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Metastatic Brain Tumor Surgery in New Jersey

Profile of Neurosurgeon Dr. Raab, an expert in metastatic brain tumor surgery and treatments

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enters for Neurosurgery, Spine & Orthopedics (CNSO) has extensive experience treating metastatic brain tumors and spine tumors performing both open and minimally invasive brain surgery. Located in northern New Jersey, CNSO is the state’s most comprehensive brain and spine care center. Learn more about metastatic brain tumors and what patients undergoing brain tumor surgery should expect.

What Is a Metastatic Brain Tumor?

A metastatic brain tumor is a type of malignant (cancerous) tumor that spreads from other parts of the body. This is also known as secondary brain cancer. Brain metastases are one of the most common types of brain tumors.

Diagnosis and Staging

Cancer in another part of the body can travel through the bloodstream or lymphatic system, eventually developing into tumors in the brain. One of the most common causes of brain metastases is lung cancer, but other common primary cancers are breast cancer, kidney cancer, and melanoma.

Metastatic Brain Tumors Symptoms

Signs and symptoms of a metastatic brain tumor can include:

  • Chronic or severe headache
  • Fatigue
  • Difficulty with coordination or balance
  • Memory loss
  • Changes in personality or behavior
  • Seizures
  • Vision problems
  • Nausea or vomiting
  • Numbness or tingling feelings

Symptoms can vary based on the location of the tumor and the part of the brain it is affecting.

Diagnosing Metastatic Brain Tumors

Typically, several tests are used to confirm a diagnosis of brain metastases:

  • Imaging: Pictures of the brain usually are generated through an MRI, although providers may also rely on a CT scan or PET scan to study the tumor.
  • Neurological exam: A healthcare provider will test a patient’s vision, hearing, balance, coordination, and reflexes to assess how a tumor is affecting them.
  • Biopsy: A biopsy can be performed as a standalone procedure or during surgery to remove a brain tumor. This helps determine whether the tumor is malignant or benign.

Staging

Unlike other types of cancer, metastatic brain tumors are not assigned a stage or grade. However, an oncologist may assess brain metastases using the TNM system (tumor, node, metastasized). Because metastatic brain tumors develop when cancer spreads from other parts of the body, they are secondary (not primary) brain tumors. They typically develop in the upper part of the brain, known as the cerebrum, but can also appear in the cerebellum. Metastatic brain tumors are more common than primary brain tumors. Additionally, secondary brain tumors are always malignant, whereas primary brain tumors can be malignant or benign (non-cancerous).

The goal of treatment for brain metastases is to slow tumor growth, relieve the patient’s symptoms, and extend their life. Treatment options include:

Treatment plans are personalized to each patient and will depend on tumor size, symptoms, and the patient’s overall health. Even with treatment, metastatic brain tumors can come back.

Preparing for Surgery

A patient may be a good candidate for surgery if the brain tumor is located in a place that is accessible and can be removed without damaging surrounding brain tissue. If tumor resection is the best option, a patient will have several tests and preoperative appointments before being cleared for surgery. At CNSO, they will work with a multidisciplinary team of specialists that includes oncologists, neurologists, and neurosurgeons. The medical team will explain the risks and benefits of surgery and answer any questions the patient has about the procedure.

Surgical Techniques

Metastatic brain tumor surgery may be performed using a traditional (open) or a minimally invasive approach. Imaging tests will help neurosurgeons develop the surgical plan.

Traditional Open Surgery

A common surgical approach for removing metastatic brain tumors is a craniotomy. In this procedure, a neurosurgeon makes an incision in the patient’s scalp and temporarily removes a small piece of bone from the skull to expose the brain. They remove as much of the tumor as they can and then replace the bone flap and close the incision after the surgery is complete. The location of the incision will depend on where the brain tumor is located. Craniotomies are performed under general anesthesia.

Minimally Invasive Approaches

Instead of open surgery, some patients can be treated with minimally invasive surgical techniques, such as a keyhole craniotomy. In this procedure, the neurosurgeon makes a small incision behind the patient’s ear. This option is a good fit for tumors located near the base of the skull.

