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The Department of Neurosurgery at Cedars-Sinai Medical Center treats the broad spectrum of benign intracranial disorders, including meningioma, epidermoid, dermoid, hemangioblastoma, colloid cyst, subependymal giant-cell astrocytoma, pleomorphic xanthoastrocytoma, and craniopharyngioma tumors.
Weekly Tumor Board
One component of the Department of Neurosurgery is its 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 Image-guidance and Technology for Surgery
The department's surgical expertise is supported with advanced technology to help improve surgical outcomes and patient recovery. Our advanced operating suite has a real-time image-guidance system, state-of-the-art surgical microscopes and specially designed instruments for complex tumor resection.
The real-time image-guidance system creates a 3D image of the patient's brain utilizing X-ray, computerized tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasound images. This 3D image helps surgeons pinpoint the exact location of the tumor, display real-time images and instrumentation during surgery and avoid contact with nearby eloquent areas, healthy tissue and nerves.
Radiosurgery Treatment Advances
Because no two patients are alike and no two tumors are alike, a referral center specializing in the diagnosis and treatment of all types of brain, cranial base and spinal cord tumors must offer the most advanced technologies for each individual situation.
Imaging studies are typically the first step in diagnosis and treatment planning, and the S. Mark Taper Foundation Imaging Center provides a full spectrum of sophisticated diagnostic options.
The choice of treatment depends on many factors, including the type, location and aggressiveness of the tumor, and the age and overall health of the patient. Some tumors that grow slowly and pose little threat may be monitored for years with periodic imaging, never requiring intervention.
For some tumors, surgery may be an option, either alone or in combination with other therapies. But because tumors often invade "eloquent" areas of the brain - those responsible for thought, speech and other high-level functions - advanced surgical technologies, such as "awake" brain surgery and brain mapping, enable neurosurgeons to remove as much tumor as possible without injuring vital tissue.
Many procedures that once required a large opening can now be performed minimally invasively, resulting in shorter recovery times and reduced risk of complications. And with the development of radiosurgery - using the Gamma® Knife or Trilogy System - some tumors can be treated without any incision at all.
Gamma® Knife Surgery
Every patient is the center of attention
Highly focused radiation technology provides customized treatment for certain tumors, delivering a potent dose of radiation to a tumor while limiting exposure to normal tissue. Advanced planning and treatment systems enable a radiation dose to be shaped to the three-dimensional structure of a tumor. These systems also allow specialists to vary dosage strength as needed within a tumor. Although terminology sometimes overlaps, "radiosurgery" is accomplished in a single setting with a high dose of radiation, while focused "radiotherapy" consists of "fractionated" treatments delivered over a period of days or weeks. The goal of either approach is to bombard the tumor "but not healthy tissue" with a destructive dose of radiation.
These noninvasive procedures do not remove a tumor, but are designed to stop its progression by killing its cells - without the risk, cost, hospital stay and recovery time of a traditional surgery. Patients usually go home the same day, with few side effects and little discomfort.
The Gamma Knife® is an extremely precise, "fixed" radiosurgery system that is ideal for treating tumors in the head. With as many as 201 separate beams of radiation converging at a target, it produces a high dose at the site of the tumor, but only slight exposure at any other single point. Unlike other systems that have moving parts, the Gamma Knife® remains stationary during treatment. The patient's head also is stabilized, temporarily attached to a "stereotactic" frame that provides a 3-D targeting system. As a result, the Gamma Knife® is accurate to the sub-millimeter level.
Although Gamma Knife® systems have undergone numerous enhancements through the years, the technology has a history dating back decades, with hundreds of thousands of patients being treated and more than 2,500 professional journal articles being written in support of its use.
Focused radiation may be used alone or in conjunction with surgery and other therapies, depending on the type of tumor and the patient's overall health. These technologies may provide a treatment option for patients who are not good candidates for general surgery and in cases where a tumor is considered inaccessible or inoperable. Mostly used for small to medium sized tumors, the Gamma Knife can be used for benign brain tumors, including meningiomas, pituitary adenomas, and acoustic neuromas. A single-session treatment is usually administered in an outpatient setting with periodic follow-up. Benign tumor control is usually achieved in more than 95 percent of cases.
At Cedars-Sinai, every patient's care is planned and provided by a multidisciplinary team of specialists, including neurosurgeons, radiation oncologists, medical oncologists and physicists. Dedicated oncology nurses are always available to the patient from check-in to check-out. The services are provided through the collaboration of experts from the Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute, Department of Neurosurgery, and the S. Mark Taper Foundation Imaging Center to provide the comprehensive care and expertise.
For additional background on GAMMA Knife and linear accelerator radiosurgery, preparing for radiosurgery, treatment steps and expectations, please review "Radiosurgery of Intracranial Lesions," and 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.
Offers New Treatment Options for Spinal Tumors
The System provides highly focused, "image-guided" radiotherapy and radiosurgery options for treating tumors and other lesions located close to the spinal cord or other critical structures. It may be used alone or in combination with surgery, depending on a tumor's location and type.
Using a specialized CT scanner built into the treatment planning machine, Trilogy ensures that a radiation dose precisely hits its target. Among other features is a "respiratory gating" capability that can take a patient's breathing into account and time delivery of radiation accordingly.
Image-guided radiotherapy allows precisely focused radiation, reducing considerably the size of a treatment field. Radiation is delivered through multiple "arcs," minimizing radiation exposure to surrounding tissue, while intensifying dosage at the point of intersection.
Trilogy is a "frameless" system able to precisely treat lesions in areas of the body that are not easily immobilized. It adds another dimension to Cedars-Sinai's radiation therapy arsenal, which includes the Gamma Knife® Center. Each system has its strengths and offers advantages in certain situations. The Gamma Knife, which uses a frame to immobilize the head, is the first choice for most tumors and other lesions in the brain.
Surgical Technology and Research
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,
For an appointment, a second opinion or more information, please call 1-800-CEDARS-1 (1-800-233-2771) or e-mail us.