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Thanks so much for joining me today.
We're talking about malignant brain tumors, and I'm happy you could help
me to understand when is surgery indicated for that diagnosis?
>> Well thanks for having me.
So surgery really is the primary treatment for nearly all individuals
who have been diagnosed with the malignant brain tumor.
The goal of surgery would be two fold,
first to obtain a diagnosis understand exactly what type of
malignant brain tumor we are dealing with and secondly to try to take out
in most cases as much as we can as safely as possible.
The surgical options range from everything from a needle biopsy,
where we take only a very small piece of the tissue, purely obtained
diagnosis, to much more intricate surgeries, such as awake craniotomy,
where we keep the patient awake during tumor resection to maximize
the extent of our tumor resection, as well as to ensure that
the patient's neurological function is preserved during surgery.
>> Is surgery usually performed in conjunction with other treatment
options?
>> Typically not.
Usually at the time of diagnosis, surgery is performed with the goal,
again, of obtaining a diagnosis.
But in rare cases, in a certain subset of brain tumors,
we are able to place chemotherapy wafers,
the technology that has been developed here at Johns Hopkins,
by the chairman Henry Brown several years ago,
in which we are able to deliver chemotherapy at the time of surgery.
But this is only for a subset of patients.
>> What types of surgical options are there and when are they used?
>> So, the exact surgical option is gonna be tailored
to the needs of the individual patient.
This really can span the gamut from a needle biopsy to awake craniotomy
to intraoperative MRI, all approaches that are gonna be based
on where the tumor is located and what the patient's symptoms are and
to try to maximize safe surgery for that patient.
>> You mentioned intraoperative MRI.
There are number of technologies that are available here at
Johns Hopkins that help you with surgery, aren't there?
>> Absolutely, and that's really been one of the biggest advances
in the treatment of malignant brain tumors over the last ten years.
This is our ability to understand the brain better before going into
the surgical field and that includes preoperative imaging,
preoperative neuropsychological testing, intraoperative
tools that allow us to define the boundaries of the tumor,
as well as our ability to maximize extent of tumor removal.
And this is really all in place to allow us to do safer and
more effective surgery for our patients.
>> What would you say is the most important thing or things people
should consider when they choose where to have treatment for
malignant brain tumor?
>> Well this is a very important consideration.
The number one consideration in my mind is
the relationship between the patient and
the providers that that individual is gonna be interacting with.
That includes the surgeon, anesthesia doctors, ICU team as well
as medical oncologist and radiation oncologist in many cases and
having a relationship that's comfortable and reassuring is very,
very important.
A second point to consider would be what is the experience of the team
that's taking care of you?
All there vast number of patients treated at these centers?
I think that's important because, thankfully, malignant brain tumors
are in the realm of rare diseases, rare tumor types.
So having a center that has vast experience is gonna be very,
very important.
>> You've told me, of course, that treatment is highly individualized.
But I wonder if you can just offer some
ideas about what surgery will be like recovery time.
>> That's also very important question.
Typically, after surgery, which can last anywhere from two to four hours
in most cases, patients are watched in an intensive care unit and
amazingly, most patients can actually leave the hospital two to
three days after surgery.
Vast majority of whom were able to regain normal neurological function
and able to assume the next level of care as determined by the exact
diagnosis.
>> And again, to emphasize the individual nature of this I
understand, but what about prognosis for different types?
>> That's certainly the most challenging question
that we get on a daily basis.
It all depends on exact sub type of tumor that we're dealing with.
There are certain malignant brain tumors that we've made incredible
advances in where we're able to cure a large fraction of those patients
with that type of tumor.
There are also other tumor types that unfortunately we haven't made
such progress yet.
But that doesn't mean there's no hope, it just means that we have to
be very thoughtful and collaborative in the decisions that we
make to help all these patients as best as we can.
>> Thank you so very much.
>> Thank you for having me.
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