The Department of Neurosurgery at the University of Florida is unique in that it is the only center in the region with neurosurgeons who dedicate their practices specifically to the surgical treatment of brain tumors. We have trained many of the neurosurgeons in practice in the surrounding area in our techniques, and we have devoted our careers to providing the highest quality of care for patients with brain tumors. Our neurosurgeons have had regionally unmatched experience with a large number and variety of brain tumors requiring procedures of multiple levels of complexity. Thousands of patients with brain tumors have come to the University of Florida to receive the most cutting-edge treatment available. We are also actively involved with the study and development of new therapies for patients with brain tumors.
Our surgeons regularly utilize a combination of functional imaging, intraoperative image guidance, and “awake” surgery with intraoperative mapping. These techniques, which are not performed by most community neurosurgeons, significantly increase our ability to achieve aggressive tumor removal in the safest possible manner. Recent data has demonstrated that increased tumor removal can be critical for improving response to treatment and overall survival for patients with brain tumors. Therefore, our specific expertise and experience provide the best initial surgical option for patients with brain tumors in Florida and the surrounding states.
We work in conjunction with a renowned brain tumor team that includes experts in the fields of neuro-oncology, neuro-radiology, neuro-pathology, neuro-intensive care, neurology and rehabilitation here at the University of Florida. In addition, we interact with a network of expert colleagues throughout the nation who are involved in progressive brain tumor treatment, providing us with constant updates on cutting-edge developments for patients with brain tumors.
The brain is a complex organ that controls movement, sensation, speech, thought, memory, emotion, consciousness, breathing, heart rate, body temperature and many other crucial functions. A brain tumor is a mass of abnormal cells in the brain that can interfere with its normal functioning.
Brain tumors are either “primary” or “metastatic”. Primary brain tumors originate from cells in the brain and rarely spread to other parts of the body. Metastatic brain tumors originate from cells in other organs then metastasize (spread) to the brain.
Primary brain tumors are categorized as benign (non-cancerous) or malignant (cancerous) and assigned a grade based on the aggressiveness of the tumor. The World Health Organization grading system is used at the University of Colorado as well as most other institutions to assign a grade of I to IV to primary brain tumors. Grading is based on how quickly the tumor cells are dividing, how abnormal the tumors cells look under a microscope, the extent of invasion of the cells into normal brain tissue, the likelihood of the tumor becoming a higher grade, and other features. All metastatic brain tumors are considered malignant based on the fact that they have spread from one organ to another. Metastatic brain tumors are assigned a grade according to the accepted grading system for the organ in which they started.
Brain tumors are presumed to occur due to alterations in the genetic material of normal cells, causing them to develop and divide abnormally. The vast majority of brain tumors are not thought to be caused by inherited genetic changes (ie do not “run in families”), although there are rare genetic syndromes that result in increased risks for brain tumors. The source of the genetic alterations is generally unknown, but our researchers and others are actively exploring potential causes.
Symptoms of brain tumors depend on the location and size of the tumor, as well as how quickly the tumor is growing. Symptoms can be due to pressure on specific areas of the brain by the tumor itself or to pressure on the entire brain from swelling or hydrocephalus. Hydrocephalus is an abnormal accumulation of the fluid (cerebrospinal fluid) that normally flows around the brain and spinal cord. Occasionally a brain tumor will be discovered incidentally during an evaluation for an unrelated health problem in a person with no symptoms.
The most common symptoms of brain tumors are one or more of the following:
- Nausea and vomiting
- Changes in thinking or memory
- Changes in behavior
- Problems with vision, hearing, or speech
- Weakness in the arms or legs
- Numbness or tingling
- Difficulty walking due to trouble with balance or coordination
Brain Tumor Treatment
Treatment options for a brain tumor depend on the type, location, and size of the tumor and may include surgery, radiation, chemotherapy or most likely a combination of these options. Treatment can be postponed in some cases if a tumor appears to be slow-growing and is not causing symptoms. Although there are initial standard-of-care treatment plans for most tumors, in some cases, experimental therapies may be recommended if standard therapies are unsuccessful.
