Room With A High Tech View

This technology puts Yale-New Haven way above the curve in the standard of care we can offer. Phillip Dickey, MD, YNHH Neurosurgeon

Brain surgery combines precise science, delicate art and constant innovation, a special blend that is a hallmark of Yale-New Haven Hospital’s Neurosciences services. Over the years, its multidisciplinary teams of highly trained physicians and researchers have achieved remarkable success in diagnosing and treating an ever-expanding range of neurological conditions, from brain tumors and aneurysms to strokes and epilepsy.

In 2010, YNHH raised the bar yet again with the installation of an extremely sophisticated neurosurgery suite in its new Smilow Cancer Hospital. The suite comprises side-by-side operating rooms, equipped with the strongest magnetic resonance imaging (MRI) device available. The space-age machine resides in a bay between the ORs and can quickly glide into either one along a ceiling-mounted rail. Its so-called 3 Tesla technology, produced by IMRIS, allows neurosurgeons in both ORs to generate real-time, instantaneous images of the brain before, during and after procedures.

With the neurosurgery suite’s unique configuration, Yale-New Haven Hospital was the first hospital -- and remains one of the few hospitals -- in the nation to offer both intraoperative MRI and biplane X-ray angiography, the latter which produces 3-D imagery of blood vessels in the brain. Perhaps most amazing, all this happens without ever having to move the patient from the operating table. Compared to conventional methods, this

advancement greatly increases the safety and effectiveness of performing complex brain surgeries.

Phillip Dickey, MD, began his career in neurosurgery at YNHH in 1983 as an intern. “We didn’t even have MRI back then,” he recalls when considering the technological leaps that have resulted in the 3 Tesla imagery. “This is groundbreaking in the sense that it puts Yale-New Haven way above the curve in enhancing and expanding the types of treatments and standard of care that we can offer.” For instance, while performing intricate surgery to remove a brain tumor, Dickey can utilize the IMRIS device to ensure that the entire mass is eliminated. “We can avoid a second operation and all that entails,” he says.

During similarly complicated neurovascular and skull base surgery, Ketan R. Bulsara, MD, relies on the instantaneous imagery of the brain’s tiny blood vessels. Bulsara, director of neuroendovascular and skull base surgery at YNHH and one of a select group of neurosurgeons dual-fellowship-trained in cerebrovascular/skull base microsurgery and endovascular neurosurgery, recalls a case in which a patient was suffering from a brain aneurysm. At first, he attempted to reach the aneurysm directly

through a blood vessel, but soon decided that open brain surgery would be necessary. “Only with the use of this novel angiography technology could we successfully do such a procedure without ever moving the patient,” Bulsara states.

Assisting Bulsara, Dickey and other YNHH neurosurgeons in the suite are nurses, anesthesiologists and other specialists, as well as a cadre of radiologists trained specifically on the IMRIS device. Stationed in a futuristic control room overlooking both ORs, they snap into action whenever the machine is called for, overseeing its operation and analyzing images with the surgeons. The meticulous interaction of the entire team is truly a marvel of ultramodern medicine.