Brain tumors and vascular lesions

The management of brain tumors and vascular lesions (abnormalities in blood vessels) has changed dramatically over the last 25 years due to improvements in the quality of imaging and the development of new treatment options.

The improvement of preoperative imaging has allowed us to see more accurately the proximity of a tumor to nearby structures. This allows us to choose a “minimally-invasive” surgical approach that limits the risk of damage to the surrounding tissue (brain, nerves, blood vessels, etc.), which are often quite sensitive to surgical manipulation.

Technology also has improved our ability to see during surgery. In addition to high-powered microscopes, high-definition endoscopes allow us to bring the light source close to tumors to decrease the size of the surgical opening without sacrificing the quality of the surgical resection.

While we are getting better at taking tumors out, there have been improvements in other treatment options as well, such as radiation. Stereotactic radiosurgery uses many precisely focused radiation beams to treat tumors. Each beam has very little effect on the tissue it passes through, but a targeted dose of radiation is delivered to the site where all the beams intersect. The high dose of radiation causes tumors to shrink.

There also have been many changes in the treatment of vascular lesions. The advent of detachable coils in the late ’80s and early ’90s has allowed us to treat aneurysms without having to preform open brain surgery. While open surgical clipping may be a better option for some aneurysms, the long-term results of coiling have been very encouraging.

I think it is important for physicians to offer as many options as possible. Sometimes you need to use the larger, more traditional open methods to remove tumors. If you can totally remove it, in many cases that is the best possible outcome. But you don’t want to sacrifice quality of life for the removal of a tumor. It’s important that surgeons understand their patients’ surgical goals and can offer many options to best fit what the patients want and to help them get back to their lives as soon as possible.