In an effort to make medicine more personalized and improve outcomes, physicians at
Houston Methodist Hospital are using all the imaging data that the patient has received to
make surgical and radiation therapy decisions that could lead to better outcomes and
provide fewer side effects for patents.
Surgical deficits in the brain, head and neck can lead to long term side eects that dramatically
diminish the quality of life of the patient. It is important for physicians to be able
to visually understand where critical or eloquent pathways exist in the brain or in the head
and neck area, and to have a predetermined idea of where blood vessels and cranial
nerves lie. Eloquent areas in the brain include speech, visual, and motor fiber tracts.
The brain and the head neck area are the most complex in having a three dimensional and
stereoscopic understanding of individual patients. Using technologies integrated in a
Computer Augmented Virtual Environment (CAVE) called Plato’s CAVE, surgeons and
radiation oncologists are able to plan surgery and radiation therapy, by understanding
where the safest corridors of approach for their radiation beam or surgical scalpel.
Dr. Gavin Britz, Chair of Neurosurgery and Co-Director of the Houston Methodist Neurological
Institute, Dr. David Baskin, Director of the Peak Brain Tumor Center, Dr. Donald
Donovan, Chair of Otolaryngology, Dr. Mas Takashima, Otolaryngology, and Dr. Brian
Butler, Chair of Radiation Oncology, use this visual decision-making platform to design
the best and safest strategy for the patient, and to plan therapies well in advance of delivering
them. “For those of us in the neurosurgical spectrum, Plato’s Cave provides a preoperative way
to delineate the important fiber tracts in the brain and determine the best
surgical corridor to access lesions,” says Britz. “It is absolutely one-of-a-kind.”
Houston Methodist physicians are developing techniques that better preserve the most
important human functions – the very things that make us who we are and enable us to
communicate with our world. By advancing the art of functional avoidance, we can better
treat patients with brain, ear, nose and throat tumors which lie close to the eloquent pathways
that create or store memories, fetch words, make our fingers feel and our ears hear.
Anatomic avoidance techniques are well defined, using images of structures such as the
brain stem or the spinal cord. Functional avoidance goes several steps further, identifying
and avoiding the electronic and chemical circuitry in the brain that brings to life essential
activities such as speech, thought process, word recall, or meaningful gestures of a hand
or an eye.
Drs. Butler, Britz, Baskin, Donovan and Takashima have created a functional map of the
brain that identifies “safe” corridors through which surgeons and radiation oncologists
can navigate for the best outcome. On a case-by-case basis, physicians use the functional
map, reference markers and a triangulating GPS-like system to safely work within millimeters of
a critical functional pathway. The map also identifies which pathways are serial or parallel.
Serial pathways have no redundancy, so there is no recovery if they are cut. This vital
information further helps determine the safest approach to a tumor.