Evaluation and Diagnosis
Neurological Evaluation
Your initial visit involves a neurological evaluation, a review of any existing imaging studies that you might have (such as MRI and CT scans) and determination of next steps.
We may need to do additional imaging (magnetic resonance angiography, magnetic resonance spectroscopy, spinal tap, PET/CT, thallium scan) to find out more about the tumor and the area where it developed.
Biopsy
Making a correct diagnosis also involves taking a tissue sample called a "biopsy." Most of our biopsies are performed stereotactically, a less invasive and more precise procedure than an open biopsy that requires removing a piece of the skull.
A stereotactic biopsy uses computerized planning of radiologic images (CT and MRI fused to pinpoint the area to be biopsied). This allows the neurosurgeon to obtain a representative tissue sample by drilling a small hole into the skull and passing a narrow tube (cannula) into the tumor along a pre-calculated trajectory (pathway) to remove tissue samples.
Define the Underlying Tumor
The purpose of the biopsy is to define the underlying tumor by type, grade (how aggressive and advanced the cancer is), molecular biological markers, and growth pattern.
Unlike some other neurosurgical brain tumor programs, we take many small serial biopsies from the tumor – not just one tissue sample – to ensure the proper diagnosis and molecular profile. Once the neurosurgeon obtains the sample, a pathologist examines the tissue in the operating room under a microscope to get an immediate answer of the tissue components.
Guide Treatment
The neuropathologist’s findings and the radiologic studies help us stage the extent of the tumor spread (cancer), to determine if the tumor has progressed and if so where, and to guide treatment. Our team of doctors work quickly to determine your best treatment options. Treatment can involve surgery, radiation, and/or chemotherapy.
