#3 BRAIN SURGERY WITHOUT A CUT
5 AMAZING BRAIN SURGERY INNOVATIONS in Health Hub from Cleveland Clinic. Health Hub from Cleveland Clinic presents medical, health and wellness news, information and insights from Cleveland Clinic’s experts.
The brain, with its delicate twists and turns, can be a mine field for surgeons and their teams working to remove tumors. Medical technologies have evolved in creative, exciting ways to treat tumors while conserving the healthy, normal surrounding tissue. Here are five important innovations that have extended the lives of brain tumor patients.
1. Destroying cancer cells with laser-directed heat
When cancer is located in hard-to-reach brain areas or areas that control a person’s vital functions, it can be too risky to perform traditional surgery.
Laser interstitial thermal therapy transmits heat to coagulate, or “cook,” brain tumors from the inside out. A medical innovation called NeuroBlate offers precise positioning of the laser to target, heat and destroy brain tumors. It integrates it with intra-operative magnetic resonance imaging (MRI) technology, producing detailed images of internal organs without using radiation.
This innovation offers an option for tumors once considered inoperable. Surgeons can reference high-resolution images as they are operating. They can see and direct the progress of tumor destruction as it happens, which increases the likelihood that tumors will be completely treated.
2. Making tumors ‘glow’ to help surgeons remove them
Often, surgeons must be conservative when removing brain tumors. They may need to leave some of a brain tumor behind to avoid damaging a person’s healthy tissue – especially if the tumor is located near areas that control important functions. The challenge comes in locating the edges of the tumor. The edges of a tumor can look just like healthy tissue.
During a traditional surgery, surgeons will remove all that they can and patients are later treated with chemotherapy and radiation to kill the remaining cancer. For aggressive brain tumors, called glioblastomas, doctors are working on a way to get more of the tumor during surgery: making them glow a pinkish-red color when exposed to blue light. The technique is still experimental but it allows surgeons to more clearly see the margins of a tumor. This can make a big difference in the cancer fight by offering a better prognosis for patients.
How it works: Before surgery, a patient will drink a liquid that contains 5-aminolevulinic acid (5 ALA), a substance that causes the tumor, and only the tumor, to glow. This allows for more precise removal during surgery.
3. Performing brain surgery without a cut
Today, it’s possible to have brain surgery in the morning and be home later that day with Gamma Knife surgery. This is a minimally invasive, targeted therapy that delivers radiation into a specific area of the brain.
In a single treatment, 201 beams of gamma rays are focused at multiple points which are designed to deliver radiation that matches the shape of the tumor. Because of this precise focusing ability, aggressive, high-dose gamma radiation can be delivered to stabilize, shrink, or destroy some lesions – even those deep in the cerebral hemispheres or brain stem.
Most patients don’t feel anything during the treatment or recovery. Being able to treat some brain tumors without making any cuts is a huge step forward for patients. The most common use for this treatment is brain metastases – or cancer that originated in some other part of the body but which has spread to the brain.
Experts say Gamma Knife is often equal or superior to regular brain surgery in effectiveness, is virtually painless and has fewer complications.
4. Using electric fields to slow tumor growth
It’s interesting that very low-intensity, intermediate-frequency alternating electric fields can slow growth of some recurring tumors. Called tumor treating fields (TTFields), they can inhibit the growth of tumor cells. These tumor treating fields are particularly useful in treating glioblastoma, an incurable malignancy with overall survival of 15-18 months.
This noninvasive treatment works to stop the tumor cells from dividing and keep them from growing. TTFields therapy is frequency tuned to specific cancer cell types.
One study compared the use of TTFields with chemotherapy in recurrent glioblastoma patients and found that TTFields therapy is associated with minimal toxicity, better quality of life, and comparable effectiveness to chemotherapy. Researchers have ongoing and future studies planned to evaluate TTFields in newly diagnosed glioblastoma, solid tumor brain metastases, nonsmall cell lung cancer, and ovarian and pancreatic cancers.
How it works: As these aggressive tumor cells try to grow, the electric fields disrupt them. One system, the Novo TTF-100A®, involves a patient wearing what looks like a very thin swimming cap on his head. This “cap” contains electrically insulated surface transducer arrays that deliver TTfields generated by a device that he can wear on his back.
5. Team approach for lesions in the base of the skull
Lesions located in or around the base of the skull are very difficult to treat surgically. It’s a challenge for surgeons to reach and remove deep-seated intra- and extra-cranial skull base lesions while protecting healthy brain tissue.
When it comes to skull base tumors, a team effort is instrumental to success. It can require the highly specialized techniques of specialists in interventional neuroradiology, otolaryngology (ear, nose, throat), neurosurgery, ophthalmology, plastic surgery, and neuroanesthesiology. The main goal of skull base surgery is to allow surgeons access to difficult-to-reach lesions by moving (anatomic displacement) or removing parts of the base of the skull.
These techniques reduce or eliminate the need for pushing back or moving brain tissue, which helps protect injury to the brain, cranial nerves, and blood vessels.
*NeuroBlate is a trademark of Monteris Medical IncCleveland Clinic, Brain & Spine Team “Five Amazing Brain Surgery Innovations” Brain & Spine Health / Cancer Health, October 6, 2014.