Brain Surgery for USN&WR

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San Francisco, California, January 6, 2011 - Dr. Philip Starr, neurosurgeon (standing left) adjusts the head of patient Linda Sharp prior to her iMRI surgery. 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. In 2008, Larson, Starr, and Martin partnered with the medical device company SurgiVision to develop new technologies for the iMRI DBS technique. This includes an MRI-compatible, skull-mounted aiming device and MR coils specifically designed to provide optimal imaging during surgery.