Colorful blueprints of nerves help surgeons in new way

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Blending art and medicine. Local doctors create colorful blueprints to map delicate nerves. The designs give surgeons a view like never before.

Dr Michel Kliot, Northwestern Medicine neurosurgeon: “Not only are they beautiful but clinically useful images.”

They look like pieces of art – bold, colorful images you’d likely see lining the walls of a modern gallery. But these pictures are displayed in an operating room.

Dr Kliot: “Here you can see the spinal cord. Now you can see the individual nerves coming off the spinal cord.”

It’s called diffusion tensor imaging – the technology has long been used to map the brain. Now doctors at Northwestern Medicine are harnessing its power to help them remove tumors tangled among delicate peripheral nerves.

Ryan Rendino, nerve tumor patient: “I had started working out and kind of noticed a lump in my neck.”

The finding alarmed 26-year-old Ryan Rendino, who was told the mass needed to be removed.

Ryan Rendino: “I was worrying about what it could be, what it might impact and how it might come out.”

Dr Kliot: “You don’t want to damage the nerves since the nerves supply sensation, they supply strength and they can create pain if they are mistreated.”

A conventional MRI, which highlights structures not nerve fibers, pales in comparison.

Dr Kliot: “In the middle of the neck here you can see a mass. You do not see the nerve connections here at all. You can tweak it a bit so you see outlines.”

But the vibrant designs paint a different picture. They are the handy work of neuroradiologist Tom Gallagher, who relies on a specific property nerve fibers have but surrounding tissue doesn’t – water.

Dr Tom Gallagher, Northwestern Medicine neuroradiologist: “When water diffuses along nerves or nervous tissue, it likes to follow a certain trajectory, and we can image that phenomenon of diffusing water. All of the diffusing water molecules in the spinal cord around those nerves and tracks are kind of going in one direction. We color that direction blue and say everyone is headed this way. The nerves coming off the spinal cord, they’re headed a different direction so they get a different color.”

Dr Kliot: “And you can actually see how they envelop the tumor. For instance, all the fibers are surrounding the tumor except in this one area here.”

And that’s the path neurosurgeon Dr Michel Kliot took to access the mass entangled in Ryan’s neck.

Dr Kliot: “In the past sometimes you would get in there and you would be surprised and also you couldn’t really tell the patient you could remove it without damaging his nerve fibers.”

But the diffusion images have changed that.

Ryan Rendino: “There are several nerves, from what I’ve learned, that could have been impacted. Very reassuring and it was kind of neat to see.”

The technology has been in use at Northwestern Medicine for about eight months. And doctors there hope to eventually expand its use to image other parts of the body.



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