The surgeons of the Brain and Spine Tumor Program at Froedtert & the Medical College of Wisconsin focus on treating specific tumor types. Caring for a large number of patients with specific kinds of cancer enables surgeons to develop uncommon expertise and skill.
The surgeons in the Brain and Spine Tumor Program are actively involved in efforts to improve neurological surgery. Through research, quality initiatives and the exploration of new techniques, they are developing ways to conducting safer surgeries that reduce side effects and optimize treatment benefits for patients.
Surgery is the first step in treatment for most patients with a brain or spine tumor. Some benign tumors can be cured through surgery alone. For patients with malignant cancers, surgical removal of the bulk of the tumor can improve neurological symptoms, provide biopsy samples for diagnosis, and set the stage for additional radiation and chemotherapy.
Focus on Tumors in Complex Areas of the Brain
The challenge of brain tumor surgery is to remove as much cancer as possible while leaving critical brain functions intact. The surgeons of the Brain and Spine Tumor Program specialize in operating on tumors growing in or near areas of complex brain function — for example, areas that control movement, speech and memory. The team’s longstanding goal is to develop better techniques for locating critical brain structures, allowing them to maximize tumor removal while minimizing damage to brain function and patient abilities.
In all cases, the location and type of tumor determine the best technique for your individual diagnosis.
Awake Brain Surgery
Surgeons in the program have extensive experience using “awake” surgery to guide tumor removal while protecting brain function. Neurological testing with live feedback from patients allows surgeons to precisely locate areas of speech, movement, memory, etc.
Some tumors are accessible through small incisions in a natural crease of the eyelid or behind the ear. These are called keyhole approaches because the opening is approximately the size of a keyhole. Even though the incision is small, the surgeon gets a wider view of the approach and tumor by using an endoscope — a thin tube with a camera and light on it. The minimally invasive approach requires a shorter hospital stay — one to two days, as opposed to the five to seven day required after traditional brain surgery.
The keyhole technique is especially effective for treating skull base tumors — deep-seated lesions located in a band around the bottom of the head, behind the eyes, the ears and the nose. Your surgeon will help you determine if keyhole surgery is an option for you.
Special MRI Techniques
Physicians in the program are pioneers in the use of advanced imaging technologies — such as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) — to map the functional networks and major “wiring” connections of the brain.
Prism Software System
Medical College of Wisconsin physicians were instrumental in the development of Prism, a software system that integrates a variety of diagnostic image sources (including fMRI and DTI) to help surgeons plan safer tumor removals.
The development of these and other tools and techniques is helping surgeons reduce surgical complications. Functional outcomes for patients are now dramatically better than they were just a few years ago.
These skills and technologies are especially important for treating recurring brain tumors, which typically are more deeply infiltrated into brain tissue. The physicians of the Brain and Spine Tumor Program care for a high number of patients with these recurrent tumors.
Surgeons in the Brain and Spine Tumor Program treat a large number of patients with skull-base pituitary tumors. Some pituitary tumors cause excess production of hormones, which can lead to multiple health problems. Other tumors do not secrete hormones, but grow so large that they press against critical nerves and structures surrounding the pituitary gland. These tumors can cause symptoms like headache and loss of peripheral vision.
Not all pituitary tumors require surgery, and some can be controlled with medications alone. When surgery is required, the goal is to remove as much tumor as possible to normalize the patient’s hormone levels and decompress surrounding structures.
Minimally Invasive Surgery for Pituitary Tumors
Previously, pituitary surgery required an incision inside the mouth, under the upper lip. Now, surgeons in the Brain and Spine Tumor Program work in conjunction with an otolaryngologist to remove the majority of pituitary tumors using minimally invasive techniques.
The procedure is performed through the nostril using endoscopic instruments, with no incision required. In most cases, patients experience fewer complications, less post-operative pain and a quicker recovery. (In certain situations, traditional surgical approaches are required.)
Multidisciplinary Pituitary Care
Most pituitary tumors require several forms of treatment in addition to surgery, including radiation therapy (either external beam radiation or Gamma Knife radiosurgery) and various drug therapies. Pituitary tumor patients have access to a full team of physician specialists — neurosurgeons, otolaryngologists, radiation oncologists, medical oncologists, endocrinologists (experts in hormone conditions) and neuro-ophthalmologists (who work with tumor-related vision loss).
Spine Tumor Surgery
Surgeons in the Brain and Spine Tumor Program treat every kind of spinal tumor, including tumors of the bony spine (vertebral tumors) and rare tumors of the spinal cord.
Vertebral tumors are usually cancers that have spread to the spine from other parts of the body and are growing within the vertebral bone. The goal of surgery is to remove the cancer, take pressure off the spinal cord, stabilize the spinal column and restore neurological function. Following resection of the tumor, the spine is reconstructed with surgical hardware.
Spinal Cord Tumors
Spinal cord tumors are usually benign, but treating them requires extremely intricate surgery. Some spinal cord tumors grow within the membrane that lines the spinal cord, but not within the cord itself. When tumor is growing within the substance of the cord, microsurgical techniques are used to remove as much cancer as possible while preserving neurological function.
The surgical team uses evoked potential (EP) monitoring and rectal electromyelography (EMG) during the procedure to assess the patient’s sensory and motor function and guide the extent of the resection.