Click to expand a topic below and learn more about the treatment offerings at the UC Brain Tumor Center:
Laser Interstitial Thermal Therapy
Many brain tumors can now be treated through an incision that is less than one inch, using a technique called Laser Interstitial Thermal Therapy (LITT). A biopsy is performed to confirm the tumor diagnosis, and a focused laser probe is then inserted through the same, tiny opening. In the MRI suite, our neurosurgeons and radiologists watch under live MRI as the neurosurgeon uses the laser probe to heat the tumor from the inside out, killing tumor cells while leaving normal brain cells intact.
The best thing about this treatment is that it can usually be done as an outpatient procedure, and patients can go home the same day with minimal or no new symptoms.
Millimeters matter when infiltrating tumors are located very close to critical brain structures. In situations like these, we use a custom-built operating room with an integrated MRI machine and state of the art, computerized image guidance that allows our surgeons to perform extensive tumor resections while minimizing the risk to eloquent brain areas. This may allow the surgeon to safely remove 100% of a tumor instead of 95%, and sometimes this difference is critical.
Intraoperative Fluorescence-Guided Surgery
Many common brain tumors grow by infiltrating the normal, surrounding brain tissue. In these cases the difference between tumor tissue and normal brain may not be clear, even for experienced surgeons using state-of-the-art intraoperative image guidance technologies. In these situations we can give patients special medications that collect inside tumor cells or blood vessels and produce tracers that can then be visualized in the operating room under special combinations of visible and invisible light.
This technology can facilitate more extensive tumor removal and better preservation of nearby, normal brain tissue.
When a tumor involves an area of the brain that is critical to speech and language functions, sometimes the best way to ensure safe tumor removal is to wake a patient up during surgery and perform real-time language testing while the neurosurgeon is removing the tumor.
This procedure requires not only special equipment, but also a multi-disciplinary team of extensively-trained clinicians. Our neurosurgeons, anesthesiologists, neuropsychologists, neurologists, and operating room team are experts in performing awake craniotomies. For certain patients, this approach can be critical in preserving language functions while successfully removing aggressive tumors.
Prior to surgery, most brain tumor patients undergo extensive brain imaging that allows us to identify not only the anatomic boundaries of tumors and the structures of normal brain, but also imaging that identifies tumor hot spots, tumor blood flow, and the precise location of critical white matter fiber tracts. We use the latest technologies in intraoperative image-guided stereotactic navigation to bring all of this data into the operating room, and our computer guidance systems allow us to integrate it all into a virtual 3D model of the patient’s brain.
Our neurosurgeons can see all of this data on the patient’s imaging live in the operating room, as they use real-time tracking via infrared cameras with specialized instruments to remove the tumor. This type of “Brain GPS” allows our neurosurgeons to see not only what their eyes can perceive, but also incorporate everything that the advanced imaging scans can detect – and it is all available in real time during surgery.
Even the best preoperative imaging cannot compensate for the ways that brain tissue moves during the process of removing a tumor in the operating room. Because of this, our neurosurgeons use ultrasound in the operating room to help compensate for shifting brain and to get immediate feedback on the extent of tumor removal during surgery.
This technology also helps us understand the extent and nature of the swelling around a tumor, and it helps us see how critical structures are responding to the process of removing the brain tumor. Color flow ultrasound can also help us assess the nearby blood vessels and blood flow to the brain during surgery, which helps us ensure that normal, healthy brain stays well perfused while tumors are removed.
The many imaging technologies that we use before and during surgery help us understand the anatomy of tumors and the surrounding, normal brain, but anatomy is only part of the story.
Our neurosurgeons use a variety of intraoperative electrophysiologic studies to monitor brain function during surgery. This includes somatosensory evoked potentials (SSEP) to monitor sensory pathways, transcranial and transcortical motor evoked potentials (MEP) to monitor motor pathways, microelectrical phase reversal studies to localize primary sensory and motor cortex, subcortical stimulation to locate critical subcortical white matter pathways, and electroencephalography (EEG) to monitor for intraoperative electrical seizures.
Microscopic and Endoscopic Surgery
First and foremost, good surgeries require that the surgeon be able to see even the tiniest brain structures with absolute clarity. We use a full spectrum of state of the art visualization technologies, including operating microscopes, neuro-endoscopes, and exoscopes to provide our surgeons with an unparalleled view of the brain. Combining these technologies with careful microsurgical techniques helps to ensure the safest possible surgeries, even in the most remote recesses of the brain.
Skull Base Surgery
Tumors that form around the base of the skull present a unique set of surgical challenges, and our surgeons have exceptional skills and extensive experience with surgery at the cranial base. They combine these skills in performing complex surgical approaches to the cranial base with a variety of technologies to visualize these difficult-to-reach areas, to operate in confined spaces, to monitor the activity of the surrounding brain, and to preserve critical blood flow through microscopic blood vessels in the area. Together this combination of skill, experience, and technology helps us to provide the best possible outcomes for patients with these complex tumors.
