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Georges Z. Markarian, MD, Chair of Akron General's Neuroscience Institute, stands in the Brainlab 'smart' OR that integrates intraoperative MRI with a software surgical planning and navigation system to improve patient safety and outcomes. exceeds other hospita ls' in the A kron/ Ca nton a rea ," says Dr. Hoeprich. "It 's pa r t of the reason I was drawn to this practice a nd to A kron Genera l," says Dr. Missios. ADVANCED DIAGNOSTICS There are more than 100 different types of brain tumors. Symptoms vary accord- ing to the size and location of the tumor a nd ra nge from headache to seizures to foca l neurolog ica l def icits. "Sy mptoms a re consistent with the reg ion of the bra in that is involved. If the tumor involves the motor cor tex, patients present w ith wea kness. If it involves the sensor y cor tex, patients present w it h numbness or pa rest he- sia s. If t he t u mor is located close to the a rea that controls speech, patients may present with speech dif f iculties. Tumors located in the occipita l lobes c a n c au se pat ient s t o pre sent w it h v i s u a l def icit s , t y pic a l ly i nclud i n g loss of periphera l vision. A nd tumors that involve the fronta l lobes ca n lead to persona lit y cha nges t hat patients themselves may be completely unaware of," Dr. Missios explains. A head CT is generally the first diagnos- tic imaging technology used when a brain tumor is suspected. An MRI is performed next, to determine the exact location and help determine the shape and size of the tumor. Akron Genera l's Neuroscience Institute has a 3 Tesla MRI (3T MRI), which provides high-resolution images, and biplane angiography technology. "Our 3T MRI a–ords us superior imag- ing of brain pathology," says Dr. Hoeprich. "It also allows us to get specialized MRI sequences for doing radiographic brain mapping, or what's called di–usion tensor imaging (DTI)." He explains that DTI is a special MRI sequence that a llows visua lization of white matter f ibers below the surface of the bra in. This enables the neuro- su r geon t o ev a lu at e preoper at ively where a tumor sits in relation to various structures and various communication pathways within the bra in. " We ca n work t hat i nto our surg i- c a l pl a n t o avoid t ho s e s t r uc t u r e s a nd leave more bra i n i nt a c t , wh ich leads to bet ter f unctiona l outcomes," Dr. Hoeprich says. Ma g netic resona nce spectroscopy (M R S) is of ten used to exa m i ne t he tumor's chemica l profile and determine the nature of the tumors seen on the MR I. PET is used to help detect recur- rent bra in tumors. Of ten, the only way to ma ke a def ini- tive diagnosis of a brain tumor, however, i s t h rou g h a biops y. A k ron G enera l ha s t he latest tech nolog y for t h is — Medtech's Robotic Operative Surg ica l Assista nt (ROSA). Described as "a GPS PHOTO © SMITHBERGER PHOTOGRAPHY, NORTH CANTON, OHIO M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N n M AY/J U N E 2 016 1 5