On any ordinary day, six year old Émilie Gagnon gets up and heads off to grade one at her elementary school in la Chaudière- Appalaches. But October 19 was no ordinary day. Instead of taking the bus to school Émilie was wheeled in to a new operating room at The Montreal Children’s Hospital where she underwent brain surgery.
Émilie suffers from epilepsy caused by a tumour located on her occipital lobe, the rear most portion of the brain which houses the visual cortex, the part of the brain that interprets what our eyes see. Émilie’s tumour was the size of a large egg. The roots of the tumour penetrated deep into her brain. These roots bear a striking resemblance to grey matter making it difficult for surgeons to detect the direction they are growing and where they end.
Émilie was the first child to undergo brain surgery in The Montreal Children’s Hospital of the MUHC’s new Pediatric Interventional Brain Suite, home to the first intraoperative magnetic resonance (MRI) in a Canadian pediatric hospital.
“We’re incredibly pleased to be the first pediatric hospital in the country to able to offer our patients the benefit of this remarkable new technology,” says Dr. Harvey Guyda, Associate Executive Director of The Montreal Children’s Hospital. “Equipment like this is helping us transform how we care for our patients– a transformation that will take another major step forward when shovels hit the ground later this year for the new Montreal Children’s Hospital at the Glen Campus.”
This new technology gives the three neurosurgeons at The Montreal Children’s Hospital unprecedented views of the brain before and during surgery thus improving the accuracy of procedures.
“The new intraoperative MRI gives us a tremendous advantage as we navigate through the brain to remove tumours,” says Dr. Jean-Pierre Farmer, Chief-of-surgery and a member of the neurosurgery team. “Traditionally, during brain surgery, we are guided by MRI images taken prior to the procedure. But during brain surgery, the brain can actually shift as a result of a slight movement of the head, retraction of the brain, or the draining of cerebrospinal fluid. Thus the images the neurosurgeon is relying on are no longer as precise as the surgery proceeds. With the new MRI, we will have access to images of the brain in real time. This will allow us to be much more accurate at determining where the tumour begins and ends. Furthermore the three Tesla technology of the new magnet allows us to identify eloquent areas that we need to avoid entering as we resect tumours or epileptic tissue.”
During Émilie’s 11-hour surgery, Dr. Farmer removed all visible traces of her tumour. Normally, this is when the surgery ends. However, thanks to the new intraoperative MRI, Emilie was wheeled out of operating room and in to the adjacent MRI room. The child was still under anesthesia, was still in the same position as on the operating table. In fact, the portion of her skull removed to conduct the surgery was still missing.
The MRI indicated that roots of the tumour remained. So, Émilie was rolled back in to the OR and Dr. Farmer continued the surgery removing still more of the tumour with enhanced accuracy from updated navigational information.
Basically, the new equipment prevented Emilie from having to undergo a second surgery. Also the strength of the three tesla MRI gave Dr. Farmer much clearer images of eloquent areas of her brain.
“Having to operate a second time on Émilie would have been extremely traumatic for her and her parents,” says Dr. Farmer. “In most cases, with the new MRI, we’ll be able to avoid second surgeries. In the case of Émilie, by removing more of the tumour we stand a much greater chance of stopping her epileptic seizures.”
INSTALLING THE NEW MRI
To accommodate the new piece of machinery, the MCH built what is called a two-room solution. An operating room and new MRI suite were built side-by-side on the hospital’s third floor. This design allows the MRI to be used during surgery, but also makes it available for traditional imaging when the OR isn’t in use. This will enable The Montreal Children’s Hospital to reduce patient wait times for an MRI. Currently, the MCH has 600 to 700 patients waiting for an MRI. Some can wait up to a year for the scan.
Thanks to the two-room approach, the new MRI will also be made available to MCH researchers studying the brain. The new operating room and intraoperative MRI will also be used to perform epilepsy surgery, movement disorder surgery and some orthopedic procedures.
It is also important to note The Montreal Children’s Hospital will be able to move about 75% to 80% of the equipment to its new hospital which will open in four years on the Glen Campos.
This project cost more than $ 10 million and was made possible thanks to generous donors of The Montreal Children’s Hospital Foundation, including donations from Opération Enfant Soleil, The Sarah Cook Fund and Hydro-Québec.
A tour of Pediatric Interventional Brain Suite will be possible after the press conference.
NOTE: DUE TO THE MAGNETIC FIELD GENERATED BY THE MRI, REPORTERS, PHOTOGRAPHERS AND CAMERA OPERATORS CANNOT ENTER THE MRI ROOM. YOU WILL BE ABLE TO SEE THE MACHINE FROM A DISTANCE OF ABOUT SIX FEET.
You can download photos of the new operating room, video of Émilie’s surgery and an interview with Dr. Farmer at www.thechildren.com/en/medias.aspx.
For more information:
Lisa Dutton, Manager
Public Relations and Communications
The Montreal Children’s Hospital of the MUHC