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for t he bra i n," ROS A enables a non- invasive laser measurement for patient registration and a llows the biopsy to be performed without the use of invasive ma rkers or a fra me. Dr. Hoeprich a lso utilizes ROSA for epilepsy surger y. ADVANCED SURGICAL TREATMENTS Bra in tumors a re usua lly treated with surger y followed by radiotherapy a nd/ or chemotherapy. The cha llenge for the neurosurgeon is to remove as much of t he d isea sed tissue a s is sa fely pos- sible without injuring the surrounding hea lthy tissue. According to Dr. Missios, nu merou s s t ud ies i nd icat e t hat t he ex tent of resection, especia lly as fa r as ma lig na nt tumors a re concerned, sig- nif ica ntly impacts the overa ll sur viva l of the patient. " It 's a l w a y s a b a l a n c e b e t w e e n achieving ma ximum tumor resection wh i le avoid i n g neu rolog ic def icit s," he says. " But over the pa st few yea rs, neurosurger y has become sa fer due to the introduction of new technolog y in the OR . And that technolog y is available at A kron Genera l." B r a i n l a b i s t h e n e u r o n a v i g a - t i o n s y s t e m u t i l i z e d i n A k r o n G en er a l 's Ne u r o s c ien c e I n s t it u t e . Neuronavigation relies on identif ying the location of a n object in relation to t he surg ica l f ield a nd prov ides nea r r e a l-t i me lo c a l i z a t ion , or ient a t ion a nd g uida nce. It uses the combination of preoperative MR I ima ges that a re co-reg istered w ith the patient 's head using a n infra red ca mera a imed at the patient during the surger y. " We have specia l instr uments a nd specia l markers or pointers that enable us to see on the monitors [where the MR image is displayed] exactly what part of the brain we're pointing at," Dr. Missios expla ins. "So we know precisely where to ma ke the incision for easier access to the tumor, a nd this a llows us to ma ke a sma ller incision. Simila rly, when the tumor is resected, we ca n use a pointer to exa mine the borders of the resection cavit y a nd a ssess the ex tent of tumor resection . Therefore, it a l lows us to ma ximize the resection while reducing the morbidit y of the surger y." A n intraoperative MR I (i-MR I) in a n adjoining room enables ima ges to be ta ken at t he end of t he surger y — before the surgeons close the incision a nd before the patient wa kes up — to ensure adequate tumor resection. This increa ses t he cha nce of a successf u l t u mor re se c t ion a nd de crea se s t he li keli hood of tumor residua l thereby m i n i m i z i n g reoper at ion r at e s . T he resu lt is quicker recover y times a nd shor ter hospita l stays. "Previously, we'd do the surger y a nd t hen a day or t wo later do a n MR I to eva luate for residua l tumor. If needed, the patient would then have to undergo PHOTO © SMITHBERGER PHOTOGRAPHY, NORTH CANTON, OHIO Akron General's team of neurosurgeons are all subspecialty fellowship-trained. Shown here are (L-R): Krishna B. Satyan, MD; Peter B. Letarte, MD; Ghassan F. Khayyat, MD; Mark R Hoeprich, MD; and Symeon Missios, MD. 1 6S P E C I A L F E A T U R E 1 6