6th Annual Brain Tumor Conference: Neurosurgery

Dr. Donald P. Becker - former chief of neurosurgery and has battled brain cancer himself, he's 70 years old (looks like 55!)
Elementary talk on what a neurosurgeon does. A neurosurgeon's role in treating benign or low grade gliomas, they remove it. In higher grade tumors, they are to reduce as much pressure as possible by removing as much of mass as possible and getting tissue for other research and trials. He would often take x-rays home night before surgery to really prepare himself and know as much possible, so that he assured him self he was doing the best that he could. You want your surgeon to be careful, attentive, have patience and not overloaded. Technology has really advanced the field. Back in the day, they didn't have magnification and the lighting was terrible. Now the magnification is incredible and we have headlights over our head, sometimes use operating microscope with light coming right through the lens. Usually have an MR scan done in advance to all you to have computer with images in the operating room. We register the computer pictures to the patient's head that is fixed and can use the screen during surgery to verify tumor location. Showed us pictures of a metastatic tumor removal. Patient's head fixed and shave area around where incision to be made and mark area. They make a hole in the skull to identify the durra mater underneath, place a small saw underneath and cut out the marked area of the skull with an angle (like when you cut a pumpkin lid) then wrap in gauge and place in sterile solution. They then open the durra mater to expose the brain (gyrus - hills and valleys of the brain). Tumor different color than brain tissue. Metastatic tumors can often come out completely, like Lance Armstrong. Try to take at tumor as a whole, so cells don't spread, then we put the skull back with titanium plates and screws using 3 point fixation, durra mater held up with a suture. A little talk about anatomy: have to be cognizant of where arteries are that feed the brain, cranial nerves responsible for swallowing and sensation of the throat (if you injure those patients have 6month recovery and can't swallow), optic nerves (nerves cross and operate opposite sides of body), olfactory nerves (smell, taste), vessels come off artery and can't be damaged during surgery and could cause stroke of contra lateral weakness, brain divided into frontal, parietal, temporal and occipital Lobes. Central sulcus controls motion, frontal lobes relatively silent. Cerebellum controls coordination. Frontal lobe controls personality. In the center of the brain you have lateral ventricles that hold cerebral spinal fluid, you generate 2 cups a day that helps clean the brain. With and MR scan, you can see all of the anatomy and we can tell where lesion is and if it is near risky areas. All blood vessels are critical and we try to avoid damage, but the brain is covered with veins. Every cardiac pulse, 20% of the blood goes to the brain, so we need to know where all the veins are and where they go to. Thalamus cannot be damaged or patient has weakness or contra lateral paralysis. Showed us pictures of lesions…glioblastoma is the worst kind, grows rapidly and strips its own blood supply and can end up with a hemorrhagic tumor. GBMs can have cysts in them too. As they grow they destroy brain tissue and can distort it and cause problems for the patient and their family. If it grows in the pons (near spinal cord) have trouble with sensation and eye control, but can have success with medical therapy. Metastatic are usually well circumscribed and easy to totally remove. Cranial nerve controls facial movement. Hypothalamus keeps person awake and keeps metabolism in order. When tumor is near eloquent areas, we'll do a functional MRI to test hand movement, speech and tongue movement. Questions: Are brains different from person to person? Each brain is a little different in position of central sulcus, some have larger frontal lobes (usually smart folks), some functional differences as well. If a person learns two languages, the zones for primary language is in a different area than their secondary language (functional MRIs can detect this). Being in an academic research center, we're learning fascinating new things all of the time. Have you ever used gliadel wafers? He has used gliadel wafers, but only in consult with neuro-oncologist. What about low grade astrocytomas? Low grade astrocytomas can be cured if removed properly; however, we can't always remove the whole thing if it might damage the patient's functions.