BSSNY surgeons discuss therapies and strategies for treating brain tumors

More than 84,000 Americans will be diagnosed with a brain tumor this year, according to the American Brain Tumor Association. While that may sound like bad news, there’s also some good news to balance it out.

First, the overwhelming majority — about two-thirds — of brain tumor diagnoses are benign. Second, even for people who find out that they have a malignant brain tumor, there are more options for treatment and removal than ever before.

Centers of excellence like Brain and Spine Surgeons of New York (BSSNY) are not only offering the most cutting-edge treatments in the field, but are also breaking ground by exploring creative new ways to make treatments such as chemotherapy more effective.

BSSNY surgeons Dr. John M. Abrahams and Dr. Peter Costantino discussed some of the latest technology and treatments.

A fast-paced field

While working with brain tumors is incredibly difficult and delicate, the field has made a lot of progress in the past few decades alone, Abrahams said.

“Twenty years ago, we were convinced we had to take out every piece of a benign brain tumor, but with radiation therapies being so efficient, you can stop the surgery, leave a little bit and rely on other modalities to help cure the patient,” he said.

For example, BSSNY doctors use a radiation therapy known as the Gamma Knife® to effectively target any part of the tumor that remains.

Another major advance in the field is the use of 5-ALA, a liquid solution that patients swallow before surgery. The solution causes the brain tumor to light up in a fluorescent pink color under specialized lights, making it easier for surgeons to remove the tumor without unnecessarily removing any healthy tissue.

Breaking barriers

In one of the newest efforts to push treatments even further, BSSNY’s Costantino will perform the first ever human surgery that will enable chemotherapy treatments to circumvent the “blood-brain barrier.” In healthy people, the barrier plays a critical role in preventing harmful toxins from reaching the brain. In people with brain tumors, though, the barrier gets in the way of chemotherapy treatments targeting the tumor.

Costantino described the ambitious and innovative surgical process and explained how its success could mark a new era for treating malignant brain tumors.

“Glioblastomas are a type of brain cancer that over time is always fatal due to our inability to treat them with chemotherapy drugs because of “the blood brain barrier”.  We have devised the only study that removes a very special tissue from the abdomen, called omentum.  We then take the omentum which has both immune active cells and blood vessels without a barrier, and then fill the glioblastoma tumor cavity after the cancer has been removed,” Costantino  said.

“The blood vessels that feed the omentum are then connected under a microscope using stiches half the diameter of a human hair to vessels in the neck to keep the omentum alive.  After healing we will give chemotherapy through those same vessels, allowing the drugs to get past the blood brain barrier and hopefully kill the glioblastoma cells within the brain.   With this technique, for the first time we'll be able to infuse chemotherapy right into the brain tumor sites.”

The first-of-its-kind operation has the potential to dramatically improve chemotherapy options for brain tumor patients.

Choosing the right specialist

One of the most common misconceptions about brain tumors is that if the tumor is serious, it has to be removed immediately. That leads people to incorrectly believe that they don’t have enough time to research the best doctors that can perform the most up-to-date treatments.

“If you end up in an emergency room and they identify a brain tumor, very rarely do you need to be operated on that day or the next day,” Costantino said. 

That can give patients time to do critical research to find the specialist that can offer the best options for a patient’s specific circumstances.

“You need to go and do your homework, and search out those locations for your specific type of tumor that can provide the best care. It can make not only a huge difference with your ability to survive the tumor, but also your level of function and your physical appearance,” Costantino said.

At BSSNY, for example, Abrahams and his colleague Dr. Alain de Lotbinière specialize in adult brain tumors, Dr. Avinash Mohan and Dr. Michael Tobias specialize in pediatric brain tumors, Costantino specializes in tumors at the skull base, and Dr. Ched Nwagwu specializes in endovascular surgery.

Patients should also keep in mind that choosing a practice with specialists in multiple areas also allows them to benefit from the practice’s collective expertise and from the possibility for specialists across disciplines to work together to improve outcomes.

“With some of these tumors, we now go in with a catheter and block the feeding vessels to the tumor, which make it easy to take out. Then we have access to the Gamma Knife at Northern Westchester hospital, and that allows us to help with any residual tumor,” Abrahams said. “We’ve really put together all the pieces.”

Learn more about multidisciplinary approaches to treating brain tumors by visiting Brain and Spine Surgeons of New York.

Members of the editorial and news staff of Paste BN Network were not involved in the creation of this content.