Brain tumor or spinal tumor surgery is often an important component of a patient’s overall treatment plan. After evaluating the size and grade of a brain tumor or spinal tumor, as well as the patient’s age and overall health, the Neuro-Oncology multispecialty tumor board of cancer experts at Moffitt Cancer Center can determine whether a safe resection (surgical removal) of all or a portion of the tumor is possible. In addition to or as an alternative to brain tumor surgery, Moffitt’s tumor board might recommend radiation therapy and/or chemotherapy to attempt to destroy the cancer cells and shrink the tumor, which can sometimes make a required surgical procedure less extensive. Additionally, these therapies can help alleviate some symptoms to improve the patient’s quality of life. For spinal tumors, our experts will work together to determine the best approaches to treating spinal instability and/or pain caused by the tumors.
At Moffitt, we offer the latest advances in brain tumor and spinal tumor surgery, such as robotic-assisted procedures, along with a level of surgical expertise that far exceeds that of most other cancer centers. As a high-volume cancer center, we see many brain tumor and spinal tumor patients – some with very rare and difficult-to-treat tumors – and our neurosurgeons perform a high number of complex brain cancer procedures. As a result, our neurosurgeons’ experience is extensive, and their skills are highly refined, which can make all the difference in beating brain tumors and spinal tumors.
The neurosurgeons at Moffitt perform a number of different types of brain cancer surgery, including:
- Biopsy – A surgeon obtains a tissue sample for further testing by inserting a hollow needle into the tumor and drawing up a small amount of tissue. When performed with computer-assisted guidance, this procedure is known as a stereotactic biopsy.
- Craniotomy – Using specialized instruments, a surgeon removes a section of bone from a patient’s skull to access a tumor. After completely or partially removing the tumor, the surgeon replaces the bone. Awake craniotomies (in which patients are typically awake for most of the surgery, as general anesthesia is not required) can allow for enhanced monitoring of the patient throughout the procedure. We also have the ability to use 5-ALA ("the pink drink") to make tumor cells glow red when visualized under a special light. This approach allows us to maximize the extent of tumor removal. Neurosurgeons at Moffitt pioneered the use of a 3D exoscope to visualize 5-ALA induced tumor fluorescence.
- Shunt procedure – If excess fluid is causing pressure to build in the brain, a shunt (narrow, flexible tube) can be placed, either permanently or temporarily, to move the fluid to another part of the body.
- Endonasal endoscopy – A neurosurgeon and head and neck surgeon work together to guide an endoscope and tiny camera through a patient’s nose and sinuses. Then, the neurosurgeon can remove the tumor or obtain samples for biopsy. This approach is typically used for pituitary tumors and other types of tumors that occur in the skull base.
- Neuroendoscopy – After creating a small opening in a patient’s skull, a neurosurgeon uses an endoscope and tiny camera to navigate a fluid chamber in the brain, remove tumors and obtain tissue samples.
- Skull base surgery - This procedure can be performed endoscopically or in a conventional, open approach to better reach the surgical site. This approach is most often used for benign tumors that grow from the lining that surrounds the brain, but can also be helpful for managing cancer that spreads from the head and neck region into the skull.
- Stereotactic radiosurgery – A Varian Truebeam linear accelerator with BrainLab ExacTrac image guidance system is used to generate narrow beams of high-dose radiation. These beams are precisely aimed at a cancerous lesion from multiple angles.
- Laser Ablation/Laser Interstitial Thermal Therapy (LITT) - This MRI-guided treatment can be used in place of traditional surgery for certain tumors that develop in the brain or spine. This approach uses a fiberoptic laser to carefully heat tumor tissue to the point where it cannot recover. Moffitt uses the Visualase® Laser Ablation system.
- Kyphoplasty – This minimally invasive approach is used to treat pain caused by cancer that metastasizes to the spine. A neurosurgeon uses x-rays in the operating room to guide a catheter into the spinal tumor and then injects cement to help repair the damage to the spine caused by the tumor.
- Spinal Stabilization – Moffitt neurosurgeons use both conventional and minimally invasive techniques to relieve pressure on the spinal cord or nerves and stabilize the spine in cases where spinal metastases cause pain, instability of the spine, and/or loss of neurological functioning.
Moffitt is widely known and respected for its robust clinical trial program, through which many of our patients benefit from exciting new breakthroughs in brain tumor and spinal tumor surgery and other treatments as soon as they become available. Some of these trials are available for patients undergoing brain or spinal surgery, for example to obtain tissue to evaluate the effect of a new type of medical treatment, or to directly deliver experimental therapies to brain tumor tissue. While keeping abreast of new medical developments, our Neuro-Oncology tumor board closely monitors each patient’s progress on an ongoing basis and refines the treatment plan as necessary. In addition to multiple expert opinions, our patients receive highly individualized treatment and compassionate care, and no referrals are required to consult with the experts in Moffitt’s Neuro-Oncology Program.
Medically Reviewed by Dr. Michael Vogelbaum, Program Leader, Department of Neuro-Oncology.