The seizure struck during the summer like a bolt of lightning on a sunny day.
One minute, 29-year-old Scott Schwab of New Brighton, Minn., was driving a forklift in a warehouse. The next minute, he was wandering around the loading dock in a daze.
It came “out of nowhere,” Schwab said of the seizure. He had no headaches or other warnings.
Schwab’s startled co-workers called out his name.
“I’d look at the guys, but I guess I was just looking right through them,” he said.
Fortunately for Schwab, the wife of one of his longtime friends works at the University of Minnesota. She told him about Dr. Walter Hall, an assistant professor of neurosurgery who uses a state-of-the-art MRI scanner to guide him while he takes brain biopsies and removes brain tumors.
The high-tech procedure, which could revolutionize the field of brain surgery, is being performed in a new $3.5 million operating room at Fairview-University Medical Center in Minneapolis.
By bringing MRI technology into the operating room, Hall and his colleagues say, they can obtain more accurate brain biopsies and remove tumors without damaging surrounding brain tissue.
Removing the tumor is important because small chunks missed by surgeons tend to grow into more deadly tumors.
“Your best chance is your first chance,” said Dr. Charles “Chip” Truwit, director of neuroradiology and associate professor of radiology and neurology at the university.
Truwit, who spearheaded the drive to build the operating room, said bringing the project to fruition was a major task that involved neuroradiology, neurosurgery, anesthesiology and operating room personnel and staff.
“A lot of services have to step up to the plate and figure out how to work together productively,” he said.
Patients who have brain tumors removed in typical operating rooms are usually rescanned several days after their operations. If small portions of tumors remain, they and their doctors must weigh the costs and risks of a second major operation against the potential benefits.
In most instances, patients with tumor remnants are treated with radiation rather than surgery.
In Fairview-University’s operating room, a state-of-the-art MRI scanner sits about a dozen feet from the operating table. Once surgeons feel they have removed the tumor, they slide the patient back into the MRI scanner and take more scans.
If the new images show that a small portion of tumor remains, the doctors move the patient back into the operating area and quickly remove the remnants before closing the incision.
Because patients who undergo the procedure have smaller incisions, remain neurologically intact and do not require postoperative MRI scans, they recover quicker and leave the hospital sooner.
“It’s ultimately going to make medicine cheaper,” Hall said.
The operating room, which opened in January, is only the third one of its kind in the nation. The others are in Boston and Los Angeles.
Unlike its predecessors, the Fairview-University operating room is the only one in North America equipped to perform angiograms, Truwit said. What’s more, its MRI has a more powerful magnet, which means the images it generates are more detailed.
While installing an MRI in an operating room is new, efforts are under way to streamline the technique. Researchers from Leica, the lens and camera manufacturer, recently visited the site in preparation for designing and building a microscope that is immune to the MRI’s powerful magnetic waves.
Once the new microscope is available, Truwit said, all brain surgical procedures will be performed at the back end of the MRI scanner. During surgery, only the patient’s head and shoulders will protrude from the MRI. To rescan, doctors will slide the patient backward about four or five feet.
“When that happens, there will be no reason to perform brain surgery anywhere else,” Truwit said.
Brain surgery is only one chapter in the rapidly evolving project. It also has application in tumor diagnosis.
The operating room also is being used to guide special carbon-fiber biopsy needles, thereby ensuring that tissue samples are taken from the most suspect portions of brain tumors.
During this procedure, doctors use MRI scans to calculate the precise angle for inserting the biopsy needle. Once the needle is in place, the patient is pushed back into the MRI and another scan is taken to ensure that the needle is in the tumor.
Getting an accurate biopsy is critical to selecting the proper treatment, Hall said.
In the future, the special room will be used to treat stroke victims and guide surgeons while they install electronic brain stimulators to control tremors in patients with Parkinson’s disease and other neurological disorders.
Schwab is a staunch supporter of the new procedure. “I’m all for it,” he said. “It was a piece of cake.”
He was released from the hospital two days after his Aug. 8 operation. Although the MRI scans and a preliminary pathology report indicated the tumor was benign, additional tests showed that it contained isolated malignant cells, Hall said. “It’s sort of like looking at the stars, with each star representing a malignant cell.”
Because the MRI scans indicate the tumor was removed, Schwab will not undergo radiation treatment, which would be typical after such surgery. Instead, he will be closely monitored.
If a future MRI scan uncovers new tumor growth, Schwab will begin radiation treatments. In some cases, radiation destroys all the malignant cells and cures the condition, Hall said.
Although Schwab has been told to take it easy, he’s back playing golf and has taken a fishing trip on Lake Superior with his friends.
Schwab’s mother, Val, remains convinced that her son’s chances are much better than they would have been had he undergone traditional surgery.
“I’m so sure it would have been a whole different story had we not gone there,” she said. “We’re very fortunate to have such a facility in Minnesota.”
