Brain Tumors at Sylvester Comprehensive Cancer Center

New Developments Make Brain Surgery More Precise

Dr. Ricardo Komotar and Dr. Michael Ivan are part of a team of neurosurgeons at Sylvester Comprehensive Cancer Center, part of University of Miami Health System. For more information on brain tumors or to make an appointment, call 305-243-1000 or visit the University of Miami's health news blog.

Gliomas are the most aggressive form of brain cancer and can be difficult to remove completely, but developments in science and technology are improving the precision with which neurosurgeons can reach tumors in the brain, while minimizing risk for patients.

Under normal, white light, tumor tissue can be very difficult to distinguish from healthy brain tissue. But a chemical compound newly on the market in the U.S. is changing how neurosurgeons see tumors by lighting them up from the inside.

5-ALA fluorescence is a drug taken orally by patients a few hours before surgery. The tumor tissue metabolizes the compound at a much faster rate than the healthy tissue around it, causing the tumor to appear to glow in neon pink.

"We know from research that the more tumor we can remove, the better the chances the patient has for tumor control and survival long term," says Dr. Michael Ivan, neurosurgeon and leader of the Sylvester Neuro-oncology Site Disease Group at Sylvester Comprehensive Cancer Center, part of University of Miami Health System. "If we can ensure that all of the tumor is removed, it’s going to greatly benefit patients."

Using 5-ALA fluorescence during surgery, Dr. Ivan can switch back and forth from white light to blue light. The blue light picks up the fluorescence, allowing the surgeon to see if any tumor remains. It is an especially helpful tool for "checking your work" at the end of surgery, says Dr. Ivan. "It allows us to see that the tumor is bright pink. In many cases, it’s a very sharp border between the healthy brain tissue and where it’s pink and glowing."

A new generation of surgeons will be trained with 5-ALA fluorescence as a tool. "I think this is going to be the new way to teach how to do glioma surgery and brain tumor surgery for all of our residents and medical students," says Dr. Ivan. "In my laboratory, where we focus on brain tumor research, we're developing new ways to enhance 5-ALA and to improve its capabilities."

Dr. Ricardo Komotar, director of surgical neuro-oncology, is pioneering the use of another tool for improving precision during brain surgery. In January, Dr. Komotar used the ROSA robot to perform the first robotic assisted brain biopsy at Sylvester.

Tumors located deep within the brain can be hard to reach by conventional methods. "In these situations, the highest possible level of accuracy is critical," says Dr. Komotar. "The ROSA robot uses advanced technology to make sure the needle or the laser’s catheter is placed in the exact location that it needs to be."

Regardless of the technology, the role of the surgeon remains critical to these procedures, says Dr. Komotar. The physician chooses the entry point on the patient’s head and identifies the target. The ROSA then calculates the best trajectory for the laser’s needle to enter. The ROSA robot is an "example of how medicine is evolving," says Dr. Komotar.

Patients benefit from this minimally invasive approach because it decreases the amount of time in surgery and allows for quicker recovery. “Sylvester offers the most comprehensive tools and techniques as well as sub-specialists in the field of brain surgery,” says Dr. Komotar. “Our team and the technology available to us reduces patient complications and improves quality of life.”


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