University of Miami Division of Surgical Neurooncology

• Glioblastoma (grade IV glioma)
• Anaplastic astrocytoma (grade III glioma)
• Low-grade astrocytoma (grade II glioma)
• Pilocytic astrocytoma (grade I glioma)
• Oligodendroglioma
• Ependymoma
• Mixed Glioma

Glioma treatment depends on the clinical and pathological presentation of the tumor. Treatment involves a combined approach that may utilize surgery, radiation and chemotherapy.

Any type of cancer which has arisen from another part of the body that has spread to the brain are referred to as cerebral metastases

Meningiomas are the second most common primary tumor of the central nervous system although they are usually benign. Treatments for Meningioma may include preoperative embolization and radiation therapy.

Also known as a vestibular schwannoma, Acoustic Neuroma can be managed conservatively or surgically.

Treatment may be conservative depending on the clinical presentation and the physician decision. Conservative treatment involves monitoring the tumor annually to assess growth. This practice is usually common in elderly patients.

Surgery may also be an option for patients. Special Consideration is taken to ensure preservation of patient's hearing and facial function. UM specialists tend to collaborate with the school's neurootology team to ensure good outcomes. Surgery may also be coupled with radiotherapy. Currently, minimally invasive endoscopic surgery for these tumors is an option at specialized medical centers such as UM. Radiation therapy can include cyberknife radiosurgery or fractionated stereotactic radiotherapy, or proton therapy.

After radiation treatments for vestibular schwannomas, patients must receive MRIs annually due to the possibility of recurrence of secondary tumors.[7]

Pituitary adenomas are tumors that occur in the pituitary gland.

Pituitary tumors can be treated with medicine to decrease the tumor size and symptomatology. Treatment for larger tumors can be accomplished with radiation therapy or surgery. Surgery is usually performed transsphenoidally and also may involve Cyberknife surgery.[8]

• Nasal carcinomas
• Chordomas
• Chondosarcomas
• Glomus

Skull base tumors can be treated in a variety of ways including surgery, radiation therapy, chemotherapy or even a combination of these treatments. Patients are given the option for open surgery or minimally invasive procedures.

Open Surgery Depending on the tumor type and location, open surgery may be preferred for certain patients. The bone is removed and the tumor is able to be resected widely. Usually after the tumor is removed, the neurosurgeons seek the multidisciplinary help of plastic surgeons to help reconstruct the soft tissues to provide little or no facial deformities.

Minimally Invasive Surgery This surgery utilizes image guiding, endoscopy, or real-time MRI to determine tumor location and facilitate resection. Endoscopy uses a flexible camera tube through small openings in the skull to view tumors in the skull base. Alternatively, image guided surgery uses preoperative MRIs or CTs to give the surgeons navigation to enhance the precision of resection. Even more advanced, some surgeons at UM are able to use real-time MRI to determine the extent of resection of the tumor intraoperatively, which naturally reduces the need for extra operations.[9][10]

Intraoperatively, University of Miami neurosurgeons and neurologists use certain techniques to reduce and prevent damage to essential areas of the brain used for language, muscle skills, and sensation. In order to avoid damage to these areas, neurosurgeons must determine the location of these functional areas that are mapped while the patient is awake. Using special mapping procedures while the patient is awake during the operation, certain areas of the brain are stimulated with a mild electric current to determine the functionality of various areas. If certain areas are critical for the patient's function, that area of the brain is preserved, meanwhile the tumor in the non-functional areas will be targeted and removed.[11]

1. The operation is begun with the patient asleep to ensure patient comfort.
2. The sedation is lifted slowly during the critical part of the surgery.
3. The patient is asked to talk, move and follow commands from the neurology team during the operation.
4. If stimulation hinders any of the tasks, then care is taken to avoid this area.
5. Once the tumor is removed, the physicians anesthetize the patient to allow the neurosurgeon to finish the operation.

Awake Craniotomies can be used to treat tumors and focal epileptic areas in the brain. Research studies have shown that awake craniotomy may increase the feasibility of removing the entire tumor, reduces morbidity, and increases survival.[12][13]