State-of-the-Art Surgical Procedures

Brain Mapping and Awake Craniotomy

Our neurosurgeons employ a technique called electrocortical mapping to provide the greatest measure of safety during brain tumor removal. Because areas of the brain that control speech and motor function look very similar to other brain areas with little known function, they are at risk for injury during brain tumor surgery.

During electrocortical mapping, the patient remains awake. The brain has no nerve endings that register pain, so the patient experiences no discomfort. The patient responds verbally to a series of images displayed on a computer monitor, while the neurosurgeon stimulates the surface of the brain with a very mild electrical current. The patient’s responses enable the surgeon to determine which areas control important functions (such as speech), and to map the boundaries between the tumor and healthy tissue.

Intraoperative MRI (iMRI)

Our operating suite is equipped with the PoleStar N-20 intra-operative MRI scanner, a device that takes MRI scans during surgery to confirm that the tumor is removed completely. When the iMRI detects residual tumor tissue that the neurosurgeon cannot see visually, a stereotactic guidance system directs the surgeon to the brain site where that tumor tissue can be. The use of iMRI has been shown to increase the completeness of tumor removal and to prolong progression-free survival in patients with primary malignant gliomas called glioblastoma.
 

Perfexion Gamma Knife Stereotactic Radiosurgery

This medical treatment destroys a brain tumor by zapping it with 192 intersecting gamma ray beams. That’s the concept behind the Leksell Perfexion Gamma Knife, a minimally-invasive treatment used primarily to treat benign tumors and malignant metastatic tumors that have spread to the brain from other parts of the body.

The Gamma Knife unit is also used to treat other brain conditions, including trigeminal neuralgia and arteriovenous malformations. In some cases, Gamma Knife enables treatment of deeply embedded tumors that cannot be reached with conventional surgery. Gamma Knife Radiosurgery is done as an outpatient procedure, in a single day, and does not require general anesthesia. Roswell Park is the only Buffalo institution to offer Gamma Knife radiosurgery. We treat more than 400 patients with Gamma Knife annually. 

Endoscopic Skull Base Surgery

This procedure, called expanded endoscopic endonasal surgery, is performed to remove pituitary tumors and other tumors located at the skull’s base. The surgical team includes a neurosurgeon and head and neck surgeon working in concert. The head and neck surgeon inserts an endoscope — a thin, lighted telescope with a camera on one end — through the patient’s nostril, and the camera sends images from inside the head to a flatscreen TV in the operating room. Surgical instruments are introduced through the other nostril so the head and neck surgeon can create a working channel through the nose and sinuses toward the skull base, while monitoring the field on the TV. The neurosurgeon then removes the tumor using similar techniques.

This procedure is used to treat pituitary tumors, including those in patients with acromegaly and Cushing’s Disease, and for patients with meningiomas, chordomas, craniopharyngiomas, esthesioneuroblastomas and other midline skull base tumors.