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Nasopharynx 2% Hypopharynx 2% Ear and related 1% structures 19% 19% 12% 16% 7% 6% 7% 2% 0 300 600 900 1200 1500 222 581 400 294 224 562 613 766 910 806 Skull base procedures (endosopic & open volume) endoscopic open 0 10 20 30 40 50 60 TORS cases 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 8% 2% 2% 26 MD Anderson Cancer Center NEUROSURGERY Frederick F. Lang, M.D. Department chair Thomas Campbell Division of Surgery | Surgical Outcomes FY18 27 Brain, spine and skull base tumors are rare tumors that can severely impact a person’s ability to think, see, hear, move and breathe. The Neurosurgery team at MD Anderson is one of the most experienced groups in the nation when it comes to successfully removing these tumors without harming critical functions. In Fiscal Year 2018, MD Anderson neurosurgeons saw 1,833 new patients and consults, and completed 1,100 operations and nearly 600 stereotactic radiosurgery procedures. MD Anderson provides comprehensive care for all benign and malignant tumors of the central and peripheral nervous system, as well as cancer-related pain. Some of the most common tumors treated at the Anne C. Brooks Brain and Spine Center and MD Anderson’s Houston-area locations include: • Acoustic neuromas • Chordomas • Craniopharyngiomas • Ependymomas • Gliomas, including: o Astrocytomas o Glioblastomas o Oligodendrogliomas • Metastatic brain and spine tumors • Meningiomas • Medulloblastomas • Neurofibromas • Pituitary tumors • Schwannomas “Our goal is to remove as much of the tumor as possible, as safely as possible,” says Frederick Lang, M.D., chair of Neurosurgery. “We’re able to do this and provide the best possible outcomes for our patients because of the subspecialized expertise and experience of our faculty members.” Neurosurgeons at MD Anderson are particularly renowned for their ability to achieve a high extent of resection, even for tumors in eloquent brain regions that are often considered “inoperable,” and to remove many tumors in one piece (en bloc). They use several advanced surgical technologies and techniques to provide the highest quality patient care with low complication rates. These include: • Awake craniotomy and functional brain mapping: the patient is awakened during the operation to verify his or her ability to think, speak, move or reason. MD Anderson neurosurgeons regularly use this procedure to map brain functions before and during tumor removal. By directly stimulating the brain, they are able to identify and preserve areas of the brain necessary for specific functions. • BrainSuite® iMRI and intraoperative CT suite: highly advanced operating rooms that provide real-time imaging during surgery through intraoperative MRI and CT systems. The IOCT Suite was designed by MD Anderson neurosurgeons specifically for imaging and complex surgery for spine patients. • Image-guided brain surgery: state of-the-art MRI and CT imaging to plan and execute brain and spine surgery. The 3-D volumetric images created by these navigation systems allow surgeons to precisely navigate the patient’s brain and spine anatomy during surgery. • Gamma Knife radiosurgery and spinal stereotactic radiosurgery: non-invasive, outpatient, accurate tumor targeting with a single dose of radiation. MD Anderson’s second Gamma Knife unit opened in 2019. • Endoscopic skull base tumor surgery: with no incisions or a few small ones in the skull or back of sinuses, the A guitar concert during awake craniotomy By Meagan Raeke When Robert Alvarez was diagnosed with a low-grade brain tumor in 2013, the active 19-yearold athlete and musician felt the risks of surgery were worse than living with the tumor. “The doctors told me surgery could leave me paralyzed,” he says. Since his symptoms were still minor, Alvarez “just hoped it wouldn’t grow and tried to be careful.” That changed in 2017, after he started having seizures and came to MD Anderson, where he met neurosurgeon Sujit Prabhu, M.D. “Dr. Prabhu told me I would be OK. That’s what I wanted to hear,” Alvarez says. His brain tumor had grown across areas that control speech, motor function, emotions, memory and mood. Prabhu recommended an awake craniotomy, a procedure where the patient is woken up during surgery to help map and safely preserve critical brain functions as the tumor is removed. He also asked Alvarez to play guitar during surgery to ensure his musical talents wouldn’t be harmed – making it the first brain surgery at MD Anderson to include a musical instrument. “Everything just worked like a symphony,” Prabhu says. He successfully removed 90% of the tumor, and Alvarez continued playing guitar through chemotherapy. VIDEO: bit.ly/guitarbrainsurgery. A longer version of this story originally appeared on MD Anderson’s Cancerwise blog. 28 MD Anderson Cancer Center surgeon uses an endoscope to biopsy or remove the skull base tumor. For certain tumors, this approach may reduce complications, damage to healthy tissue, hospital time and recovery time. In addition to the established neurosurgical oncology program at MD Anderson, recent years have seen several new initiatives develop: Neurosurgeons at MD Anderson pioneered the use of laser interstitial thermal therapy for brain tumor treatment. This
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