Miami, Florida (March 3rd, 2021) – Today, an estimated 700,000 people in the United States are living with a primary brain tumor, and approximately 85,000 more will be diagnosed in 2021. Brain tumors can be deadly, significantly impacting on quality of life, and changing everything for a patient and their loved ones. Gliomas are the most common type of primary brain tumor, coming in a variety of histologic subtypes and grades affecting their behavior and prognosis.
Dr. Simon Buttrick, neurosurgeon at the Memorial Healthcare System in South Florida, explains that over the past two decades it was been shown quite convincingly that the more tumor can be removed surgically the better patients do. Patients who have a complete resection have significantly better outcomes than those who only have a partial resection or a biopsy. And there is mounting evidence that a so-called ‘supramaximal’ resection – meaning complete removal of the tumor and a surrounding rim of normal brain tissue – adds further benefit.
Glioma symptoms vary by tumor type as well as the tumor’s size, location, and rate of growth. Some gliomas do not cause any symptoms and might be diagnosed when you see the doctor about something else. Common signs and symptoms of gliomas include: headache, confusion, memory loss, difficulty with balance, vision problems, speech difficulties, weakness in the arm or leg, and seizures.
Frequently, gliomas are within or adjacent to eloquent regions of the brain. Our brains are organized according to relatively constant functional patterns. One part controls motor function, one part controls visual function, one part controls speech, and so on. On top of this, many of these areas are interconnected through white matter tracts – essentially the cables of the brain. This delicate anatomy gets distorted when a glioma starts to grow, making the brain’s functional organization less predictable.
Consequently, we frequently perform awake craniotomies for these types of tumors to be able to monitor not just the anatomy but also the function of the brain in real time. With these cases, we work very closely with our chief of neuro-anesthesiology, Dr. Kavan Clifford. Local anesthesia is used to numb the scalp, then the patient is sedated and essentially sleeping for the first part of the operation, during which the brain is exposed. The patient is then gently awakened so he or she can speak to us. The brain itself has no pain receptors, which means that most patients do not feel significant discomfort. Dr. Madiley Broz, one of our neuropsychologists, then runs the patient through a battery of tests while the surgical team stimulates various areas of the brain in order to localize all the areas essential for speech or motor function.
Once the mapping is completed, we know which areas can be safely removed. The tumor removal then proceeds with the patient still awake and talking to us so that we know in real-time when we are getting close to critical structures. After the tumor resection is completed, the patient is sedated again and closure is completed with the patient asleep, affirms Dr. Buttrick.
Most of these patients recover very rapidly, as only a small amount of anesthetic is used. In fact, they can often be discharged home the day after surgery.
“I know that the day a patient comes to see a neurosurgeon is usually among the worst days of their lives. I strive to not only offer the technically best, most cutting-edge surgical treatment to help them feel better but also try to make that day just a little less traumatic and give them hope for their future,” stated Dr. Buttrick.