Surgery is usually the first step in the treatment of brain tumors. The purpose of surgery is to obtain tissue to verify the diagnosis. Additional goals of surgery are to relieve symptoms, decrease pressure on the brain or spinal cord, and minimize the size of the tumor that will need to be treated with radiation or chemotherapy. Importantly, recent data suggests that extensive removal of a brain tumor improves long-term treatment outcomes. Therefore, the goal of surgery is to remove as much of a tumor as possible without damaging healthy brain tissue. Although complete removal of all tumor cells is an ultimate goal, this is often not possible in many brain tumors due to invasion into the brain or microscopic amounts of cells that cannot be seen. Therefore, in many cases patients will need additional therapy after surgery.
Types of brain tumor surgeries
Biopsy: If the tumor is in a part of the brain where removal would cause considerable neurological damage, a biopsy may be taken. A biopsy is a surgical procedure in which a small opening is made in the skull and a needle is inserted into the tumor to obtain a sample of tumor cells. The tumor cells are examined under a microscope by a pathologist who establishes a diagnosis so that appropriate treatment can be recommended.
Resection: A resection is surgical removal of as much of a tumor as possible. This often requires a craniotomy which is the removal of a piece of the skull so that the neurosurgeon can gain access to the tumor. The piece of skull is replaced after the resection and held in place by thin pieces of titanium. Tumors in the region of the pituitary gland can sometimes be removed through the nose and do not require a craniotomy. A resection is called a “gross total resection” when there is no obvious tumor visible on a brain scan performed soon after surgery. If a portion of the tumor can still be seen on a post-operative brain scan, it is called a “subtotal resection.”
Stereotactic surgery: A precise computerized map of the brain is made using an MRI or CT scan. The neurosurgeon uses this map during surgery to precisely locate the tumor and to navigate around critical brain structures during resection or biopsy of the tumor, a technique that is known as “intraoperative image guidance.”
Microscopic surgery: A microscope is used during surgery for detailed evaluation of brain and tumor tissue.
Radiation therapy is the use of beams of energy called “ionizing radiation” to slow or stop the growth of tumor cells. Radiation oncologists are the physicians who manage radiation therapy. They determine the most appropriate form and amount of radiation to be delivered according the type, size, and location of the tumor.
Types of radiation therapy
Fractionated radiotherapy: A specific dose of radiation is delivered in parts rather than all at once. Radiation is usually delivered in daily sessions five days per week for two to seven weeks. The radiation oncologist determines the treatment schedule.
Focused radiation = radiation that is directed only at the tumor.
Whole brain radiation therapy = radiation is directed at the entire brain. This form of radiation is used cases where there are multiple tumors or a tumor spreads over a large area of the brain.
Stereotactic radiosurgery = A single high-dose of radiation is delivered precisely to one or more small tumors on an outpatient basis. Novalis BrainLab®, Gamma Knife® and CyberKnife® are brand names of types of stereotactic radiosurgery.
Chemotherapy is the use of powerful medications to slow or stop the growth of tumors. Oncologists are the physicians who prescribe and manage chemotherapy. Neuro-oncologists are oncologists who specialize in treating nervous system cancers. Chemotherapy can be given by mouth, through an I.V., or directly into the brain during surgery.
Standard versus Experimental Treatment
Standard treatment is a commonly accepted form of treatment for a certain medical condition. It is based on either experimental data, expert opinion or both. Experimental treatment is treatment that is currently being tested in clinical trials (research studies). An experimental treatments may become a standard treatment if it is proven to be more effective than current standard treatments.
Most people who have been treated for a brain tumor will require long term follow-up with routine brain scans, neurological exams, and visits to one or more of the healthcare providers involved in their treatment. This is to monitor the response to treatment and to watch for tumor recurrence.
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