By Marvin Ellis
Staff Writer, Tyler Morning Telegraph

Installation of the first advanced image guided surgical system for brain and spinal operations in Texas began Tuesday at East Texas Medical Center. This $1 million system uses a Zeiss MKM microscope (German abbreviation for microscopic manipulator) to assist surgeons in delicate operations by using a three-dimensional computerized image of the patient's brain tumor to assist with the operation.

The microscope system is expected to be in use in the next few weeks following text procedures.

Ronald J. Donaldson, Tyler neurosurgeon and medical director of the East Texas Medical Center Neurological Institute, said this system is the latest technology to assist surgeons in brain and spinal surgery, with only 20 of these units in service in the United States. The closest MKM units are located in St. Louis, Mo., and Birmingham, Ala.

"When coupled with a computer, the MKM microscope creates a projected image using digital information from CT or MRI scans taken before the operation," Donaldson said. "The ability to pinpoint the tumor within less than one millimeter will decrease the chance of interfering with healthy, unaffected brain tissue."

He simplified the procedure by comparing the brain to a watermelon with one seed in the middle that needed removing. "We don't want to tear up the watermelon to get the seed, and it is the same with a brain tumor. We don't want to injure the healthy brain tissue to remove the tumor. This system will help us remove brain tumors with out damaging surrounding tissue."

Surgeons using the Zeiss MKM microscope see a computer display of the patient's brain tumor superimposed on the actual tumor. Surgeons can follow the outline of the projection to remove the tumor. The 3-D image produced can also be used in the successful planning of the operation.

The image projected into the microscope lines exactly corresponds to the part of the brain the microscope is focused on, letting the surgeon see the tissue in two modes and better determine the boundaries of the tumor. Focusing the microscope forward, the surgeon can go through the magnetic resonance data and preview what they can expect to encounter.

ETMC Neurological Institute neurosurgeons who will be using the microscope during brain surgeries include Donaldson; Dr. Thomas W. Grahm; Dr. Jon T. Ledlie; Dr. Robert S. Knego; and Dr. Mark B. Renfro. The neurosurgeons traveled to New York recently for two days of intensive training to be certified to use the microscope.

"Brain surgery is one of the world's most difficult medical procedures, and the addition of the Zeiss MKM microscope allows us a greater peace of mind and better ability to pre-plan our actions," Grahm said.

Ledlie added, "The MKM microscope brings a new level of technology to Tyler and all of Texas. This is the only system of its kind in Texas and only one of 20 in the nation. "We can't even accurately predict how far-reaching the ramifications of this technology will be. There is one thing we do know, ETMC has provided a chance to help patients in a way that is unparalleled in this part of the country."

"The MKM microscope, is considered the leading technology in neuronavigation systems, is precisely crafted by technicians who install and review each component to meet the industry's strict standards. The microscope offers the surgeon a wide range of flexibility and can be configured to accommodate procedures requiring the highest levels of accuracy.

Knego compares the level of technology to that of a fighter pilot aiming at a computer-plotted image of a distant target.

"These computer displays are similar to ones used in fighter jets," Knego said. "The level of technology is amazing. Patients will have the benefit of knowing that they are receiving the absolute best care available anywhere in the world."

Before technology such as the MKM microscope, the surgeon shouldered the burden of determining where the tumor was located and exactly how the cut should be positioned. Using this microscope enables the surgeon to know exactly where to cut with minimal damage.

Once the surgery has begun, there is no need for additional medical personnel to aid in the process. The MKM microscope is designed to run only on the surgeon's direction, without the immediate additional aid of nurses or other surgeons.

Establishment of Tyler Neurosurgical Associates in 1972 by Donaldson served as the initial building block for the ETMC Neurological Institute, a partnership between physicians and ETMC Tyler, which has been the site of approximately 20,000 neurosurgical procedures in the past 25 years.