Our Expertise & Technology

	Neurosurgeons, Philip Gutin and Mark Bilsky

Memorial Sloan-Kettering is one of a few hospitals in the country that has an intra-operative imaging suite equipped with a high-field strength magnetic resonance imaging (MRI) scanner in the operating room. Performing brain surgery in this setting allows the neurosurgeon to reevaluate the tumor with MRI during the operation, thus enabling him or her to operate with increased precision and reducing the need for a second surgery.

Frameless Stereotaxy

Frameless stereotaxy, also known as surgical navigation, is used in almost every brain tumor operation at Memorial Sloan-Kettering. Using stereotaxy, the neurosurgeon is able to plan an operation precisely and three-dimensionally without securing a rigid frame around the patient's head, which is normally required. For the patient, the advantage of surgical navigation is increased accuracy, the possibility of working through a smaller incision (since the navigation system allows the neurosurgeon to "see" the lesion relative to the surface of the head), and possibly a shorter operation.

Our Brain Tumor Center Learn about our research on primary brain tumors and metastatic tumors to the brain more

Functional MRI

Functional MRI (fMRI) is an imaging technology that attempts to identify the location of the functional areas of the brain -- such as those responsible for movement, or the generation and comprehension of speech. The exact location of these areas varies among individuals, particularly when a large tumor has developed in the brain.

Functional MRI supplements standard MRI images of the brain by indicating areas of increased activity that correspond to specific tasks the patient performs. During this type of MRI, a neuropsychologist asks the patient to tap fingers, count, or describe images. The surgeon can see which areas of the brain are activated during these tasks, and with this additional "functional" information can plan the surgery accordingly, optimizing the patient's chances for the best quality of life after the operation. The test is painless and brief and can make a difference in the final outcome.

Fusion Software

Memorial Sloan-Kettering also uses another kind of navigation system -- called fusion software -- to help the surgeon plan and execute surgery on lesions that are close to highly-functional areas of the brain, such as those responsible for movement or speech. This sophisticated software allows information obtained during functional MRI testing to be integrated into the anatomic MRI that is used for stereotactic surgical navigation. This system can also be used in surgical procedures of the spine.

Intraoperative Brain Mapping

When the tumor is in immediate proximity to areas in the brain that are responsible for movement or speech, the surgery carries an increased risk of injury to these high-performance regions. Surgeons can use a technique that provides greater "real time" accuracy than that offered by functional MRI. Intraoperative mapping allows our surgeons to identify crucially important areas of the brain during the operation, so that they can preserve them as much as possible.

	Nurse Patsey Yeo-Ramaker and Neurosurgeon Philip Gutin

By using high-energy radiation from x-rays and other sources, radiation oncology applies the principles of physics (the interaction of matter and energy) to kill cancer cells and shrink tumors. Precise (stereotactic) positioning, computer guidance using MRI scans, and other modern technologies enable radiation oncologists to deliver these high-dose radiation treatments to tumors anywhere in the brain.

Memorial Sloan-Kettering's radiation oncology and medical physics departments work together using stereotatic radiosurgery and radiotherapy to treat many kinds of brain tumors, including astrocytoma, glioblastoma, acoustic neuroma, meningioma, chordoma, and brain metastases from other cancers. Our experts from medical physics have contributed vast expertise to the design of stereotactic radiation systems.

At Memorial Sloan-Kettering, we use a highly sophisticated system known as BrainLAB for stereotactic radiation. Rather than using Gamma knife or conventional linear accelerator radiosurgery systems, BrainLAB uses mini-multileaf collimators, which shape the radiation beam in such a way as to protect healthy tissue while delivering the dosage to the cancerous tissue. Treatments with the BrainLAB system can be accomplished on an outpatient basis.

This treatment is now being combined with various chemotherapeutic drugs targeting newly discovered mechanisms in cancer cells in an attempt to sensitize tumors to the radiation beam.