Another minimally invasive approach is a supra-orbital craniotomy, which accesses the brain tumor through an incision in the eyebrow. Because this technique uses an incision that is less than two centimeters, the patient has less bleeding and scarring. Additionally, both types of minimally invasive procedures often result in less post-operative pain and shorter recovery times. However, these approaches limit the parts of the brain that can be accessed, so they are not a fit for every patient with metastatic brain tumors.

Radiosurgery

Metastatic brain tumors are often treated using stereotactic radiosurgery, such as Gamma Knife surgery. This is a type of focused treatment that directs a high dose of radiation at the tumor while minimizing radiation exposure to the rest of the brain. Radiosurgery is an option for treating small tumors that are not easily accessible through open surgery.

The location and size of the brain tumor will help determine whether craniotomy, minimally invasive surgery, or radiosurgery is the best option. If a patient has multiple brain metastases, their neurosurgical team may use more than one approach, such as a keyhole craniotomy for larger tumors, and stereotactic radiosurgery for smaller lesions.

Intraoperative Procedures

The primary purpose of metastatic brain tumor surgery is to remove as much of the tumor as possible – a process known as tumor resection – without harming the normal brain tissue that surrounds it. However, surgery also offers an opportunity to biopsy the brain tumor so that it can be analyzed by a pathologist. Although imaging tests can give a provider relative confidence in the presence of brain metastases, a biopsy is the only way to definitively diagnose that a brain tumor is cancerous. The results of the biopsy can help inform future surgeries or other forms of treatment.

To minimize the risks associated with operating on the brain, a neurosurgical team will use several types of medical technology during the procedure. First, they will rely on intraoperative neurophysiological monitoring (IONM) to ensure patient safety. IONM helps map the structure of the nervous system to prevent damage to healthy brain tissue and preserve functionality as much as possible. Of course, other vital signs will be monitored throughout the surgery as well, including pulse, respiration, and blood pressure.

Next, the surgical team will use image-guided technology to help navigate the brain and pinpoint the tumor. This is known as intraoperative magnetic resonance imaging (iMRI). Traditionally, imaging tests were performed beforehand to help medical teams develop surgical plans. Now, imaging tests are used during the operation to provide real-time information without needing to move the patient. The iMRI allows neurosurgeons to:

  • Obtain accurate, real-time pictures of the brain
  • Locate tumors with more precision, even if the brain shifts during surgery
  • Distinguish cancer cells from healthy tissue
  • Protect crucial brain structures
  • Improve resection accuracy

Shorten the patient’s recovery time

Complications and Risks

Brain surgeries are carefully planned and monitored to minimize the risk of damage to critical structures. However, any type of surgery carries a degree of risk. Potential complications of metastatic brain tumor surgery include:

  • Infection
  • Blood clots
  • Swelling
  • Bleeding inside the brain
  • Reactions to anesthesia
  • Seizures

The biggest concern is the potential loss of brain function. This is why surgery will be very carefully planned so the tumor is removed as safely as possible without damage to surrounding healthy tissue. To reduce the risk of post-operative swelling, most patients are given corticosteroids after surgery. The patient also will follow a post-surgical rehabilitation plan to help them recover.

Recovery and Rehabilitation

After brain surgery, a patient will need to stay in the hospital for post-operative care. The length of the hospital stay can vary – some patients are discharged after a few days, while others have to stay for more than a week. Patients are closely monitored during this post-operative period and may meet with inpatient rehabilitation specialists. The patient care team will manage any side effects of the surgery and treat post-operative pain or swelling. If there is any loss of function, such as difficulty with speech or motor skills, the patient will work with dedicated rehabilitation specialists. This can include speech therapists, occupational therapists, or physical therapists. Rehabilitation may continue even after the patient has been discharged.

Follow-up and Monitoring

Because metastatic brain tumors are likely to recur, regular follow-up care is critical. These follow-up appointments can include:

  • Physical examination
  • Neurological testing
  • Imaging tests, such as an MRI or CT scan
  • Blood work

Ongoing monitoring also is important to address any emerging issues, such as new symptoms or other changes in the patient’s health.

Alternative and Adjunct Therapies

Patients with metastatic brain tumors may have other forms of treatment besides surgery. Brain tumor treatment may include:

Chemotherapy

Chemotherapy uses drugs to kill cancer cells and usually is administered intravenously. However, new advancements in chemotherapy mean these drugs can be placed directly into brain tumors using a technique called convection-enhanced delivery.

