Doctors to see into patients' brains to ensure success of tumour surgery

SCIENTISTS in Scotland hope to revolutionise the treatment of brain tumour patients using scans to direct surgeons.

The technique will use a scanning process known as functional magnetic resonance imaging (fMRI) to map the "thinking" parts of the brain before surgery.

It should mean that patients who won't benefit from operations no longer have to undergo invasive procedures to discover if they are suitable.

It will also help surgeons produce the best results in patients who do have surgery by making sure they do not interfere with parts of the brain which control movement and speech.

The work, funded by Cancer Research UK and Scotland's Chief Scientist Office, has just started through the Experimental Cancer Medicine Centre (ECMC) in Edinburgh and brain imaging centre at Edinburgh University, and will test 70 healthy people and patients with tumours.

Surgery is seen as the most effective way of treating patients with a tumour known as glioma. But operations can cause problems as it is difficult to assess where the tumour is relative to parts of the brain which are essential for normal functions.

Research suggests that slow-growing tumours in 18 per cent of patients contained functioning brain tissue, meaning they may not be suitable for surgery because the risks involved outweigh the benefits.

Currently, doctors assess the "thinking" parts of the brain by opening up the skull and using electrodes to stimulate different areas to see what response it produces. This is distressing for patients, and ultimately may be unnecessary if it shows that they are unsuitable for surgery. But scientists believe fMRI can assess the active parts of the brain without need for an invasive procedure.

Those taking part in the trial will carry out tasks such as moving their fingers or performing mental challenges while their brain is scanned and the functioning areas mapped out for doctors.

Researcher Dr Cyril Pernet said that sometimes tumours contain neurons which affect functions such as movement or speech.

"So if you remove the tumour, obviously you will have a neurological deficit," he said. "The only way to know that at the moment is to open the brain and stimulate the tumour and see if it impairs or stops your language or your movement," he said.

He added that fMRI was not currently used widely in the NHS and there had been no systematic review of its use in brain tumours.

"The NHS in Scotland doesn't pay for it," he said. "When it is done in England the NHS may pay but it will be on a case-by-case basis. But there is no trial where you scan loads of people and say this is the cost and this is the benefit."

The fMRI technique can be carried out using normal MRI scanners with some extra equipment added and with staff trained to use it.

Dr Alexander Henzing, research manager at the Edinburgh ECMC, said: "This study could vastly improve the way we treat people with brain tumours.

"The technique will essentially let us draw a map of a person's brain and show us where the tumour is located in relation to the functioning tissue.

"It will allow surgeons to plan whether or not to carry out surgery and improve the outcome in patients who are eligible."

Dr Sally Burtles, Cancer Research UK's director of the ECMC network, added: "This innovative study could vastly improve the treatment of people with brain tumours."