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David N. Louis, MD
Chief, MGH Pathology
Pappas Center @ MGH
Neuro-Oncology @ MGHNeurosurgery @ MGHNeurology @ MGHRadiation Oncology @ MGH
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INNOVATIONS IN TECHNOLOGIES, TECHNIQUES AND TREATMENTS FOR BRAIN TUMORS

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A SHARPER IMAGE FOR SURGEONS

“More accurate imaging is one of the major advances in brain tumor surgery over the last decade,” says Robert Martuza, MD, chief of the Department of Neurosurgery. “Preoperative and intraoperative imaging with PET, CT and MRI scans can now anatomically define tumors for surgeons, showing exactly where they are and how they relate to blood vessels, nerve fibers and brain functions.” With the new generation of MRIs, which show changes to blood flow in response to brain activity, for example, “when the patient wiggles a finger or a toe, you can see the part of the brain that lights up. Or when the patient says a word, you can see which part of the brain is used.” Innovations in image- and computer-guided surgeries allow neurosurgeons to remove the tumor without damage to the patient’s functioning brain circuits.
 
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One surgical innovation made possible by improved technology is endoscopic cranial base surgery, a minimally invasive technique. It is performed at only a few centers in the country, including at the Cancer Center by neurosurgeon William Curry, MD, of the Cranial Base Tumor Program, a subspecialty group within the Pappas Center. Cranial base tumors are especially challenging, explains Curry, because they are located at sites where critical and delicate blood vessels, nerves and brainstem tissue are closely packed, surrounded by thick bone. A tumor in this area often encases these arteries and nerves, compounding the complexity of removing it.
 
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Minimally invasive cranial base surgery takes advantage of natural pathways into the body, such as the nasal opening, to avoid making a large incision. The surgeon inserts an endoscope — a small tube with a powerful light, camera and magnifying lenses — through the nostrils, and video monitors display a detailed image of the patient’s anatomy.
 
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This approach, which Curry performs with head and neck cancer surgeons from the Massachusetts Eye and Ear Infirmary, may be safer than traditional open surgery for some tumors and shortens the patient’s recovery period.
 
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.Curry recalls one patient, a 52-year-old program manager,who had been treated for a skull base tumor several years ago. When the patient began to experience double vision and other neurological problems, several surgeons near his home in Virginia told him that his tumor had returned and was inoperable.
 
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Curry evaluated the patient earlier this year and found a tumor the size of a tangerine. “We used an endoscope and, without making a single incision, removed about
80 percent of the tumor,” he says. “We were able to take the pressure off his cranial nerves, including his optic nerves, and prevent him from losing his vision. He was ready to go back to work in two weeks.”
 
William Curry, MD, (left)
and Robert Martuza, MD
 
“We were able to take the
pressure off his nerves and
prevent him from losing his
vision. He was ready to go
back to work in two weeks.”

MOLECULAR GUIDES TO DIAGNOSIS

Accurate biopsy diagnosis is essential for the management of brain tumors since different types of brain tumors are treated in different ways. Specialized neuropathologists from the Massachusetts General Hospital Pathology Service interpret biopsies at the Cancer Center to ensure these tumors are attacked with the most effective combination of surgery, radiation and drugs. The pathology department also serves as a consultation center for the diagnosis of unusual tumor specimens from around the world. “It is exciting that our depth of expertise in traditional biopsy interpretation is now complemented by remarkable strengths in molecular diagnosis,” says David N. Louis, MD, chief of Massachusetts General Hospital’s Department of Pathology and Benjamin Castleman Professor of Pathology at Harvard Medical School. Many novel methods now enable pathologists to look directly at abnormal chromosomes and genes in tumors.
 
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Mass General pathologists were the first to show that brain tumors could be more precisely diagnosed through the examination of molecular features, and the first to demonstrate that molecular differences could guide therapies. Delivery of new smart drugs that target a specific molecule will require precise biopsy analysis to determine which drug will have the greatest chance of destroying a tumor. A new laboratory at the Cancer Center and Pathology Department enables widespread testing of tumors for such molecular changes.
 
Advancing the Specialized Care of Individuals with Brain Tumors
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APPOINTMENTS & REFERRALS

MGH Brain Tumor Center
Yawkey Building 9th Floor
Boston, Massachusetts,  02114
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Patients & Families with questions about referrals, consultations or appointments may contact:
Telephone: 617.724.8770
Fax: 617.724.8769

PHYSICIANS' INFO SERVICE

Physicians with
questions may contact:
Tracy Batchelor, M.D.
Executive Director,
MGH Brain Tumor Center
 
Harvard Medical School
Mass General Hospital
MassGeneral.org
MGH Cancer Center
NS @ MGHNS Diagnosis @ MGH
Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreement." See also: the MGH Disclaimer, the MGH Privacy Policy, and the MGH Interactive Program Disclaimer - Copyright 2008 MGH Neurosurgical Service - All Rights Reserved. System Info Contact: C.Owen
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