Benign Tumor Program

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 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 patient has a benign lesion, radiosurgery will be usually be performed with single dose of radiation. 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. Following the treatment, benign tumors usually shrink over a period of 18 months to two years.

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 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.

The Gamma Knife Center brings together a multidisciplinary team 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.

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," 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.

Image Guided Radiosurgery

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.

Spinal Radiosurgery

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 department, has the potential to eliminate surgery for many types of cancer.

For an appointment, a second opinion or more information, please call 1-800-CEDARS-1 (1-800-233-2771) or e-mail us.