Radiation Therapy

Radiation therapy uses high-powered beams to shrink or destroy tissues. It may be used before surgery to shrink the size of a tumor, or after surgery is complete to kill off cells that could not be removed. Radiation therapy can be delivered as external-beam radiation or internally in the form of a medical implant. This is also known as brachytherapy or interstitial therapy, and it can be used to treat new or recurrent brain metastases.

Immunotherapy

Immunotherapy treatment uses drugs to change the way the patient’s built-in immune system works. Some immunotherapy treatments help the immune system target specific proteins on the surface of cancer cells, while others modulate the body’s natural immune response.

Targeted Therapy

Targeted therapy sometimes is used in place of chemotherapy because it can have fewer side effects. This drug treatment works by targeting specific genes or proteins present in tumor cells.

Some metastatic brain tumors can cause seizures or swelling, so patients also may receive oral medications to mitigate these symptoms. Cancer research is always advancing and innovating, so there may be other experimental treatments or clinical trials available to patients with brain tumors. The neurosurgical team can help assess whether a patient is a good candidate for a clinical trial.

Coping Strategies and Support Systems

Learning that cancer has spread to another part of the body can be very discouraging. It is normal to feel fear, anger, or confusion after receiving this type of diagnosis. Patients are encouraged to talk with their healthcare providers about services that can support their mental and emotional health while going through cancer treatment. This may include one-on-one counseling, joining virtual or in-person support groups, or participating in awareness and advocacy networks.

Cancer also takes a toll on the patient’s caregivers and loved ones, so family members and friends should take advantage of these resources, as well.

Advancements in Surgical Research

Innovative technologies and advancements in cancer research mean patients may be able to access treatment options that offer more precision and fewer side effects. One newer area of research is the tumor microenvironment (TME), or the cells and other structures that surround a malignant tumor. New drugs like small-molecule inhibitors are being developed that target the TME and make it more difficult for a tumor to grow. Another promising area of cancer treatment is personalized medicine, which looks at specific biomarkers in a particular patient’s genetic information to determine what types of cancer drugs may be the most effective.

Frequently Asked Questions About Metastatic Brain Tumor Surgery

Frequently asked questions regarding metastatic brain tumors and surgical treatment include:

How Long Does It Take To Recover From Brain Tumor Surgery?

Each patient is different and recovery times can vary. In general, a patient will need to stay in the hospital for a few days after brain surgery, and then continue to rest and refrain from strenuous activity at home. Complete recovery from brain tumor surgery can take six to 12 weeks.

Are There Any Non-surgical Treatments for Metastatic Brain Tumors?

Yes, metastatic brain tumors may be treated with radiation therapy, medication, chemotherapy, or other treatments. Some patients will receive a combination of different therapies. For example, radiotherapy may be used after tumor resection to destroy or shrink metastases that cannot be surgically removed.

What Are the Chances of Tumor Recurrence After Surgery?

Even after treatment, brain metastases are likely to recur. One study of surgically treated metastatic brain tumors found a 43.5% recurrence rate.

Can Brain Tumor Surgery Affect Cognitive Abilities Permanently?

Brain tumor surgery does carry the risk of complications, including problems with cognition and motor skills. Rehabilitation after surgery, such as occupational therapy, physical therapy, and speech therapy, is designed to help patients regain these functions.

Find Expert Neurosurgery at CNSO

Patients who require brain tumor surgery will find an experienced and knowledgeable team of specialists at Centers for Neurosurgery, Spine & Orthopedics (CNSO). With multiple locations throughout northern New Jersey, CNSO’s neurosurgeons use the latest advancements in brain tumor treatment, including intraoperative neuro-navigational systems and minimally invasive surgical techniques.

In addition to award-winning neurosurgeons, CNSO’s medical staff features a comprehensive team of orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists, all working together to assure appropriate care. CNSO takes a conservative approach to pain management and treatment, recommending surgery only when there is a clear benefit. Each evaluation involves the consideration of whether an evidence-based, non-invasive technique ultimately would provide the best health outcome. For more information or to schedule a consultation, contact CNSO today.

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Our Medical Staff

In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.

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