Surgery is generally the first treatment step for a brain tumor and often the most important and technically challenging aspect. The pathology of the tumor is then analyzed to help guide the next stages and develop a management plan with the neuro-oncologist and radiation oncologist. The goal of surgery is to remove as much of the tumor as possible without injuring nearby critical brain tissue. Surgical options at Capital Health include both traditional open surgery and minimally invasive approaches. The minimally invasive approaches utilize procedures such as awake brain surgery where patients are awake and able to be assessed by the team during surgery. For deep seated tumors, specialized ports can be inserted deep into the brain to access tumors that are not able to be removed by traditional methods. This minimally invasive technique uses advanced MRI imaging to choose the best suited corridor into the tumor.
Surgery is assisted by intra-operative surgical navigation which allows for a smaller and more directed surgical approach. Benefits of this kind of surgery can include less potential injury to brain tissue and a faster recover due to the less invasive nature of the procedure. Dr. Redjal also has extensive experience in traditional open surgery, including awake craniotomies using cortical mapping, when minimally invasive approaches are not an option.
Our neurosurgical team uses brain mapping techniques, working with our neuro-radiologists, to first map and then avoid, as much as possible, critical areas of brain function during complex tumor surgery. This can include functional MRI (fMRI) which detects blood flow to certain areas of the brain while tasks are performed and advanced white matter imaging utilizing diffusion tensor imaging (DTI) which helps determine how fibers are connected in the brain. These techniques help identify critical activity areas of the brain which control things like language and motor function. This information helps our neurosurgical team work to steer clear of them while resecting or removing the tumor since these images can be imported into the surgical navigation computer used during surgery.