Cancer and Benign Tumors
When it comes to benign tumors of the spine and brain, even non-cancerous tumors can cause life-threatening complications if they are not treated. Spine tumors cause spinal cord compression, pain, and neurological problems while brain tumors exert pressure on the brain, compressing tissue as they grow. In addition to tumors of the spine and brain, our neurologists treat tumors of the pituitary gland, which is located at the base of the brain, and skull-base tumors, located at the bottom of the skull.
Spine, Brain, Neuroendocrine, and Pituitary Tumors
Finding out that a tumor is benign is generally good news. Unfortunately, when it comes to benign tumors of the spine and brain, the situation is more complicated. Benign tumors grow slowly and have distinct borders. They do not spread to other parts of the body. However, a non-cancerous tumor of the spine can cause spinal cord compression, pain, and neurological problems as it grows and even lead to paralysis. Benign brain tumors can lead to serious complications by exerting pressure on the brain and compressing brain tissue. A benign tumor of the pituitary, an endocrine organ located at the base of the brain, may press on the optic nerve and cause vision loss.
While there are many different types of brain tumors, they fall under three general categories. Primary tumors originate in the brain. Secondary tumors are metastases from tumors that begin in other parts of the body, most frequently breast, lung, or prostate. Brain stem tumors are in the most dense, complex areas of the brain and are especially challenging to remove.
The Eisenhower neuroscience team is known for its excellent outcomes in the treatment of brain tumors. Every case is extensively studied and discussed by our elite Brain Tumor Board, which includes neurosurgeons, neurointerventional radiologists, radiation oncologists and medical oncologists. Working together, these specialists will arrive at the optimum treatment plan for each individual case. Factors such as risk to the patient and their general health, their quality of life, and the type and location of the tumor must all be carefully weighed. The patient is directly involved in the decision process.
Neuroendocrine tumors affect neuroendocrine cells, specialized cells that are similar to nerve cells and hormone-producing cells. These tumors can occur in different parts of the body but when they occur in the pituitary gland, located at the base of the brain, neuroendocrine tumors require specialized treatment by a neurosurgeon. Eisenhower Neuroscience Institute provides evaluation, diagnostic testing and medical and/or surgical treatment of patients with neuroendocrine disorders. Treatment uses a collaborative approach between Endocrinologists, Neurologists, and Neurosurgeons and may require a multimodal approach involving surgery, radiosurgery, and/or radiation therapy.
Spinal tumors can be malignant or benign. A malignant spinal tumor may be a primary tumor, meaning that the tumor originated in the spine, or a metastatic tumor. Untreated, common cancers such as breast, lung, and prostate often metastasize to the spine. Spinal tumors are described based on their location on the spine (cervical, thoracic, lumbar, and sacrum) and their location within the spine itself:
- Intradural-extramedullary tumors are located inside the thin covering of the spinal cord, known as the dura, but outside the spinal cord itself.
- Intramedullary tumors grow inside the spinal cord. While they are often benign, they can be challenging to remove.
- Extradural tumors are located outside the dura, which is the thin covering surrounding the spinal cord. These kinds of tumors are typically, but not always, metastases from a tumor in a different part of the body.
Asymptomatic, slow growing spinal tumors may simply be monitored with regular MRIs. Some spine tumors respond well to chemotherapy or radiation. Indications for surgery include intractable pain, spinal-cord compression, or the need to stabilize “pathological fractures,”– spontaneous fracturing of weakened bone.
The skull base is the medical term for the bottom of the skull. Composed of 5 different bones, this complex area includes the eye socket, the top of the nasal cavity, some of the sinuses, and the bones surrounding the inner ear. The spinal cord and many blood vessels and nerves all pass through the skull base, making it challenging for surgeons to see and reach.
At Eisenhower Neuroscience Institute, skull base surgery is a collaborative process that combines otolaryngology, neurosurgery, and neuroradiology.
Skull base surgery may be used for both benign and malignant growths. It is also used to correct certain abnormalities on the underside of the brain or the vertebrae at the top of the spine. Most skull-base surgery can now be performed through a minimally invasive endoscopic procedure. The surgeon inserts the endoscope and tiny surgical instruments through the nose, mouth, or by making a small hole just above the eyebrow.
The combination of an exceptional team and access to the latest technologies has a direct impact on outcomes:
- Micro neurosurgery uses a high-powered operating microscope to greatly magnify a surgical area, and specialized instruments to navigate around tiny blood vessels and nerve endings in the brain with remarkable precision.
- Stereotactic neuroendoscopy allows for highly targeted, minimally invasive removal of a tumor. An endoscope, a tiny probe with a light and camera attached to it, is inserted into the brain through the nose or a small incision in the skull, guiding the procedure using a 3D coordinate system similar to GPS. Eisenhower Medical Center is the only medical center in the Valley to use this technology, which has made it possible to remove brain stem tumors that were previously deemed inoperable
- Brain mapping allows for patients to be awake for part of their surgery so that the surgical team can monitor the patient’s active responses. (This is possible because the brain has no pain receptors). Depending on the part of the brain being operated on, patients might be asked to answer questions to check on their speech or wiggle their fingers or toes to monitor their motor abilities.
- Stereotactic radiosurgery is a non-surgical, non-invasive radiation treatment for benign and malignant brain tumors. Using a three-dimensional coordinate system, the tumor is treated with a precise, robotically guided dose of intense radiation. Because targeting is so specific, a more intense dose of radiation can be delivered straight to the tumor without affecting surrounding tissue. The radiation damages tumor cell DNA, destroying their ability to reproduce. Thanks to stereotactic radio surgery, it is now possible to treat tumors that can’t be removed through conventional surgery. Eisenhower Neuroscience Institute’s multidisciplinary Stereotactic Radiosurgery team meets regularly to review cases and determine the best treatment and delivery system for each patient. Stereotactic radiosurgery treats various neurological disorders including acoustic neuroma, meningioma, metastatic tumors, melanoma, arterial venous malformations (AVM) and trigeminal neuralgia.