Stereotactic Radiosurgery (SRS)

The department has been an innovator in the area of Stereotactic Radiosurgery (SRS). SRS is a method of treating lesions in the brain and at the skull base, with a highly concentrated dose of x-rays, by aiming radiation beams only at the target and not the surrounding brain. A very powerful dose can be delivered while making a risk of complications minimal. Drs. Gandhi, Goldstein and Liu use the latest radiosurgical planning system developed by Radionics Incorporated, known as X-Knife RT, in conjunction with two linear accelerators (LINAC). With this technology, the doctors are able to target the area of interest, as well as avoid radiation to critical parts of the brain. SRS is used to treat patients with a large variety of conditions, including gliomas, meningiomas, acoustic neuromas, other schwannomas, trigeminal neuralgia, and arterial venous malformations.

 

Image-Guided Neurosurgery

The Center for Image-Guided Surgery is dedicated to providing patients with the latest advances in neurosurgical technology. What these methods have in common are the incorporation of cutting edge imaging modalities, including intraoperative MRI, high-field strength MRI, and functional imaging into the treatment plan and surgical procedure itself. As part of our mission to advance the field of image-guided neurosurgery, we work in conjunction with other departments at UMDNJ, other leading medical centers, and various high-tech companies on a number of projects.

We were the first institution in North America, and only the second in the world, to use the innovative Pole Star N-10 intraoperative MRI system. We have recently installed the latest generation of this device, the Pole Star N-20. The acquisition of continually updated images during surgery, coupled with intraoperative navigation, allow for maximum precision of tumor resection and minimal disturbance of normal areas of the brain.

Intraoperative MRI allows the surgeon to monitor the progress of a procedure, for instance, during tumor removal. The possibility of a surgical cure is increased because no surprises are left for an MRI scan done the day after surgery, as was done in the past. The potential dangers of brain shift, whereby, during surgery the brain can move and render inaccurate coordinates obtained from preoperative imaging, is overcome by the freshening of images obtained during surgery.

For image-guided surgery, we were the first to describe the method whereby critical brain areas (such as those responsible for movement, sensation, vision, and speech) can be mapped onto a computer in the operating room in a non-invasive way via intraoperative MRI. For example, using surgical navigation in the operating room, we can precisely define not just the location of a lesion, such as a tumor, but also areas of the brain that must be avoided during surgery. Our functional imaging laboratory also develops ways of mapping the surface of the brain along with the critical pathways, known as white matter, that connect the brain to other parts of the body. We also reported the first series of incorporation of functional MRI for stereotactic radiosurgery. Thus, we can utilize functional image guidance not just for open surgery, but also for non-invasive treatment of a variety of intracranial lesions.