Yale-New Haven neurosurgeons verifying effective eye tumor drug delivery localization with iMRI in VISIUS® Surgical Theatre
Intraoperative MRI and angiography confirms retinoblastoma chemotherapy
MINNEAPOLIS, MN, June 19, 2013 /PRNewswire/ – IMRIS Inc. (NASDAQ: IMRS; TSX:
IM) (“IMRIS” or the “Company”) today announced that Yale-New Haven
Hospital, New Haven, CT, neurosurgeons are confirming effective
chemotherapy delivery in treating eye cancer using intraoperative
imaging within the VISIUS(®) Surgical Theatre.
Selective intra-arterial chemotherapy is a growing strategy for treating
retinoblastomas – a rapid growth cancer in the eye primarily affecting
infants. The technique allows for delivery of an increased
concentration of the drug directly to the tumor and reduces the need to
use systemically delivered chemotherapy which can cause significant
Using the VISIUS Surgical Theatre with iMRI during the treatment
procedure is a novel approach to this strategy that permits Yale
neurosurgeons to confirm successful delivery of chemotherapy at the
tumor site. “Combining the intraoperative MRI with biplane angiography
has allowed us to rapidly acquire an intraoperative MRI and indirectly
confirm that the chemotherapy reached the site of interest,” said Dr.
Ketan R. Bulsara, Associate Professor of Neurosurgery and Director of
Neuroendovascular and Skull-Base Surgery at Yale School of Medicine. He
believes Yale-New Haven Hospital is the first to use the iMRI for
confirming this treatment method.
The VISIUS Surgical Theatre at Yale-New Haven Hospital features a
high-field iMRI that moves between three rooms for diagnostic and
surgical usage. Installed in 2010, the multi-disciplinary suite also
has biplane angiography in the third room to add a true intraoperative
imaging advantage to neurosurgical, endovascular and microsurgical
operating capabilities. The VISIUS iMRI does not require the patient to
be moved from the OR table to other rooms for scanning because the MR
moves on ceiling rails, so optimum positioning for neurosurgery is
never compromised and typical clinical workflow is not impacted.
For the retinoblastoma cases, the Yale-New Haven setup allows Dr.
Bulsara to use angiography to guide the drug delivery catheter from the
entry point at the femoral (leg) artery to the ophthalmic (eye) artery.
The surgeon can then confirm that the chemotherapy reached the site of
interest using iMRI – all in a single procedural space without ever
moving the patient.
A case report on the initial patient using iMRI, a seven-month-old
infant, was published in the Journal of NeuroInterventional Surgery in Nov. 2012. Multiple patients have been treated since then, and in
these cases complete tumor remission has been seen so far, according to
Bulsara. He added that this has avoided the need to remove the eye or
the need for systemic chemotherapy for these patients.
During the procedures, iMRI scans were obtained within 15 minutes after
drug delivery. “The iMRI provided enhanced visualization of the tumor
and the space around the eye using gadolinium as an indirect marker,”
said Dr. Bulsara.
In the first case, after each of three treatments – spaced four to six
weeks apart – imaging showed significant tumor reduction in the child’s
eye until it was all gone with no major systemic side effects
observed. “So far there hasn’t been a need to adjust the delivery
method because we haven’t seen evidence of the therapy going
elsewhere,” Bulsara said.
Patients selected for this method, he noted, undergo an extensive
evaluation by a Yale-New Haven Hospital team that includes Dr. Miguel
Materin, ophthalmologist; Farzana Parshanker, oncologist; and Jeremy
Asnes, pediatric cardiologist and co-surgeon.
Dr. Bulsara, one of only a select few neurosurgeons in the country that
is dual fellowship trained in skull based cerebrovascular microsurgery
and endovascular neurosurgery, believes that physicians are only
beginning to see the potential advantages of having all these
capabilities in a single room.
More about Retinoblastoma
Retinoblastoma is a rapidly developing cancer that develops in the cells
of the retina – the light detecting tissue of the eye. Affecting
children up to about 30 months old, an estimated 250-300 in the US
annually will develop the disease, according the American Cancer
Society. Representing about 3 percent of all childhood malignancies, it
is the most common inherited childhood malignancy. In the developed
world, retinoblastoma has one of the best cure rates of all childhood
cancers (95-98%), with more than nine out of every ten sufferers
surviving into adulthood. The first sign of retinoblastoma is usually a
white reflex in the eye, often called a cat’s eye appearance, in which
a white-yellow tumor mass is seen through the pupil.
IMRIS (NASDAQ: IMRS; TSX: IM) is a global leader in providing image
guided therapy solutions through its VISIUS Surgical Theatre – a
revolutionary, multifunctional surgical environment that provides
unmatched intraoperative vision to clinicians to assist in decision
making and enhance precision in treatment. VISIUS Surgical Theatres
serve the neurosurgical, cardiovascular and cerebrovascular markets and
have been selected by leading medical institutions around the world.
SOURCE IMRIS Inc.
Image with caption: “The VISIUS Surgical Theatre at Yale-New Haven Hospital features a high-field intraoperative MRI that moves between three rooms for diagnostic and surgical usage. The third room also has a biplane angiography for neurosurgical, endovascular and microsurgical operating capabilities. (CNW Group/IMRIS Inc.)”. Image available at: http://photos.newswire.ca/images/download/20130619_C9577_PHOTO_EN_28242.jpg