AMIGO Update: Neurosurgery Procedures and More- Clinical & Research News - For and about the Physicians and Researchers of Brigham and Women's HospitalAMIGO Update: Neurosurgery Procedures and More- Clinical & Research News - For and about the Physicians and Researchers of Brigham and Women's Hospital

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AMIGO Update: Neurosurgery Procedures and More

The Advanced Multimodality Image-Guided Operating (AMIGO) Suite, and Ferenc Jolesz, MD.

The Advanced Multimodality Image-Guided Operating (AMIGO) Suite is the nation's first integrated operating suite to offer immediate intra-procedural access to an extensive range of advanced imaging modalities. AMIGO's 5,700 square-foot space is divided into three interconnected procedure rooms housing real-time anatomic, functional and molecular imaging, including 3T MRI, PET/CT, fluoroscopy and ultrasound. The AMIGO team recently marked the 100th case performed in the new suite.

AMIGO is part of the National Center for Image-Guided Therapy at BWH. The brainchild of Ferenc Jolesz, MD, Surgical Planning Laboratory, AMIGO is designed to facilitate the introduction of new image-guided therapies and enhance current image-guided techniques. For his work, Jolesz was recently selected as one of The Boston Globe's 2012 list of Most Innovative in Massachusetts.

Alexandra J. Golby, MD Edward R. Laws, MD, FACS

Neurosurgeons Alexandra J. Golby, MD, director of Image-guided Neurosurgery, and Edward R. Laws, MD, FACS, director of the Pituitary/Neuroendocrine Program, are treating complex primary brain tumors and pituitary tumors in the AMIGO suite.

"AMIGO represents the latest advances in our extensive history in image-guided neurosurgery," said Golby. "We designed this suite based on our experience in this field, with specific capabilities that will enable us to initiate the next generation of neurosurgical interventions."

Built with support from the National Institutes of Health and BWH as a medical and surgical research environment, AMIGO's design optimizes surgical guidance and supports intra-operative decision-making among cross-disciplinary neurosurgical teams, including neurosurgeons, neuroradiologists, neuropathologists and other specialists.

Current procedures include individualized treatment for patients with brain tumors using intra-operative MRI-assisted craniotomy and biopsy and minimally invasive treatment with interstitial laser ablation, endoscopic pituitary surgery, and anterior skull base surgery. AMIGO's capabilities also will facilitate future minimally invasive approaches, including robotic surgery.

"Performing endoscopic pituitary surgery in AMIGO enables us to achieve more complete tumor excisions and restoration of impaired vision, while still preserving normal pituitary function," said Laws. "With high-resolution intra-operative MR imaging, we also are able to confirm success of the procedure and rule out any complications while in the operating room."

More AMIGO Research Endeavors

Neurology

Nathalie Agar, PhD

  • Nathalie Agar, PhD, director of Surgical Molecular Imaging Laboratory, is working on a mass spectrometric probe for intra-operative use. Tissue analysis using this technology is compared with histopathological analysis and imaging to validate results.
  • Golby and collaborators are working on a beta probe designed to identify residual tumor. The cyclotron at BWH will be helpful in developing a radioisotope tracer to be used with this probe and the PET-CT scanner in AMIGO.
  • Golby and collaborators are also working on development and validation of multi-modality image fusion, non-rigid image deformation, and co-registration. This will maximize intraoperative information, updated as the procedure progresses.

Cardiology

  • Ehud Schmidt, PhD, of the Department of Radiology, is studying MRI-guided electrophysiology that will allow specialists to navigate a catheter to the problematic site, as well as map arrhythmia and problematic source. One of the many goals with using MRI technology is to reduce repeat surgeries by 30 percent, reduce complications and monitor ablations in real time.
  • Schmidt is developing a 12-led ECG that is compatible with MRI technology, as well as an MRI-compatible electro-anatomic mapping that will allow use of catheters both inside and outside the MR space.

Kemal Tuncali, MD

Tumor Biopsy and Ablation

  • Kemal Tuncali MD, of the Abdominal Imaging Radiology Department, has performed multiple solid organ biopsies and percutaneous cryoablation procedures. The first PET/CT-guided cryoablation case was recently performed to treat a metastatic deposit in a rib bone.

Gynecology and Urology

  • Akila Viswanathan, MD, of the Radiation Oncology Department, along with Tina Kapur, PhD, of the Department of Radiology, Schmidt and others are focusing on needle targeting, tracking and refinement and use of real-time MRI for brachytherapy of women's reproductive organ cancers.
  • Clare Tempany, MD, chair for Radiology Research and director of Clinical Focused Ultrasound, and Jolesz are working with Paul Nguyen, MD, of the Radiation Oncology Department, on optimizing MRI-guided brachytherapy in prostate cancer treatment and combining it with the standard module of ultrasound to develop magnetic resonance-guided focused ultrasound (MRgFUS).
  • Tuncali and Tempany are also utilizing AMIGO to optimize prostate biopsy by better defining biopsy targets.
Akila Viswanathan, MD Clare Tempany, MD Paul Nguyen, MD


Image-Guided Surgery

Mehra Golshan, MD Eva Gombos, MD Kirby Vosburgh, PhD Nobuhiko Hata, PhD

  • Mehra Golshan, MD, director of the Breast Surgical Services Dana Farber-BWH Cancer Center, and colleagues are working with Eva Gombos, MD, of the Radiology Department, Kirby Vosburgh, PhD, AMIGO associate director, and a team from Radiology and AMIGO to investigate possible improvement in "lumpectomy" by providing the surgeon with improved image-based information during the procedure.
  • Nobuhiko Hata, PhD, Surgical Planning Laboratory, and Vosburgh are exploring the application of advanced ultrasound imaging and real-time tracking of surgical instruments within the body combined with MRI, CT and nuclear medicine imaging for surgical applications such as parathyroid and sarcoma surgery.


Article adapted from original piece in Oncology Advances, Dana-Farber/Brigham and Women's Cancer Center