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.