Malignant Tumor Program
The Department of Neurosurgery at Cedars-Sinai Medical Center treats the broad spectrum of malignant intracranial disorders, encompassing all types of primary and metastatic brain tumors. These conditions include gliomas, (astrocytomas, ependymomas, glioblastoma multiforme, oligodendrogliomas, and mixed gliomas) and malignant cancers that mestastasize to the brain.
One component of the Department of Neurosurgery is the Wednesday morning Tumor Board. A comprehensive specialty team of neurosurgeons, medical oncologists, radiation oncologists, neurologists, neuroradiologists, pediatric oncologists, neuro-oncologists and neuropathologists review individual patient cases and provide recommendations on the most optimal treatment alternatives. The Tumor Board provides unparalleled expertise, allowing physicians to consult with a variety of specialists in one setting.
Sophisticated Imaging Technology for Open Procedures
The department currently uses state-of-the-art imaging technology when performing open surgery on intracranial lesions and tumors. Advanced imaging modalities precisely define brain structure and function, helping surgeons to identify eloquent areas of the brain prior to and during resection. In addition, we utilize sophisticated surgical microscopes and specially designed instruments for tumor resection.
The Maxine Dunitz Neurosurgical Institute (MDNSI) is the exclusive West Coast research center for ZEISS, an imaging technology leader. This relationship gives Cedars-Sinai patients access to new image-guided technologies even before they become widely available on the market. The combined technologies include computer-assisted navigation systems for neurosurgery that integrate the microscope, ultrasound, magnetic resonance imaging (MRI) and various other state-of-the-art technologies to improve outcomes in the neurosurgical operating suite.
Cedars-Sinai Medical Center recently developed a 21st century, advanced image-guided operating suite, complete with real-time imaging capabilities. In this environment, surgeons utilize state-of-the-art navigational microscopes, computerized navigation, functional intraoperative MRI studies and optical technologies to determine the exact location of a tumor in real-time, three-dimensional space. By pinpointing where the eloquent areas of the brain are in relationship to pathology such as tumors, surgeons are able to perform surgical resections more safely and efficiently.
Gamma Knife® surgery is recognized worldwide as the preferred treatment for selected lesions, tumors and conditions that afflict the body's most important organ: the brain. Supported by more than 2,500 peer-reviewed research articles, Gamma Knife can be used to treat brain tumors, arteriovenous malformations and brain dysfunctions, such as trigeminal neuralgia.
The Gamma Knife is noninvasive and is an alternative for many patients for whom traditional brain surgery is not an option because it avoids the physical trauma and most of the risks associated with conventional surgery. The single-session treatment is also usually administered in an outpatient setting with periodic follow-up.
The Gamma Knife Center brings together a multidisciplinary team of experts from the Outpatient Cancer Center at the Samuel Oschin Comprehensive Cancer Institute, Department of Neurosurgery and the S. Mark Taper Foundation Imaging Center to provide the finest care available.
Radiosurgical Treatment Alternatives
Patients at the Department of Neurosurgery have direct access to the full range of radiosurgery options, including conformal, fractionated and fixed radiosurgery. Cedars-Sinai Medical Center is on the leading edge of this field and has the first FDA-approved, three-dimensional software for conventional radiotherapy. Three-dimensional planning and computer-generated, conformal technology help reduce the amount of adjacent normal tissue contained within treatment fields, leading to reduced morbidity.
The department is also a leader in radiosurgery. Cedars-Sinai Medical Center is the first medical facility on the West Coast to offer the Radionics ConforMAX Mini-Multileaf Collimator (MMLC) and Head and Neck Localizer (HNL). The FDA-cleared ConforMAX MMLC is a device used to treat malignant and benign tumors. The technology precisely shapes the radiation beam to the targeted tumor, minimizing risk to surrounding healthy tissue and critical structures, such as the brain stem and optic nerves.
The MMLC system utilizes a neurosurgical headframe to immobilize the patient. Information from diagnostic imaging tests, including MRI, CT and angiography, is integrated with the Radionics Xplan treatment planning software that views the brain tumor three-dimensionally to determine the exact angles and radiation doses required to destroy the tumor. This process enables the team to accurately trace the tumor and position the MMLC to ensure the linear accelerator (LINAC) delivers the stereotactic conformal radiation to the precise location of the tumor.
If the patient has a benign lesion, like an arteriovenous malformation, radiosurgery will be performed whereby a single dose of radiation is delivered. If the lesion is primary or metastatic brain cancer, the patient will be treated with stereotactic radiotherapy, utilizing lower doses of fractionated radiation treatments over a series of sessions.
Surgical Technology Program
Department of Neurosurgery surgeons perform more than 300 operations for brain tumors each year. Their goal, however, is to make surgery for brain tumors obsolete. Our surgeons are working on a technique to destroy brain tumors non-invasively using focused microwaves. This technology could also be used to destroy other tumors without surgery including breast or prostate tumors. Microwave thermal ablation, also being developed at the MDNSI, could eliminate surgery for many types of cancer.
The Latest Treatments
Cedars-Sinai researchers have spent the past nine years developing innovative means of targeting brain tumor cells. Because one of the greatest challenges in the treatment of malignant brain tumors is their ability to escape an immune response, researchers are harnessing the immune system to target these tumors. Immunotherapy trials have demonstrated a favorable survival outcome for patients compared to those undergoing traditional therapy, and there have been very minimal adverse effects as would be associated with more harsh chemotherapies and radiation therapies.
Cedars-Sinai scientists also are conducting gene therapy and biological therapy trials. They and other researchers recently described the isolation and characterization of a cancer stem cell, which appears to be both the initiator and the supporter of malignant brain tumors. Researchers have demonstrated that these cancerous stem cells can escape traditional therapies, including radiation therapy and chemotherapy. To counter this, researchers developed a novel biologic approach that targets these cancer stem cells, and have incorporated this experimental therapy in patient treatment.
For more about clinical trials at Cedars-Sinai, please visit Clinical Trials.
New Test for Brain Tumors: Laminin-411
In 2001, Cedars-Sinai researchers using leading-edge, gene-chip analysis discovered a new cancer biomarker: laminin-411 (formerly known as laminin-8). Human gliomas excessively produce laminin-411, which plays an important role in the ability of tumor cells to spread and grow (Cancer Res. 2001, 61:5601-5610). This biomarker was later analyzed in a number of human gliomas and showed a significant correlation with glial tumor grade, time to recurrence and patients' survival times (Cancer, 2004 101:604-612).
Methods to inhibit laminin-411 synthesis were developed on cell cultures and in laboratory animals. After laminin-411 was inhibited, glioma cells were less invasive and animals with brain tumors survived longer (Mol.Cencer Ther, 2003, 2:985-994; Angiogenesis 2006 9:183-191).
In the Cedars-Sinai Department of Neurosurgery, we are using this test to evaluate the biological behavior of gliomas in order to better plan individualized therapeutic treatment and follow-up regimens for each patient.