A delicate dance

A tumor pressing against a vital part of Carol Fichtner's brain must be removed. A surgery this precise requires deft hands and the best technology an operating room can have.

Mother and daughter have choreographed their response. When Carol Fichtner feels her head involuntarily turn to the right, she has two seconds to call out to her daughter. Clara Mae Fichtner rushes into the room and positions herself between her mother and any sharp corners.

Then comes Carol's involuntary "Statue of Liberty pose": Her right arm shoots skyward, her left cradles at her waist. Her knees lock, and she falls to the floor, unresponsive. Clara Mae calls 911.

Since March 2009, these seizures have become an unwelcome guest, crowding the small Tigard apartment that Carol, 60, and 19-year-old Clara Mae share. The first one arrived violently, striking Carol in the walkway outside their apartment. She was "out" for two hours. She doesn't remember taking the ambulance ride to Providence St. Vincent Medical Center, or undergoing CT and MRI scans.

She does remember, however, the doctor's diagnosis.

"He said I had a mass in my brain."

 A walnut-sized tumor is growing on Carol's left frontal lobe, encroaching on an area that controls movement on her right side. It’s unclear whether the tumor is benign or malignant, but it needs to be removed, and the surgery will be delicate.

"The tumor is very close to her primary motor cortex," says neurosurgeon Daniel Rohrer, M.D., as he examines a scan of Carol’s brain. The tumor shines like an egg in the gray image. “There’s a certain amount of language function on that side as well.”

Dr. Rohrer faces a familiar challenge: If he’s too conservative, the tumor is more likely to grow back; too aggressive and Carol could lose precious function. Surgery this precise requires deft hands, advanced equipment to monitor brain function, and highly detailed navigation and imaging.

A case like this is why Providence Brain Institute, with the help of private donors, has built one of the most sophisticated neurosurgical suites in the world. Housed on the first floor of Providence St. Vincent Medical Center, the operating room has advanced navigational technology and a moveable intraoperative MRI – one of just 16 in the world and the only one on the West Coast.

Unlike standard MRIs, housed in a diagnostic room elsewhere in the hospital, this state-of-the-art model sits on the other side of the operating room wall. When surgeons want to check their work, they summon the scanner, which enters the suite on ceiling tracks through stainless steel doors.

The patient isn't moved, the surgical coordinates aren't disturbed and the results are immediate.

This means that surgeons such as Dr. Rohrer, co-medical director of cranial services at Providence St. Vincent Medical Center, can confirm on the spot that they've removed as much of a diseased area as possible before the patient is wheeled out of the operating room.

Living with a brain tumor

Few things are as alarming as hearing the words “brain tumor.” Yet long-term survival for people with malignant brain tumors has climbed steadily over the decades, giving hope to the more than 20,000 Americans diagnosed each year.

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