The Department of Neurosurgery at Cedars-Sinai Medical Center treats the broad spectrum of malignant intracranial disorders, encompassing all types of primary and metastatic brain tumors. These conditions include gliomas, astrocytomas, meningiomas, acoustic neuromas, medulloblastomas, metastatic tumors and pituitary tumors.
Weekly Tumor Board
One component of the Department of Neurosurgery is the weekly Tumor Board meeting. A comprehensive specialty team of neurosurgeons, medical oncologists, radiation oncologists, neurologists, neuroradiologists, pediatric oncologists, neuro-oncologists and neuropathologists review individual patient cases and provide recommendations on the most optimal treatment alternatives. The Tumor Board provides exceptional expertise, allowing physicians to consult with a variety of specialists in one setting.
Sophisticated Imaging Technology for Open Procedures
The department currently uses advanced imaging technology when performing open surgery on intracranial lesions and tumors. Advanced imaging modalities precisely define brain structure and function, helping surgeons to identify eloquent areas of the brain prior to and during resection. In addition, sophisticated surgical microscopes and specially designed instruments are utilized for tumor resection.
The Department of Neurosurgery has a highly advanced image-guided operating suite, complete with real-time imaging capabilities. In this environment, surgeons utilize state-of-the-art navigational microscopes, computerized navigation, functional intraoperative MRI studies and optical technologies to determine the exact location of a tumor in real-time, three-dimensional space. By pinpointing where the eloquent areas of the brain are in relationship to pathology such as tumors, surgeons are able to perform surgical resections more safely and efficiently.
Radiosurgery Treatment Advances
Patients at the Department of Neurosurgery have direct access to the full range of radiosurgery options for brain and spinal tumors.
Stereotactic radiosurgery is a highly precise form of radiation therapy used primarily to treat tumors. Despite its name, stereotactic radiosurgery is a non-surgical procedure that delivers a single high-dose of precisely-targeted radiation using highly focused gamma-ray or x-ray beams to target the tumor. Stereotactic radiosurgery is an important alternative to invasive surgery, especially for brain tumors located deep within or close to vital areas of the brain. If the lesion is primary or metastatic brain cancer, the patient will be treated with stereotactic radiotherapy, utilizing lower doses of fractionated radiation treatments over a series of sessions. Sometimes radiosurgery is performed after surgery to treat any residual tumor cells. Stereotactic radiosurgery does not actually remove the tumor; rather, it damages the DNA of tumor cells and causes them to lose their ability to reproduce. As a result, these cells lose their ability to reproduce.
Cedars-Sinai has all the current treatment options for stereotactic radiosurgery including Gamma Knife one of the most accepted and widely used radiosurgery treatment and linear accelerator (linac, or x-ray) radiosurgery.
Gamma Knife Surgery
Gamma Knife® surgery is recognized worldwide as the preferred treatment for selected lesions, tumors and conditions that afflict the body's most important organ: the brain. Supported by a large body of peer-reviewed research articles, Gamma Knife is a noninvasive and is an alternative for many patients for whom traditional brain surgery is not an option because it avoids the physical trauma and most of the risks associated with conventional surgery. Gamma knife is a multi-source photon-based device emits gamma ray photons. These photons travel as high-energy beams and are delivered at a predictable rate, allowing precise radiation delivery to a tumor target.
Through the use of three-dimensional and computer-aided planning, Gamma Knife treatment can help minimize the amount of radiation to surrounding healthy brain tissue. Intense doses of radiation can be given to the targeted area(s) to irradiate relatively small targets in the brain with extremely high precision. Mostly used for small to medium sized tumors, the Gamma Knife can be used to treat selected malignant primary brain tumors or tumors that have spread to the brain for other tumors in the body (metastatic tumors). A single-session treatment is also usually administered in an outpatient setting with periodic follow-up.
The brings together a multidisciplinary team of experts from the Samuel Oschin Comprehensive Cancer Institute, Department of Neurosurgery and the S. Mark Taper Foundation Imaging Center to provide the finest care available.
