Africa’s most advanced neurosurgery theatre and first interventional MR and CT centre was officially opened in Cape Town last night and early indications are that it will become ‘an important healthcare asset to the nation.
This is according to neurosurgeon Dr Gerrit Coetzee who says that, considering how widespread brain tumours are, the new Interventional Centre of Excellence, which is based at the Netcare N1 City Hospital, is a most welcome addition to South Africa’s arsenal in the fight against cancer.
‘Some 2% of all routine autopsies reveal a brain tumour,’ continues Dr Coetzee. ‘This is a frighteningly high figure and it is good to know that we now have one of the most advanced neurosurgery theatres available anywhere in the world right here in Cape Town.’
The event was attended by neurosurgeons, neurologists, oncologists, physicians, local hospital managers, delegates from the Department of Health, members of GP organisations, Medical Research Council representatives, Netcare executives and staff members, the team from Symington & Partners, representatives of GE Healthcare and a host of other VIPs from within the healthcare sector. The guest speaker was Dr Ian F Parney from the famous Mayo Clinic in USA and one of the world’s foremost experts on brain tumours. He spoke on the future of intra operative MRI.
The Interventional Centre of Excellence is a partnership between Netcare, Dr Coetzee and Symington & Partners Radiology, which bought and installed a 3 Tesla MR (magnetic resonance) scanner as well as a 64-slice CT (computed tomography) scanner. The MR scanner can do functional MR, spectroscopy as well as diffuser tensor imaging. Dr Coetzee explains that the centre is designed to treat and improve outcomes in patients with primary brain tumours, or tumours that develop within the brain itself.
As pointed out by Dr Anton van Wyk, General Manager of Netcare N1 City Hospital the centre was not merely for neurosurgeons practicing within the Netcare group, but is being made available to healthcare professionals throughout South Africa. ‘The general idea behind the centre is for it to become a neuro-oncological reference site for the entire African continent. It will also have an important training function. All of the technology in the centre is linked to high definition video equipment and this will allow personnel and trainees to observe live or recorded procedures in order to learn from them.’
‘The centre shows what can be achieved when various roleplayers come together to cooperate for the greater good of patients around the country,’ adds Van Wyk. ‘Netcare, Dr Coetzee and Symington & Partners Radiology have a long relationship and have been able to use it to develop a continental hub for neuro-cancer treatment and research.’
The theatre will be used by neurosurgeons to do more complete resections, or excisions, of especially low-grade gliomas, a type of tumour that starts in the brain or spine, and pituitary tumours, suggests Dr Coetzee. It may also be useful to assist the neurosurgeon in undertaking more complete resections of complex skull base tumours.
He explains that back in the 1990s doctors did brain scans using an MRI (magnetic resonance imaging). Once they had mapped out the brain and the tumour, they were able to operate on the tumour. As it is not possible to distinguish between healthy brain tissue and tumour tissue with the naked eye, doctors have to rely on computer-generated images of the brain in order to do their surgery.
‘Unfortunately the brain floats in a liquid suspension and, when the surgeon cuts open the skull, these liquids no longer hold the brain in the same position,’ he continues. ‘This can completely throw the computer image off. The result being that many doctors tended to be cautious and even over cautious, cutting away less of the tumour than they may otherwise have done in order not to damage healthy brain tissue.’
The problem was that such an approach often left cancerous cells behind after the surgery. This meant that the operation was only a temporary answer to the problem, as the cancer that was not excised could easily spread again. Before long the patient would therefore have to undergo another similar operation with much the same result.
Other surgeons went to the other extreme in an attempt to make sure that they cut out all of the cancer and excised more healthy brain tissue than they should have. This could have a negative impact on brain function.
The Interventional Centre of Excellence at Netcare N1 City Hospital changes all of this and allows for patients to be operated on with pinpoint accuracy. The patient is now scanned using the new 3 Tesla MR scanner before surgeons open their skull. Thereafter the patient is rescanned to accurately ascertain where the tumour lies after the opening. This overcomes all of the problems of locating the tumour once the skull is opened.
Jacques Basson, a partner at Symington & Partners Radiology, says that the planning software at the Centre allows a surgeon to take MR or CT scanning images simply and quickly and ensures that there are no surprises when the surgeon operates. The software shows exactly where the tumour is and in what brain tissues it lies in so that doctors are able to ascertain what parts of the body these brain cells control.
The technology maps out a surgical plan, which is sent via a network to a Navigation computer. This allows the doctor to operate on the patient with the utmost accuracy via virtual reality technology. One of the great advantages of using this technology is that it dramatically decreases the risk of the neurosurgeon causing unnecessary neurological damage to the patient during surgery. The anaesthesiologist and nursing staff can follow the operation on a large high definition LCD screen as if looking through a microscope.
‘It is formidable technology that will save lives,’ points out Basson. ‘And if one considers that it reduces the need for follow up surgery and improves the chances of total recovery, then it may be regarded as a highly cost-effective form of treatment too.’
‘Currently fewer than 30% of patients who undergo brain tumour surgery survive longer than five years,’ notes Dr Anton van Wyk. ‘These are not encouraging statistics and it is important for us to improve outcomes in brain tumour sufferers. This wonderful centre with its state-of-the-art technology is an important step in this direction. I believe that in the future it will come to shine as a beacon of hope to brain tumour sufferers around the African continent.’
Issued by : Martina Nicholson Associates (MNA) on behalf of Netcare
Contact : Martina Nicholson or Graeme Swinney
Telephone : (011) 469 3016
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