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On Cancer: Memorial Sloan Kettering Experts Discuss Awake Surgery for Brain Tumors

By Allyson Collins, MS, Science Writer/Editor  |  Monday, May 6, 2013

The multidisciplinary team of experts at Memorial Sloan Kettering’s Brain Tumor Center is among the most experienced in the world, providing treatment options for all types and grades of brain tumors, including the use of innovative surgical techniques.

For some patients with brain tumors located near areas of the brain related to speech or movement, our experts perform surgery while the patient is awake during portions of the procedure.

“Doing awake surgery gives the surgeon and the patient a safety margin, so that we can continue to remove the tumor while confirming that the patient is well and capable of having normal conversation and movement,” says neurosurgeon Viviane Tabar.

Prior to surgery, a functional MRI is performed, which helps guide neurosurgeons during the procedure.

“Functional MRIs, unlike structural MRIs, show functional regions like language areas and motor areas in the region of the tumor,” explains Nicole Brennan, a functional MRI specialist. “We bring those maps into the operating room to guide the surgeon during the awake procedure.”

Doing awake surgery gives the surgeon and the patient a safety margin, so that we can continue to remove the tumor while confirming that the patient is well and capable of having normal conversation and movement.

-Viviane Tabar, neurosurgeon

During the awake surgery, sedative medications allow anesthesiologists to bring patients in and out of consciousness, so patients can speak and move at the appropriate times.

Often, surgeons ask patients to count or name objects, which allows them to map the speech areas of the brain. They also stimulate the brain and watch movements of the arms and legs to map the motor regions. This allows surgeons to plan a path to the tumor that will protect critical functioning.

In the operating room, our experts use surgical navigation – similar to a GPS for the brain – and an MRI scanner.

“The role of the intraoperative MRI is to give us an updated map during surgery,” says neurosurgeon Cameron W. Brennan. “The system is remarkably precise.” The intraoperative MRI ensures that as much of the tumor is removed as possible, and that the motor and speech areas are protected.

“I love operating on difficult tumors and getting them out, but I enjoy interacting with patients the most,” says Philip H. Gutin, Chair of the Department of Neurosurgery.

“I like to look patients straight in the eye after the procedure and tell them that the job was well done, and that this hurdle is behind them,” Dr. Tabar says.

Comments

In 2001, I was diagnosed with stage IV brain cancer and had a glioblastoma multiforme removed from my brain. Dr. Tabar was my neurosurgeon. Thanks to her AMAZING abilities, a functional MRI, and God, I am still here almost 12 years later. Although my tumor was very close to my speech center, I am still able to speak and process information successfully. I Thank God, MSKCC, and Dr. Tabar every day for my health and happiness!

I was diagnosed with lung cancer in 2004 which spread to my brain in 2007. I had whole brain radiation and then surgery. Dr. Gutin was wonderful. Before the surgery he he explained the process and with his comforting demeaner he made me feel as comfortable as a person can be who is about to have a hole drilled in his head. I would like to thank everyone at Sloan for not only saving my life but for the manner in which I was treated. They made a difficult time much easier.

As a 10 survivor of NHL, having a auto-transplant in 2002, am keenly aware of what miracles the good doctors at MSKCC perform.

Dr Philip Gutin performed 2 life extending surgeries on my late sister-in-law Kathy Lemeir, allowing her to spend the much appreciated time with her children and family members.. While her passing on March 7, 2012 was truly a sad time for the family, I remember Kathy's effervescence soon after surgery. We all were amazed she was cognizant of her surroundings and able to converse with family members. Dr Gutin was very kind and professional, explaining the procedure and the diagnosis and the treatment to follow.. We are forever grateful to the doctors and the staff at this World Class Facility... June Fairhurst Fay-Cancer Survivor

I am interested in this discussion. Thank you.

My son 38 has been diagnosed with left lobe tumor 5.3 cm. diagnosed Sunday 13th of April still waiting I for biopsy results.
He is the perfect picture of health, Body trainer, does not drink, smoke, does not drink not even coffe.
I suppose i would like to hear positive, what could be done, the biopsy was done at NYC University hospital.

Berit, if your son would like a consultation at Memorial Sloan Kettering, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information on how to make an appointment. Thank you for your comment.

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