Brain Surgery for USN&WR

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San Francisco, California, January 6, 2011 - From left, Dr. Ellen Air, a clinical fellow, and University of California San Francisco Medical Center neurosurgeon Dr. Philip Starr look at real time scans of patient Linda Sharp during her iMRI surgery at UCSF Medical Center. The MRI machine photographs the patient during the surgery allowing the doctors operating to view the procedure as well as support doctors and technicians to monitor from an outside room.  The iMRI procedure uses Deep brain stimulation (DBS), which has been used for over a decade to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia. DBS uses a pulse generator implanted in the chest, similar to a pacemaker, to deliver pulses to specific regions of the brain via a permanently implanted electrode. In the U.S., DBS is normally done while the patient is awake, because the surgeon needs to induce the symptoms (like the involuntary movements of Parkinson's) to know if he's in the right place, and if the patient is unconscious, the symptoms can't be induced. Many patients find it hard to tolerate. Their head is clamped in a frame, they're aware of their surroundings, and the surgeon is deliberately producing tremors and twitches while they lie there...Interventional MRI (or iMRI) allows surgeons to implant these electrodes while the patient is unconscious taking advantage of MR imaging in real time by performing procedures inside the scanner itself. Doctors Paul Larson and Philip Starr were both involved with this technology during its development in the 1990s. In 2002 they began to think about how to perform DBS using this technique at UCSF. Working with Alastair Martin PhD in the Department of Radiology, Jill Ostrem MD in the Department of Neurology, and others, they developed a technique of implantation using a modified but commercially available skull-mounted aiming device and custom-made, MR-compatible surgical instruments.