Northwestern Medicine

Northwestern Medicine Surgeons Develop New Approach to Removing Nerve Tumors

Northwestern Memorial Hospital May 21, 2015

Better imaging before surgery gives neurosurgeons a more precise path to tumors

CHICAGO, IL - When Ryan Rendino first felt the small lump along the side of his neck, he figured it was a muscle strain and took a couple weeks off from weight lifting. But the lump didn’t go away.

DTI imagery of a nerve tumorA series of doctor appointments followed before Rendino, 26, was referred to Michel Kliot, MD, a Northwestern Medicine® neurosurgeon and expert in treating peripheral nerve disorders. An MRI and biopsy confirmed the lump in Rendino’s neck was a schwannoma, a rare tumor that forms in the tissue that surrounds nerves. While most schwannomas are benign and slow growing, Rendino’s tumor was progressing and causing him pain making surgical removal necessary.

In nerve surgery, the surgeon must navigate around crucial nerve fibers to access and remove the tumor. These surgeries are particularly challenging because traditional MRIs often do not give the surgeon a complete picture of the patient’s unique nerve fibers. To better define this picture, Kliot, along with Thomas A. Gallagher, MD, a Northwestern Medicine functional neuroradiologist, have successfully applied diffusion tensor imaging (DTI), a unique type of MRI sequence, to map the course of vital nerve fibers prior to surgery to remove the nerve tumor.

“This advanced imaging technology helps us know more about a tumor’s makeup and its location before instead of during surgery,” said Kliot, who is also professor of neurological surgery at the Northwestern University Feinberg School of Medicine. Kliot is one of the few surgeons in the country with expertise in peripheral nerve surgery and the only one in the Chicago area.

DTI allows surgeons to better understand the intricate architecture and orientation of nerve fibers by studying the diffusion of water molecules in and around the nerves. The resulting colorful images can then be displayed in either a 2D format or into 3D fibers offering a better view of nerve fibers and their relationship to nerve tumors.
“By having a more precise pre-operative diagnosis, we are armed with a better surgical plan that will give us the most direct, yet least invasive path for removing nerve tumors,” said Kliot.  “For patients, this means smaller incisions and a reduced risk of damaging functioning nerve fibers.

While this technology is still new in its application for nerve tumors, the Northwestern Medicine team is encouraged by early outcomes.

“DTI can give us additional information about the organization of nerves as well as the diffusion properties within tumors; this is something that conventional MRI cannot do,” said Gallagher, who is also an assistant professor of radiology at the Feinberg School of Medicine. “Applications of this technology could extend beyond nerve tumors, and give us insight into many different nerve pathologies, traumatic nerve injuries  and even the regrowth or recovery of nerves over time.”

Rendino was one of the first patients to undergo surgery using this technology at Northwestern Memorial Hospital. He had no complications and was discharged from the hospital the same day as his surgery. The good news for patients like Rendino, is that while the cause of schwannomas isn’t known, once removed, they rarely return. Rendino returned to work about a week after his surgery.

“When I had a lump in my neck that wouldn’t go away, I immediately thought of worst-case scenarios,” said Rendino, who lives in Chicago and works in the finance industry. “I was afraid of the diagnosis and then I was afraid the surgery would cause nerve damage or a loss of mobility. But when I heard about this new technology that could map out where my tumor was and how to remove it, I was completely on board.”

Northwestern Medicine is home to the top neurosurgery program in Illinois and the 10th best program in the nation as ranked by U.S. News & World Report. Learn more information on Northwestern Medicine’s peripheral nerve program. To make an appointment, call 312.695.1608.

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