By Dr. Paul Camarata – Clinical Service Chief, Neurosurgery, The University of Kansas Health System
Brain tumors are understandably perceived as quite a grim diagnosis. Medical, surgical and technical advances, along with discoveries in research, provide more options and more hope than ever before.
Why is it so difficult to treat these aggressive brain tumors? It’s important to understand distinctions between tumor types. First, there are metastatic tumors, which invade the brain from elsewhere in the body. The tissue from which they originate isn’t brain tissue or supportive cell tissue. They grow in rough spheres and have a reasonable capsule surrounding them. They can almost always be completely or nearly completely removed.
In contrast, tumors that originate in the brain behave differently. Intrinsic to the brain, they infiltrate the brain tissue, traveling from one part of the brain to another and intertwining among functioning neurons and supporting brain cells. They lack a sharp margin, meaning that, while we can surgically remove almost all the tumor cells, we can see on an MRI scan, there are tumor cells that have spread well beyond the area in which the tumor originated. This leaves tumor cells behind and allows growth to recur.
We are living in encouraging times for those fighting brain tumors. Today, we have new chemotherapies. We have new delivery mechanisms for getting chemotherapy into the brain. We can treat brain tumors with immunotherapy. We can perform genetic testing that reveals details unique to each patient, allowing us to recognize different tumor types and attack them individually. And when surgery is appropriate, we have more tools and techniques available to make surgeries safer, more efficient and more effective.
A powerful tool in The University of Kansas Health System’s surgical arsenal is the intraoperative MRI. We have an MRI scanner within the operating room, adjacent to the surgical table. Neurosurgeons begin the resection and remove as much of the tumor as we safely can. We then slide the patient on the surgical table directly into the MRI scanner to capture real-time images that may show us more tumor cells that can be removed during the same surgery.
With the MRI immediately adjacent to the surgical suite, we can preserve sterility, maintain the anesthesia circuit and obtain real-time imaging read promptly by specialized neuroradiologists to inform next steps of the surgery. It is a much safer experience for the patient.
Another innovation that helps us achieve the best possible outcomes for patients with brain tumors involves procedures done while the patient is awake. If a tumor occurs in a relatively silent area of the brain, we can often get a wider margin around it and remove more. This is more complex when the tumor occurs in a critical portion of the brain. When patients are awake during surgical procedures, they are meticulously overseen by specialized neuroanesthesiologists to ensure the patient is safe and feels no pain – they can interact with us and guide our path. For example, we ask patients simple questions or instruct them to perform simple movements as we stimulate the brain during surgery. When they stop talking or stop moving, we know we’re in an area of the brain that we must preserve.
Advanced brain tumor care requires a comprehensive approach by a large number of people who specialize in all aspects of cancer care and supportive care. Together, we strive not only to remove tumors and eliminate cancer, but also to preserve and optimize quality of life after brain surgery.
Advances in brain tumor surgery invite more opportunity to hope than ever before. Surgery is an important first step in many cancer care journeys but is just a first step. Advances in surgery, chemotherapy, radiation therapy, research and clinical trials all suggest a much more hopeful future. Our team stands with our patients and their families every step of the way.