Neurosurgery

Neurosurgery is surgery performed on parts of the nervous system, including the brain and spinal cord, peripheral nerves, such those found in the hands and feet, and the extra-cranial cerebrovascular system. Neurosurgery may be a treatment option for:

• Primary or metastatic brain tumors
• Primary or metastatic spinal tumors
• Tumors near the spinal column or peripheral nerves
• Neurologic problems resulting from other cancers or treatments

Neurosurgeons may also treat back and neck pain, epilepsy, stroke, sciatica, herniated discs, pinched nerves and chronic pain. Neurosurgeons use a variety of diagnostic tests, such as angiograms, MRIs and ultrasounds, to help identify the specific nature of neurological conditions, diseases or injuries. The results of these tests may help in planning an appropriate course of treatment.

A neurosurgeon may work with other doctors and clinicians, including radiation oncologists, medical oncologists, pathologists, psychologists, rehabilitation therapists and others across a variety of disciplines.

Surgical procedures

In many cases, neurosurgeons are able to use minimally invasive surgical techniques and 3-D technology to take diagnostic images of the spine or brain for an extra layer of safety and accuracy.

Spinal tumors can be extradural, meaning they are located outside the dura, the sac that holds the spinal cord and fluid, or intradural, inside the dura. The two types of intradural tumors are:

• Extramedullary tumors, found inside the dura, but not in the spinal cord
• Intramedullary tumors, found in the spinal cord

When performing minimally invasive spinal surgery, a neurosurgeon may be able to use small incisions and tubes to remove the tumor with fewer impacts on muscle tissue. This technique may help reduce pain and speed up recovery, while allowing the neurosurgeon to decompress the nerves of the spinal cord and access hard-to-reach tumors in and around the spinal cord.

A variety of sophisticated tools also enhances the precision and safety of brain cancer surgery and may allow doctors to remove tumors that may otherwise have been inoperable, while preserving neurologic function. These tools include:

• Intraoperative neuronavigation uses an advanced MRI system to map areas of the brain responsible for important functions. The map then allows us to precisely plan surgery to help avoid damage to those important areas.
• Intraoperative electrophysiology “brain mapping” (also called motor mapping and language mapping) is like GPS for the brain. We use small electrodes placed on the outer layer of the brain to stimulate the brain and areas around the tumor. This helps us locate regions of the brain to avoid, such as those responsible for speech or movement.

Motor and speech impacts

During brain and spinal surgeries, neurosurgeons may use nerve monitoring technology to help ensure that the patient’s motor function is not being damaged by the procedure. For patients with lesions in the areas of the brain that control speech and motor function, a neurosurgeon may recommend awake craniotomy procedures as an extra layer of assessment, to help avoid damage to those key functions. During these procedures, patients who meet certain criteria are placed under light sedation. Patients are then woken up while the tumor is being removed, and speech or physical therapists work with them to make sure they have not lost motor or speech function. Once the tumor resection is complete and the care team is confident the patient has not lost function, the patient is placed back under sedation for the remainder of the procedure.

Mobility and pain management

Neurologic cancers of the brain and spine, or neurologic problems caused by other cancers, may present unique challenges, including mobility and communication difficulties. Your care team will offer a variety of supportive care services to help address these challenges throughout your care, so you are better able to continue treatment without complications.

Chemotherapy

Doctors may deliver chemotherapy locally to the brain during surgery. Because chemotherapy is administered as close as possible to the brain tumor edges at the resection area rather than systemically, this technique may help to reduce typical chemotherapy-related side effects.

Radiation therapy

Doctors may also use intraoperative radiation therapy (IORT) to deliver radiation directly to the area where a tumor has been removed. This may help avoid damage to surrounding normal structures, particularly the scalp and the skin on the scalp. It may also allow for higher doses of radiation to be delivered along the edges of the tumor, while helping to spare healthy areas of the brain.

Stereotactic radiation therapy (SRT) may be used to treat metastatic brain cancer, particularly for tumors in more than one location. This may help to avoid the pain, discomfort and recovery time typically associated with surgery.

Optune

Optune is a noninvasive treatment option for some patients with a recurrence of glioblastoma (GBM), a form of brain cancer, for whom surgery and other treatments, such as radiation therapy or chemotherapy are no longer an option.

Optune is a portable, battery-operated medical device that creates an electric field around the tumor to disrupt the growth and reproduction of cancer cells in the brain. Depending on the patient's treatment plan, the oncologist may have him or her wear the device for at least 18 hours per day, for at least four weeks. After charging the battery, the patient may be able to carry the device in a special shoulder bag or backpack for a few hours at a time to receive treatment without disrupting his or her daily routine.