High-power MRI Helps Surgeons Predict Cancer Outcomes

In their study, published the December 2006 issue of the Journal of Neurosurgery, clinicians from the Mayo Clinic (Rochester, MN, USA) reported on a case study of five patients. Four suffered from neurofibromatosis, a disorder with a predisposition to nerve-related tumors. All patients suffered from growths called sciatic notch, dumbbell-shaped tumors. The tumors were benign, but resulted in neurologic dysfunction and disabling pain.

"In the past, if surgeons couldn't tell prior to surgery where the exact location of the large tumor was in relation to the sciatic nerve, it meant they couldn't predict in which cases surgery could be performed safely,” explained Robert Spinner, M.D., the lead neurosurgeon on the Mayo Clinic team.

The team used a sophisticated magnetic resonance imaging (MRI) system performed on a 3-Tesla magnet to help identify suitable candidates for a complicated tumor-removal surgery. A 3-Tesla MRI system is one of the strongest commercially available.

A standardized surgical approach for safe and complete removal of sciatic notch dumbbell-shaped tumors has been problematic for at least three reasons. These tumors are comparatively rare and therefore hard to study; they are also anatomically hard to reach and remove without injuring the main sciatic nerve; and thirdly, they are difficult to visualize before surgery with enough detail to differentiate tumor boundaries from nerve. This study begins to change this situation by validating a new multidisciplinary approach for obtaining the desired favorable surgical outcomes.

With the 3-Tesla MRI images, Mayo Clinic surgeons from three specialties--neurosurgery, colorectal, and orthopedic surgery--obtained adequately detailed images of the tumor and nerve relationship before surgery in all five cases to accurately predict which patients would benefit from surgery. In three cases, the tumor was predicted to be distinct from the main sciatic nerve, and the tumor was effectively removed. All three patients experienced relief from pain and had no recurrent growth one year after surgery. In the other two instances, the tumor was predicted to be so tangled up in the nerve that surgery would have damaged the nerve. Those patients did not undergo surgery.



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