A Better Road Map for Neurosurgeons


May 6, 2013

The front page of Sunday's Philadelphia Inquirer Health section reports that, while preparing to remove a malignant tumor from the Rev. Michael Prewitt's brain, neurosurgeon Steven Brem, MD, worried that the surgery could affect his patient's ability to speak or move. He studied an MRI that showed the tumor in Prewitt's left parietal lobe. But he also examined a new type of scan: diffusion tensor imaging. For surgeons like Brem, professor of Neurosurgery and director of Neurosurgical Oncology at Penn Medicine, the new technology is like going from knowing only where a city's major buildings and parking lots are to seeing the network of roads that connect them. "That's huge," Brem said. "That is a groundbreaking paradigm shift." Joshua Levine, MD, co-director of the neurological intensive care unit at HUP and assistant professor of Neurology, said his traumatic brain injury patients are getting DTIs as part of a study. "I think we're all excited about the potential of this," Levine said. "How to use it and how useful it is has not been established definitively." Though some experts say there was no proof the scans improved surgical outcomes, Brem found some evidence it does when he helped write a review of the science for the journal Neurosurgical Focus last month. A 2007 study from Shanghai found the median survival for patients with gliomas, a category of brain tumors that includes the type Prewitt has, was 21 months for patients whose surgeons had seen DTIs before the operation compared to 14 months for other patients. The work is done partnership with Penn Radiology.

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