Program Innovation: Neurosurgery, Neurology and Radiology
Neurosurgeon Dr. Jeff Ojemann is pioneering the use of functional MRIs in young patients.
All neurosurgeons face the same delicate dilemma: how to avoid critical areas of the brain while still being able to operate on diseased tissue.
At Seattle Children’s, teamwork and technology are the keys to helping solve this dilemma and producing better outcomes for children with epilepsy and brain tumors.
Working closely with neuroradiologists and neuropsychologists, neurosurgeon Dr. Jeffrey Ojemann is pioneering the use of functional magnetic resonance imaging (MRI) scans in patients often considered too young for the procedure.
“It’s fairly common to perform functional MRIs with adults and adolescents, but rare for children under 12 and almost unheard of for children under 8,” says Ojemann. “At Seattle Children’s, we are able to do them with patients as young as 5.”
New MRI technology — including a state-of-the-art 3-T — makes it possible to obtain these scans much faster. Scanning can often be completed in less than four minutes per brain function being imaged. Any longer and most young children struggle to cooperate and concentrate. New computer processing also provides results immediately instead of hours or days later, allowing any inconclusive scan to be repeated on the spot.
The goal is to more clearly identify areas of each patient’s brain that must be avoided during surgery because they contribute to speech, language, memory and motor skills. If surgeons know where those areas are, they can avoid inadvertent injury to this important tissue — a risk than can outweigh the benefits of surgery. If the surgery is medically necessary and injury cannot be avoided, the functional MRI will alert surgeons and family members to the long-term consequences in advance.
Designed for Young Kids
During functional MRI scans, neuropsychologists Hillary Shurtleff, PhD, and Molly Warner, PhD, have patients perform sets of tasks such as tapping their fingers, reading or thinking of words. The scans then show what areas of the brain are involved in performing each set of tasks by revealing elevated oxygen levels.
Preparing young patients for functional MRI scans is as important as the scans themselves. The language-related tasks they’re asked to perform — such as looking at a picture and thinking of a related verb — were carefully chosen by Shurtleff with younger patients in mind.
Shurtleff and Warner also coach children before they undergo scans. “The biggest issue is to get younger children to lie still in a big, loud machine,” says Shurtleff. Besides remaining entirely motionless during scanning, children also must keep their heads still during the setup for scans — a total of 15 to 30 minutes.
“Functional MRI is a window into the brain,” says Dr. Dennis Shaw, one of the Children’s radiologists who works closely with Ojemann to optimize the functional MRI scanning and to interpret the results. “How we do these scans is in a constant state of evolution as we learn more about how the brain functions and adapt improvements in the scanner technology.”