Neurosurgical Oncology

Neurosurgical Oncology Overview

In simple terms, neurosurgical oncology is the surgical management of tumors involving the brain and spine. Yet, the application of neurosurgical oncology is anything but.

A specialized field within neurosurgery, neurosurgical oncology combines the deep expertise of neurosurgeons, oncologists, radiologists, and other specialists to provide comprehensive care for those with benign and malignant tumors of the brain and spine. Collectively, the goals of neurosurgical oncology are to:

• Maximize tumor removal: This looks like removing as much of a brain or spine tumor as possible while preserving neurological function;
• Provide symptom relief: This means alleviating symptoms like headaches, seizures, or neurological deficits caused by a brain or spine tumor;
• Enhancing quality of life and prognoses: This is demonstrated by improving your overall health and longevity through robust treatment plans; and
• Contribute to ongoing research and innovation: This is upheld through continuous advancement through research, clinical trials, and new technologies and therapies.

What does Neurosurgical Oncology treat?

Neurosurgical oncology treats both benign and malignant tumors of the brain, skull, skull base, spine, spinal cord, and peripheral nerves.

More specifically, that means:

• Secondary spinal tumors: These tumors or metastases also spread to the spine from other body parts.
• Primary brain tumors: These are tumors that originate in the brain, such as gliomas, meningiomas, schwannomas, and pituitary adenomas.
• Secondary brain tumors: Also known as metastases, these are tumors that begin elsewhere in the body and then spread to the brain, like lung, breast, melanoma, and kidney cancers.
• Primary spinal tumors: These are tumors that start in the spinal cord or spine, including meningiomas, schwannomas, ependymomas, and chordomas.

Neurosurgical Treatments for Brain Tumors

Surgery is often the first line of treatment for brain tumors that your neurosurgeon can remove safely without causing too much damage to surrounding tissue or neurological function.

A craniotomy is the most common surgery for a brain tumor. During a craniotomy, a neurosurgeon will make an incision in your scalp, remove a portion of your skull, and use advanced neuronavigation systems to access your brain to remove the tumor.

Awake brain surgery, or awake craniotomy, is a surgery for brain tumors in areas that control critical functions, like speech or movement. During awake brain surgery, you will be alert during the same time your surgeon removes the tumor, which allows the surgical team to monitor brain function and avoid damaging vital brain anatomy in real time.

In some cases, a neurosurgeon might recommend minimally invasive techniques to treat a brain tumor. Minimally invasive surgery uses smaller incisions and more specialized instruments to access and remove the tumor. For example, endoscopic surgery uses a tiny camera and instruments passed through a small hole in the skull, while laser interstitial thermal therapy (LITT) relies on laser energy for tumor ablation. As a bonus, these techniques can offer shorter recovery times, less visible scars, and a reduced risk of complications.

Adjuvant therapies, or treatments used in combination with surgery, will be based on your type of brain tumor and its characteristics. They can include:

• Radiation therapy uses precisely aimed beams of radiation to destroy tumors in the body. While it doesn’t remove the tumor, radiation therapy damages the DNA of the tumor cells, which then lose their ability to reproduce and eventually die.
• Chemotherapy may be given orally or intravenously to inhibit the growth of cancer cells, but it can be challenging for them to reach the brain due to the blood-brain barrier. For this reason, chemotherapy drugs are sometimes administered intrathecally, meaning they’re injected directly into the cerebrospinal fluid (CSF). Chemotherapy is often used in combination with surgery or radiation therapy, especially with tumors that are difficult to remove surgically.
• Immunotherapy involves a series of drugs that boost the body’s immune system’s ability to recognize and attack cancer cells.
• Targeted therapy uses compounds to target specific molecules vital to cancer cells’ metabolism and reproduction. By effectively targeting and interfering with these molecules, cancer growth is slowed.

Neurosurgical Treatments for Spine Tumors

Once a spine tumor is causing pain or threatening to harm nearby tissues, neurosurgical removal of the tumor may be recommended.

Tumor resection aims to remove as much of your spine tumor as possible while preserving overall neurological function. This is the primary treatment for spinal tumors. In some cases, complete removal may not be possible due to the tumor’s location.

Laminectomy involves removing some of the vertebral bone, called the lamina, to access and remove your spine tumor. This procedure helps relieve pressure caused by the tumor on the nerves or the spinal cord.

Vertebrectomy is the surgical removal of the vertebrae, or spine’s bones, to restore function to the affected nerves. A vertebrectomy may remove part or all of the affected spine when a tumor impacts a vertebrae. Additionally, a vertebrectomy may involve spinal fusion to stabilize and reconstruct the spine using a combination of grafts, plates, and screws.

In some cases, minimally invasive techniques may be recommended for spine tumors. Techniques like stereotactic radiosurgery, which uses focused radiation to treat small, well-defined tumors, and endoscopic surgery, which uses a tiny camera and instruments passed through a small hole, can minimize tissue damage and promote a shorter recovery period.

Based on the type and extent of your spine tumor, adjuvant therapies given after surgery can include:

• Radiation therapy uses precisely aimed beams of radiation to destroy tumors in the body. While it doesn’t remove the tumor, radiation therapy damages the DNA of the tumor cells, which then lose their ability to reproduce and eventually die.
• Chemotherapy may be given intravenously or orally and can target cancer cells throughout the body.

In both brain and spine tumor surgery, neurosurgeons use highly specialized tools to visualize and safely remove the tumor tissue. For example, neuronavigation relies on GPS-like systems to provide real-time guidance based on a map of your unique anatomy, while neuromonitoring surveils critical neural pathways to prevent damage during surgery.

Following a neurosurgical procedure to treat a brain or spine tumor, continuing follow-up is important to check for brain or spine tumor recurrence and manage long-term effects of treatment. Inpatient or outpatient neuro-rehabilitation is also likely to be advised. At Barrow Neurological Institute, our patients can access various neuro-rehabilitation specialists, such as physical therapists to help regain strength or balance, speech therapists to support speaking recovery, and occupational therapists to aid in daily activities such as dressing and bathing.

Though clinical trials are experimental and not yet FDA-approved, they can be the best option for those with difficult-to-treat brain or spine tumors to improve the odds of finding a potential treatment.

One Central Location with Multiple Treatment Options

At Barrow Neurological Institute’s world-class Brain and Spine Tumor Program, we treat people with complex brain and spine tumors in one robust, full-service location. Our sophisticated multidisciplinary team—neurosurgeons, head and neck surgeons, neuro-oncologists, medical oncologists, and radiation oncologists, to name a few—can offer you or your loved one the latest treatments for head and spine cancers.