Stereotactic Conformal or Linear Accelerator Radiosurgery
For linear accelerator (linac) radiosurgery, Cedars-Sinai Medical Center uses the Radionics ConforMAX Mini-Multileaf Collimator (MMLC) and Head and Neck Localizer (HNL) for benign and malignant tumors. The technology precisely shapes the radiation beam to the targeted tumor, minimizing risk to surrounding healthy tissue and critical structures, such as the brain stem and optic nerves. It also enables physicians to treat more complex, irregularly-shaped tumors.
Data from diagnostic imaging tests (e.g., MRI, CT and angiography) is loaded into Radionics Xplan treatment planning software in order to view the brain tumor three-dimensionally. This helps the team to more precisely and accurately deliver radiation to the tumor location. Unlike gamma knife, linac radiation allows for fractionation of treatment. Fractionation of treatment divides treatments into multiple sessions using smaller doses.
For additional background on GAMMA Knife and linear accelerator radiosurgery, preparing for radiosurgery, treatment steps and expectations, please review " Radiosurgery of Intracranial Lesions ," an educational article drafted by Dr. John Yu, Dr. Behrooz Hakimian and Anne Luptrawan, NP at the Cedars-Sinai Department of Neurosurgery and Gamma Knife Center.
With image-guided radiation therapy (IGRT) technology, an image of the tumor can be taken just before the delivery of radiotherapy or even during a treatment, enabling the exact tumor location to be verified. This helps to reduce healthy tissue being exposed to radiation (by five millimeters and, in certain cases, to as little as one or two millimeters). If a tumor has shifted even slightly since a patient's last visit, the radiation beams can be adjusted so that they more precisely hit the tumor.
This degree of accuracy changes the way certain types of tumors are treated. With IGRT, Cedars-Sinai is able to more safely deliver higher doses of radiation to control or help kill tumors located close to the spine and other radiation-sensitive organs and tissues.
Treating tumors that have metastasized (e.g., spread) to the spine from other organs are very challenging. These spinal tumors can cause debilitating pain and may also lead to nerve damage and paralysis. Although surgery can offer relief of symptoms, it is often very risky and only offers a temporary solution. In addition, traditional radiotherapy is restrictive because radiation oncologist are unable to deliver a dose of radiation strong enough to destroy the cancer while at the same time sparing the spinal cord.
Spinal image-guided radiosurgery at Cedars-Sinai provides is a better option because a higher dose of radiation can more precisely and safely be delivered to primary and metastatic spinal tumor(s). Spinal radiosurgery helps minimize the radiation dose to nearby normal and healthy tissue, structures and organs. Both benign and malignant (cancerous) tumors can be treated. This highly selective radiation dose often results in effective pain and/or tumor control. The treatment may be as simple as one session done on an outpatient basis.
Surgical Technology Program
Department of Neurosurgery surgeons perform hundreds of operations for brain tumors each year. Their goal, however, is to make surgery for brain tumors obsolete. Our surgeons are working on a technique to destroy brain tumors non-invasively using focused microwaves. This technology could also be used to destroy other tumors without surgery including breast or prostate tumors. Microwave thermal ablation, also being developed at the Maxine Dunitz Neurosurgical Institute, could eliminate surgery for many types of cancer.
The Latest Treatments
Cedars-Sinai researchers have spent the past decade developing innovative means of targeting brain tumor cells. Because one of the greatest challenges in the treatment of malignant brain tumors is their ability to escape an immune response, researchers are harnessing the immune system to target these tumors. Immunotherapy trials have demonstrated a favorable survival outcome for patients compared to those undergoing traditional therapy, and there have been very minimal adverse effects as would be associated with more harsh chemotherapies and radiation therapies.
Cedars-Sinai scientists also are conducting gene therapy and biological therapy trials.
They and other researchers recently described the isolation and characterization of a cancer stem cell, which appears to be both the initiator and the supporter of malignant brain tumors. Researchers have demonstrated that these cancerous stem cells can escape traditional therapies, including radiation therapy and chemotherapy. To counter this, researchers developed a novel biologic approach that targets these cancer stem cells, and through clinical trial studies have incorporated this experimental therapy into patient treatment.
For more information about our current research developments and clinical trial studies, please click on the links below:
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