Tumors of the pituitary gland, skull base, and clivus can be removed using approaches that go through the nose. This means no external incisions and faster recoveries. Our neurosurgeons and head and neck surgeons work collaboratively in the operating room to remove even the most complex tumors of these regions through these minimally-invasive approaches.
This is not surgery in the traditional sense, because there is no incision. Instead, our radiation oncologists and neurosurgeons use devices that deliver multiple small doses of radiation across multiple trajectories, all converging on the tumor being treated. This helps to ensure that normal brain cells receive only very small amounts of radiation, but the tumor itself gets a combined dose that is high enough to kill the tumor cells.
Complex 3D virtual models built from high-resolution images are used to define the target tumors, and advanced planning software is used in conjunction with specialized equipment to help our team formulate treatment plans that lead to short treatment times with few side effects.
Because the procedure is performed in the outpatient setting using “frameless” technology, patients can often have their brain tumors treated in a convenient, non-invasive, and pain-free fashion while returning to their normal lives immediately after treatment.
Proton Beam Radiosurgery
Traditional radiation treatments rely on high-energy photons to kill tumor cells. For certain types of brain tumors in specific locations, there are advantages to using a different particle, called protons, to perform a similar task.
Protons are particularly useful for treating tumors that are very close to critical normal brain structures, because the “spread” of the radiation is extremely low. As research continues, more and more benefits are being discovered for proton beam therapy, and the range of indications continues to expand.
One limitation of this technology is that it requires a specially-built facility that is entirely dedicated to the delivery of proton therapy, and this can be cost prohibitive for healthcare systems. Recognizing the value of proton therapy, the University of Cincinnati has invested in a state-of-the-art, dedicated proton facility so that our patients have absolutely no constraints on the type of radiation therapy that they can receive.
The UC Proton Center is the only proton center in a 200 mile radius, and hundreds of patients in the greater Cincinnati area and from around the country benefit each year from the availability of this facility. As the nation’s only proton facility with a dedicated research gantry, the center also helps to ensure that that the University of Cincinnati will help to define the leading edge of novel treatments with protons.
Intensity Modulated Radiotherapy and 3D Conformal Radiotherapy
Large brain tumors and tumors with complex shapes and orientations can be treated with a variety of highly-conformal radiation therapy techniques, like IMRT and 3D conformal radiotherapy. These approaches help to round out our comprehensive spectrum of treatment options for brain tumors and ensure that even the most difficult tumors can be treated safely with radiation in the outpatient setting.
Brain tumors are notoriously resistant to systemic chemotherapy, but new advances in drug development and immunotherapy are offering more options for medical treatment of brain tumors.
We offer a full spectrum of systemic chemotherapy options for brain tumors, which can be used either alone or in conjunction with surgery or radiation. Our medical neuro-oncologists not only stay current on the latest chemotherapy strategies for brain tumors, but they also lead clinical trials that help to discover the even more effective treatments of tomorrow.
For patients with primary cancers outside of the brain that have metastasized to the nervous system, our medical oncologists work closely and collaboratively with a patient’s primary medical oncologist to optimize therapies that can work on both brain and systemic disease while minimizing side effects. This type of collaboration is at the heart of our medical management program for brain tumors.
Leptomeningeal disease, or carcinomatous meningitis, describes a condition where metastatic brain tumor cells have spread through the cerebrospinal fluid and brain linings.
The prognosis once this type of tumor spread occurs has traditionally been poor, but our team works at the cutting edge of medical therapy for leptomeningeal disease. For selected patients with leptomeningeal disease, our neurosurgeons can implant drug delivery catheters directly into the fluid spaces of the brain, and our medical neuro-oncologists can use these ports to deliver chemotherapy directly to the spinal fluid. This can help reduce the extent of leptomeningeal disease and improve survival even in patients with this very serious condition.
This treatment may be an excellent option for patients seeking aggressive treatment for extensive metastatic disease in the brain.
Optune® Tumor Treating Fields
One of the most recent advances in adjuvant therapy for brain tumors is a strategy that uses electromagnetic fields to slow tumor growth. This “tumor treating fields (TTF)” therapy is delivered using the Optune® device, and studies have shown that it can lead to significant additional survival in patients with aggressive, malignant brain tumors.
Our neuro-oncologists are specialists in the use of the Optune® TTF system. Moreover, we continue to participate in research trials that test the potential value of this noninvasive therapy in novel clinical contexts and in multiple tumor types. This technology is one more tool in our armamentarium that helps us provide the best possible outcomes for patients with aggressive brain tumors.
We believe that patients should be presented with a full spectrum of treatment options during all stages of their disease. Because of this, the UC Brain Tumor Center hosts and participates in multiple clinical trials designed to bring the absolute latest in promising new management strategies to our patients. With the assistance of the UC Health Clinical Trials Department, we maintain a comprehensive clinical trials program that is dynamic and comprehensive. Our clinical trials nurses and research coordinators help to ensure that the complexities associated with participating in a clinical trial are managed seamlessly, so patients don’t have to worry about the logistics of trial participation. More information about our current clinical trials is available on our clinical trials page.