Operating on the delicate structures of the brain requires extreme neurosurgical precision, aided by microsurgical technology. Dr. Foroohar is skilled in leading-edge microsurgical techniques, allowing her to operate using the smallest incisions possible and minimizing damage to healthy brain tissue.
“The microscope, particularly in the brain, allows us to see areas we wouldn't be able to see with just a magnifying loupe,” Dr. Foroohar explains. “During brain surgery, we can rotate the microscope to view areas and see more angles deeper in the brain than we could with earlier technology. The microscope allows us to zoom in and illuminate brain structures to see them in greater detail.”
“As neurosurgeons, we're trained from the beginning to operate through the microscope,” says Dr. Foroohar. “To be able to use the microscope and manipulate the surgical tools through it—that's what neurosurgery is all about.”
In the past, neurosurgeons had to rely on MRI images on the operating room wall to guide them during brain surgery. Dr. Foroohar uses a much more advanced and precise method: the Brainlab image guidance system.
“With a primary brain tumor, the goal is to remove as much of the tumor as possible without causing neurological deficits,” Dr. Foroohar explains. “Neurosurgeons use image guidance to help guide our approach and resection.
“I use many advanced tools to make brain surgery safer and better,” she adds. “A lot of production goes into using this technology—from the pre-op brain imaging studies which may include a functional MRI, to intraoperative brain mapping to image guidance. I think these tools really do make a difference.”
Benign (non-cancerous) brain tumors—Meningiomas, pituitary tumors, acoustic neuromas and other types of non-cancerous growths in the brain.
Malignant (cancerous) brain tumors—Both primary brain tumors and metastatic brain tumors, where cancer has spread from somewhere else in the body.
Hematoma (hemorrhage)—An accumulation of blood or bleeding in the body tissues. Depending on their size and location, hematomas may require evacuation (removal and/or drainage).
Cerebral aneurysm—A defect or a weakness in the wall of a blood vessel in the brain that causes an out-pouching. If untreated, aneurysms may rupture (burst), causing a subarachnoid hemorrhage.
Arteriovenous malformation—An abnormal connection between veins and arteries, which is usually congenital or present from birth. Arteriovenous malformations can sometimes rupture or burst without warning.
Hydrocephalus (also known as water on the brain)—A medical condition caused by an abnormal accumulation of cerebrospinal fluid in the brain's ventricles or cavities. Water on the brain can cause enlargement of the skull in children. Hydrocephalus results in compression of the brain, damaging the neural tissue.
The Brainlab neuronavigation system is advanced imaging technology that helps guide neurosurgeons during surgery.
“Before surgery, the patient has an MRI with Brainlab protocol,” Dr. Foroohar explains. “That MRI is fed into the computer in the operating room. When we're ready to start the surgery, we register that patient with the Brainlab software that has the MRI. Then we're able to use a wand and point to the patient's head, and look at the MRI to see where we are in the brain.”
“Brainlab's neuronavigation system allows us to use the wand to track where we are on the MRI,” says Dr. Foroohar. “It helps us plan the scalp incision more accurately, right over the tumor or hematoma.
“Once we're inside the brain, Brainlab helps us determine how much of the tumor has been removed,” she explains. “We can also use tools such as surgical instruments and equipment such as the microscope, endoscope or ultrasound in addition to the wand and Brainlab will display their position on the patient's MRI.
“This precision navigation system guides us through brain procedures, helping us keep skull openings small and minimizing damage to healthy structures in the brain,” she adds.
Brain mapping is a system of identifying the functions of critical regions of the brain by direct electrical stimulation with an electrode array or grid. “This is done prior to and during surgical removal of a tumor,” Dr. Foroohar explains.
“We use intraoperative brain mapping for tumors located in eloquent brain cortex—areas that control movement, sensation, speech, comprehension and vision,” says Dr. Foroohar. “Using intraoperative brain mapping lessens the risk of loss of function in these critical areas of the brain.” This is done in conjunction with motor-evoked potentials.