Complex Surgery Highlights Value of New Navigation System at Monument Health

A recent complex brain surgery case at Monument Health illustrates the value of Rapid City Hospital's highly advanced new surgical navigation and imaging system. 

Monument Health invested hundreds of thousands of dollars in Brainlab Image-Guided Navigation and Ziehm Fluoroscopy to replace a 20-year-old system. Neurosurgeon Rodney Samuelson, MD, utilized the new technology in May to resect a metastatic melanoma tumor from deep inside the brain of a man in his 60s. 

The patient had been treated for ocular melanoma at Mayo clinic 20 years previously. When he came to Monument complaining of headaches and balance problems, MRI confirmed that the cancer had returned. 

"He had two tumors, one toward the surface of the brain and a medium-sized tumor deep at the base of his brain, near the brainstem," says Dr. Samuelson. "Because of the size of the lower tumor, it was pushing on the brain stem." 

The position of the tumor made precise navigation both critical and challenging. 

"That's where the new technology came in," says Samuelson. "The Brainlab system allows us to take the patient's MRI before surgery and register that with their real-life anatomy during surgery for navigation through the brain. But more than that, it allows us to acquire images during surgery to change things as needed."  

The 3D digital model generated by the system can help guide surgical instruments in the brain or spine, allowing for highly precise placement of spinal fusion material. The melanoma brain tumor case was the first complex cranial case at Monument to benefit from the new guidance system.

"Image guidance was very important in this case because the angle had to be exactly right," says Dr. Samuelson. "The patient's head position had to be flexed, almost chin to chest. We were able to use this system to show that this angle was going to be successful, even before we made an incision."

In the end, the patient had what Dr. Samuelson calls "an especially good result" and was discharged shortly after surgery. Relieved of the pressure in his brain, the patient's headaches and dizziness improved. "This was a particularly hard case with a really nice outcome," says Dr. Samuelson.

In addition to brain tumors, the Brainlab system can help with spinal cord injuries, trauma, spinal fractures, and more common conditions such as degenerative changes in the lumbar spine requiring surgical hardware. 

As the coronavirus pandemic has made travel more challenging than ever for Black Hills patients, Dr. Samuelson says the new technology means more of them will be able to get the high-level treatment they need, closer to home. 

"We will definitely be able to do things here that we were not able to do before," says Dr. Samuelson.