

To do this, the MRI is moved from OR to OR using a special system designed by IMRIS. The 3-Tesla MRI is suspended on a track from the ceiling and can travel along the length of the track, which allows it to move between the two ORs on either side of it. Garage-style doors can close off or expose the OR rooms to the left and right of the machine.

“The magnet can actually translate and move into the garage door space, which gives that particular OR an MRI at one end of the room,” Dr. Dietz says.

The MRI can also pivot and rotate by 90 degrees, which allows it to turn and face the third OR, thus giving that room access to functional MRI capabilities. The third OR room is also separated from the diagnostic imaging room, with a garage-style door that can be left open to accommodate quick imaging.

“The operating table can be disconnected from the floor in the third OR and moved, which allows us to connect it to the 3-Tesla MRI,” Dr. Dietz says. “We can also close all of the garage-style doors to do a procedure in the MRI room that doesn’t require surgical capabilities — an inpatient diagnostic study, for instance.”

Multifaceted Procedures

Though the T-suite can be used for diagnostic purposes or to accommodate surgeries on three different patients simultaneously, the main goal of the T-suite is to allow for multiple, complex MRI-guided procedures on a single patient without the need for multiple rounds of anesthesia.

“In the past, if a patient needed two different types of surgery in a staged manner, they would have to undergo two different rounds of anesthesia,” Dr. Chen explains. “We would perform the first procedure, wake the patient up, put them back to sleep, and perform the second procedure. With the way the T-suite is arranged, patients can now undergo multiple MRI-guided procedures under a single round of anesthesia.”

Another major benefit of the T-suite is that each of the ORs can be specialized for a particular type of surgery. One OR is customized to perform laser ablations, the second is tailored for endoscopic procedures, and the third is an angiosuite where physicians study blood vessels and perform embolizations to treat strokes. This configuration means patients can be swiftly moved from one room to another, depending on the surgery they need.

“For example, operating on highly vascular tumors may not be safe without stopping the blood flow into the tumors,” Dr. Chen says. “We can stop the blood flow through embolization, perform an MRI to make sure every vessel is appropriately blocked, then move to a second room where the main surgery is performed. Afterward, we can perform another MRI and go into the third room to remove residual tumors with laser ablation, if need be.”

Each OR, while designed for a specific procedure, can take on additional functionality for special cases.

Improving Outcomes

Whether a surgeon is performing one or multiple types of surgery on patients, the quick access to the 3-Tesla MRI helps prevent the need for follow-up surgery.

“In the past, if a surgeon didn’t quite remove all of a tumor during surgery, nobody would know until the MRI was performed the next day,” Dr. Dietz says. “At that point, the incision has already been closed. That means that the patient would have to go back to the OR, which has been shown to negatively affect outcomes.”

In addition to decreasing the need for follow-up surgery, surgeons can use the information provided by the 3-Tesla MRI to change their procedures in real time, based on how the brain is reacting to surgery.

“We can see how removing part or all of a tumor changes the function of the brain,” Dr. Chen says. “If we don’t need to take the entire tumor out to restore function, why subject patients to additional risks?”

The close proximity of an angiosuite also provides extra security for patients who experience a stroke during surgery.

“If we see a stroke on MRI results in the T-suite, we can have an interventional procedure ready to go in the OR two minutes away,” Dr. Chen says. “Minimizing the time between imaging and interventional treatment is the most important factor when dealing with a stroke.”

M Health Fairview specialists conducting clinical trials and researchers at the University of Minnesota will also use the T-suite as a research tool to further improve patient outcomes and innovate in the field of neurosurgery.

“We want to leverage our expertise in the utilization of intraoperative MRI on real patients to better understand the mystery that is our brain,” Dr. Chen says. “There’s no better place for this type of research, because our experts, resources and patient population are unique.”

Indeed, the researchers at the University of Minnesota’s Center for Magnetic Resonance Research specialize in pioneering new techniques and discoveries. Researchers at the center were the first in the world to perform an MRI using a 10.5-Tesla magnet, itself a technological marvel that allows for full scans of the human body in intricate detail. These same researchers will partner with surgeons with M Health Fairview to advance the field of intraoperative imaging in neurological and other surgeries through the use of the T-suite.

“The T-suite can fundamentally change how we perform surgery.” Dr. Chen says. “For example, once we understand how brain function changes in response to surgery on a tumor, we can actually define how much of the tumor needs to be removed. By advancing our understanding, we will discover how to best perform our current surgeries and perhaps find new surgeries altogether.”

Safety First

The 3-Tesla magnet in the T-suite’s MRI is extremely powerful, which means that M Health Fairview University of Minnesota Medical Center has established special safety protocols to ensure that patients and providers are safe when using the T-suite.

“We have an unprecedented institutional investment toward safety, with dedicated training time for every anesthesiologist, surgeon, nurse and support staff member,” says Clark C. Chen, MD, PhD, neurosurgeon with M Health Fairview and Lyle A. French Professor in Neurosurgery and Chair of the Department of Neurosurgery at the University of Minnesota Medical School. “Checklists, workflows and safeguards have been developed through a partnership between leaders and staff to ensure absolute safety in the T-suite.”

No one can gain access to the T-suite without having first completed training for MRI safety.

Visit mhealth.org/neurosurgery to learn more.