Treatment
Renowned Surgical Expertise
Our specially trained neurosurgeons perform several hundred brain tumor procedures each year. All surgical approaches for microscopic tumor removals are routinely employed and intraoperative image guidance (during surgery) is an integral part of all our surgical procedures. Furthermore, new high tech, 3D stereotactic imaging gives neurosurgeons a view inside the skull, so they can precisely plan their path (trajectory) to the tumor without traversing or disrupting key areas in the brain. With this imaging modality and new procedures, a significant number of tumor treatments can now be done without removing part of the skull. Neurosurgeons may be able to remove (resect) some smaller tumors endoscopically, decompress cysts by aspiration, and they can use special instruments introduced intranasally (through the nose) to gain access to the pituitary, a small endocrine gland at the base of the skull. Intraoperative CT-imaging is also used in certain cases and adds to the armatorium (all available treatments) so that complex procedures can be performed safely.
It may be necessary for you to have a shunt placed, which is a special type of drain to remove excess spinal fluid and ease pressure on your brain. Most frequently, your neurosurgeon will tunnel a tube underneath your skin to redirect the fluid from your brain to your abdomen, where it is absorbed by your body.
Your treatment may also require placement of a ventricular access device, which is a small plastic reservoir under the scalp allowing doctors to test the fluid in your brain, or to give chemotherapy to the fluid that surrounds your brain. The ventricular access device is a disk-shaped port. In a short operation, neurosurgeons place the device under your skin, with a tube that leads through the bone and into the brain cavities where the fluid is made. Learn more about neurosurgery at BIDMC >>
Advances in Neuro-Oncology
Our neuro-oncology program is a highly specialized area of care and offers you access to state-of-the-art clinical trials and coordinated systemic (chemotherapy) for cancer treatment. A neuro-oncologist is a doctor who treats tumors of the central nervous system with chemotherapy. Your neuro-oncologist will help coordinate the care you need and talk with you and your family about treatment decisions. The doctor may prescribe chemotherapy with radiation, or a combination of different types of chemotherapy – systemic and/or intraventricular.
Systemic chemotherapies are anti-cancer drugs that are either injected into the blood stream or ingested and distributed throughout the body to kill cancer cells. Intraventricular chemotherapy delivers anti-cancer drugs through a special port under the skull (a ventricular access device) into the cerebral spinal fluid to bathe the brain and spinal cord. Intraventricular chemotherapy attacks any cancer cells that are present and may help prevent the cancer from spreading.
BIDMC has specialized hematology oncology treatment areas for inpatient and outpatient care. Learn more about medical oncology at BIDMC >>
Radiation Therapy
Radiation therapy uses high-energy radiation or particles to treat cancer. High doses of radiation can kill cancer cells or keep them from growing and dividing. Radiation therapy is a useful tool for treating cancer because cancer cells grow and divide more rapidly than many of the surrounding normal cells.
CyberKnife
Our specialists in radiation oncology (doctors who treat cancer with radiation therapy) are among the most experienced in the country and have state-of-the-art equipment.
Together with neurosurgeons, they use the CyberKnife stereotactic radiosurgery system to treat certain brain and spinal tumors. CyberKnife treatment is non-invasive and offers precise targeting accuracy, with minimal exposure to surrounding critical healthy tissue.
Its real-time, image-guided robotic technology continually tracks patient movement and confirms tumor location prior to beam delivery, making it especially effective at treating hard-to-reach tumors and those previously considered inoperable such as certain spinal tumors.
CyberKnife’s high radiation dose allows for a shorter course of treatment (one to five sessions), compared to “fractionated” radiation therapy that is delivered in smaller doses over a longer period of time (daily for several weeks). However, your doctor may recommend fractionated stereotactic therapy depending upon the location of your brain or spine tumor.
Intensity Modulated Radiation Therapy
Intensity modulated radiation therapy (IMRT) is a type of fractionated radiation therapy that is especially effective at treating diffuse, larger tumors in critical locations, such as behind the eye.
IMRT features radiation beams of different intensity, from different angles, to conform to tumor size, shape and location, and target cancer cells while sparing nearby healthy tissue.
IMRT is usually delivered in small doses over a long course to minimize short- and long-term neurological side effects.
Whole Brain Radiation
Whole brain radiation, another type of fractionated therapy, targets multiple tumors – large, small and undetectable – deep within the brain. This therapy is typically used to treat metastatic disease (that is, cancer that has spread from another organ or site to the brain), and to reduce the risk of tumor recurrence following surgery and in areas remote from the surgical site. Learn more about radiation oncology at BIDMC >>
Long-Term Care
Surveillance and long-term care is an important part of our program. Our follow-up care after your initial treatment includes physician evaluation to address any symptoms, and radiologic scans to evaluate tumor relapse in the original site or in metastatic (spreading to) sites. You may need additional treatment – radiation and/or chemotherapy – if your cancer returns. Surveillance care continues at regular intervals for many years.
