Toral Patel, M.D. Answers Questions On: Brain Tumor Surgery

The first question to answer is whether the tumor started in the brain or elsewhere. After we determine the site of origin and examine the MRI of the brain, we can parse out whether the patient is best treated with surgery, chemotherapy, radiation, or some combination thereof.

The primary approaches are open and endoscopic, with stereotactic navigation systems assisting with both.

For some lesions, a biopsy is most appropriate. We can do that stereotactically through a very small opening in the skull. 

For lesions that need to be radically removed, we typically perform an open craniotomy to expose the brain and remove the lesion.

For a small subset of lesions that are in the ventricles ­– the fluid spaces in the brain – or the skull base, we can use an endoscope to remove the tumor in a minimally-invasive fashion.

For lesions that are near the motor or speech pathways – the eloquent cortex – the safest way to perform surgery is to actively monitor the function of those structures throughout surgery. Often, the best way to do that is to keep the patient awake during surgery and ask them to periodically move their limbs and/or speak, so that we are constantly receiving feedback about brain function.

Additionally, during the surgery, we use a small probe to stimulate the brain. This allows us to precisely “map out” brain function so that we can preserve brain function while removing the tumor.

Technological advances in neurosurgery are making operations increasingly safer and less invasive. These include endoscopic approaches to the skull base and techniques such as laser interstitial thermal therapy.

Additionally, I anticipate that scientific advances in understanding the genomic make-up of tumors will dramatically change patient care in the coming years. I look forward to the day when patients with brain tumors can be treated not only with surgery, but also with precise medications that target the underlying genetic mechanisms that are responsible for tumor formation.