State-of-the-Art Surgical Procedures for Brain Cancer

Dr. Fenstermaker describes how a craniotomy is used as a surgical option for the treatment of brain tumors

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 is used during brain surgery to ensure the best possible outcome. Dr. Fenstermaker explains.

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.

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.

Laser Interstitial Thermal Therapy (LITT)

Thermal Therapy treats a variety of conditions that impact the brain. Dr. Fabiano explains.

This minimally invasive neurosurgery uses heat to ablate or destroy cancerous or other damaged tissue in the brain. Through a tiny incision (less than 2 cm) a laser probe delivers light energy to the target, heating the target area and destroying the unwanted tissue. The procedure is performed under MRI-guidance so the neurosurgeon can monitor the temperature of the target area and have real-time confirmation that all the necessary tissue has been ablated and the normal brain has been preserved. The treatment does not require a large incision. Patients typically return home the day after the procedure.

LITT, which also goes by the brand name of Visualase, may be an option for patients with primary brain cancers, gliomas, metastases to the brain, for cancer that’s recurred after radiation or Gamma Knife therapy, and to treat noncancerous conditions such as epilepsy. LITT may also ablate areas of radiation necrosis (swelling or edema caused by prior radiation therapy) in the brain.

LITT is available only at select centers across the nation; Roswell Park is the only such center offering the treatment in the Western New York region.