Brain Tumor/Gamma Knife Surgery
UBNS specializes in treating brain tumors in both children and adults. As with all tumors, early diagnosis and treatment is of the utmost importance.
Early Signs
Brain tumors compress and invade crucial brain structures as they grow, giving rise to progressive neurological disturbances. A brain tumor should be suspected whenever a patient presents with slowly evolving neurological signs and symptoms, particularly those itemized below:
- Intense headaches, often accompanied by nausea and vomiting or worse in the morning
- Seizures of recent onset, generalized or focal
- Personality changes, mental sluggishness, or memory loss
- Visual complaints, such as blurred or double vision, or an enlarged blind spot
- Hearing loss
- Lack of coordination or localized physical weakness
- "Stroke-like" symptoms - particularly in the elderly
- Increasing head size (in children)
Sometimes, tumors may not become noticeable until after they bleed or when they reach a large size, often depending on their rate of growth.
Pituitary Tumors
Tumors that arise in the pituitary gland are very commonly benign in character. Nevertheless, they may cause serious neurological symptoms by compressing nerves that are critical for vision. In addition, invasion of local structures around the pituitary gland can make complete removal difficult or impossible.
Pituitary tumors can also affect the patient's general physical well-being by altering the balance of hormones in the body. This can occur as a result of excessive production of certain hormones by the tumor itself or by compression of the normal gland by the tumor with resulting underproduction of pituitary hormones. This, in turn, can lead to overproduction or deficiencies in the production of hormones by the thyroid and adrenal glands, and by the ovaries and testes.
Some symptoms of a pituitary tumor include:
- Headaches
- Memory problems
- Diminished peripheral vision
- Severe fatigue
- Excessive thirst combined with frequent urination
- Weight gain or loss
- Milk production from the breasts when not pregnant
- Loss of normal menstrual periods
- Loss of sex drive
- Impotence
- High or low blood pressure
- Progressive coarsening of facial features
- Excessive sweating
- Steady increase in glove or shoe size
Pituitary tumors are best diagnosed using a MRI scan and specific blood tests of pituitary hormone levels.
Although medication can be used to treat certain pituitary tumors, surgery is frequently required. The typical pituitary tumor is removed by way of a "transphenoidal" operation. In this minimally invasive procedure, surgery is performed through one nostril using a microscope and without the need for any externally visible incisions. Certain other pituitary tumors may be treated with Gamma Knife radiosurgery or with conventional radiation therapy.
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Cerebral Gliomas
Gliomas are a diverse group of tumors that all arise from brain tissue, but behave in very different ways and grow at different rates. Consequently, it is important to distinguish between the different types when discussing any particular patient's condition.
Each type of glioma has its own growth pattern and probability of further growth following treatment. Some gliomas may be cured or held in check for long periods by simple surgical excision alone, while others regrow despite extensive treatment. Even within a particular category, there may be wide variation between individual patients in terms of tumor behavior and response to treatment.
Metastatic Brain Tumors
Frequently cancers of the lung, breast, kidney, and other organs spread through the bloodstream to the brain and other tissues of the body—a process known as metastasis. These metastatic brain tumors may cause neurological symptoms such as headaches, weakness, seizures, vision problems, or speech abnormalities.
Currently, a number of treatment options are available for treating metastatic brain tumors. For single brain tumors, either conventional neurosurgery or Gamma Knife treatment (radiosurgery) is effective. Often, conventional radiation therapy is combined with one of these two forms of treatment. When more than one metastatic brain tumor is present, radiosurgery is usually the chosen treatment method. Appropriate selection from among current treatment options usually leads to good control of the neurological manifestations of metastatic disease.
Treatment Options
Because many tumors have a characteristic appearance on magnetic resonance imaging (MRI), this imaging study is often sufficient to make a diagnosis. If, however, a diagnosis is in question, computer-directed stereotactic biopsies are performed to make a definitive diagnosis.
Some tumors (such as lymphoma) are treated with radiation alone, whereas others are removed with surgery. Depending on location, UBNS physicians can often remove tumors using endoscopic techniques. Sellar region tumors, such as pituitary adenomas, can be removed without a skin incision using transnasal (through the nose) endoscopy. When tumors are removed, our patients are cared for in our neurointensive care unit-the only ICU in Western New York that specializes in the care of patients with neurological disorders.
Tumor embolization is a unique treatment performed by our endovascular team. By placing a catheter into the femoral artery and steering it to the arteries "feeding" the tumor, our surgeons are able to inject chemotherapeutic agents directly into the tumor bed. This allows for a high concentration of agents to be placed into the tumor without concomitant systemic side effects. Additionally, these endovascular techniques may decrease the blood supply to the tumor, resulting in arrested growth and possible necrosis (death) of tumor cells.
Some central nervous system tumors are radiosensitive. These include lymphomas, which are treated primarily with radiation. Patients with small metastatic lesions may also best be served with radiotherapy. Stereotactic radiosurgery, such as Gamma Knife radiosurgery, involves the delivery of radiation to the tumor bed while the surrounding brain tissue receives only fractions of this dose. Computer guidance allows the delivery of a dose of radiation that conforms to the shape of the tumor. By working closely with a team of radiation oncologists and neurologists, a multidisciplinary approach is used to offer optimal care to our patients suffering from brain tumors.
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Gamma Knife Surgery
Gamma Knife stereotactic radiosurgery is a technique that utilizes 201 separate beams of gamma radiation energy, all precisely directed at a single point. The Gamma Knife is used to treat benign and malignant brain tumors, as well as other brain disorders. Gamma Knife radiosurgery combines modern methods in neuroradiology (MRI, CT and cerebral angiography) with sophisticated computer technology to localize and target brain lesions with gamma rays. The precise targeting of Gamma Knife radiation in a single large dose makes it as effective as conventional surgery for certain brain conditions, but with potentially fewer serious risks.
The Gamma Knife Center at Roswell Park is a major community-based resource for the application of state-of-the-art radiosurgery in Western New York. Treatment is provided by our neurosurgeons as well as radiation oncologists and neuroradiologists working together as part of UBNS' multidisciplinary brain tumor team.
Brain tumor treatment is highly individualized. Although not appropriate for everyone, many patients benefit from having stereotactic radiosurgery as part of their overall treatment plan. The main tumor types that are potentially treatable with Gamma Knife stereotactic radiosurgery include:
- Metastatic brain tumor
- Gliomas
- Meningiomas
- Pituitary tumors
- Craniopharyngiomas
- Skull Base Tumors
For more information on brain tumors and their treatment, please visit the Brain & Spine Disorders index on this site, or contact our office at (716) 887-5200 to speak with a member of our staff.
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