Manipal Hospital uses Gamma probe to localise brain tumours

EHM News Bureau - Bangalore

Manipal Institute of Neurological Disorders and the department of nuclear medicine at the hospital joined hands to introduce Radio-Guided neuro surgery that will benefit people suffering from brain tumours. A Gamma probe is used to localise the tumour. The hospital has already treated five patients using this technology over the last two months.

The surgery for brain tumours is especially fraught with dangers for the patient and high anxiety for the surgeon. A large part of the neurosurgeon’s planning efforts are concerned with finding ways to remove the tumour without damaging the brain, and to ensure that tumour has been removed completely.

Dr Sujay Rao, consultant neurosurgeon, Manipal Hospital who led the team to this pioneering technique said, “Tumours are often very deceptive. While operating, the surgeons sometime find the tumour to be so closely resembling the brain that he can barely tell the difference. In case normal brain tissue is operated or removed, it might cause severe and irreparable damage. The use of sentinel node probe and help from nuclear medicine now enables to differentiate tumour from brain tissue with confidence.”

In the past, bizarre and cumbersome techniques have been employed to diagnose and differentiate normal brain cells from tumour, and to identify leftover tumour. Techniques range from neuro-navigation to extreme measures when neurosurgeons have even attempted to operate inside an MRI machine.

Gamma probe guided surgeries are currently in vogue in very few hospitals in United States and Europe and are largely limited to breast cancers.

Explaining the technique, Dr R V Parameshwaran, head, department of nuclear medicine said, “Many brain tumours intensely absorb technetium 99m and a three dimensional image of the brain is obtained. During surgery, the neurosurgeon runs the probe around tumour and it displays counts on the monitor and emits acoustic signals as the radioactive isotopes are detected. The neurosurgeon can carefully remove the tumour guided by the probe with nuclear medicine doctors constantly providing the reading. As the surgery progresses, the probe repeatedly detects tumour tissue till the surgeon has completely removed it.”

Radio Guided Neuro Surgery allows the surgeon to identify the hot spot easily in 3 dimensions giving greater flexibility in planning the tumour removal. It also helps to clearly identify the tumour from the adjoining normal brain tissue and ensures that there is no residual tumour. The probe itself is a compact handheld extremely light on its feet and accurate. Most importantly, it gives the neuro surgeon an accurate feedback directly from the brain and tumour in the surgical field allowing him to take immediate decisions.