Brain Tumor Treatment: Remarkable Capabilities and Care.

When your patients are diagnosed with brain tumors, they may be fearful or confused about what comes next. The good news is that Novant Health’s neurosurgery experts offer new, advanced treatment options that use minimally invasive techniques — and allow for precision care, customized to each patient.

For primary and secondary brain tumor types, our neurological surgeons are equipped to provide a variety of treatment approaches including surgery, radiosurgery, ultrasonic aspiration and laser ablation.

“We treat all brain tumors,” said Ziad Hage, MD, head of cerebral neurovascular surgery at Novant Health Presbyterian Medical Center for the Charlotte region. “Anything from simple to highly complex, skull base tumors.”

There is one rule of thumb in brain tumor surgery: maximal safe resection. “We want to achieve the most tumor removal while preserving patient safety,” said Dr. Hage. “All tumors can be removed completely, but we don’t want to do that if it causes new damage to the patient. This is where balance comes in.”

“We balance minimally invasive and maximally effective,” said Gregory Imbarrato, DO, neurosurgeon at Novant Health Presbyterian Medical Center. “We map out every surgery using three-dimensional navigation techniques with the MRIs or CT scans we have for patients, to get to the tumor in the least invasive way possible.” Partnering with the Novant Health neurological surgery team to care for your patients with brain tumors means compassionate, innovative treatment. Here are just a few of the key aspects of the team’s approach.

Preoperative tumor embolization

Dr. Hage: “If a tumor needs to be removed and the only way to remove it completely would be to sacrifice a blood vessel, that would lead to stroke. We can create a bypass to bypass that vessel so the area it supplies is not devoid of blood. So, we perform a bypass to make it safe to remove the tumor.”

Tumor assessment in the OR

Dr. Hage: “We’ll make the decision whether to use an ultrasonic aspirator in the OR as soon as we expose the tumor. When a hard tumor is exposed, the device pulverizes the tumor and allows us to suction it instead of having to cut through it with a knife. If it will add ease and make the surgery safer, we will use it. If the tumor is soft and easily removable, we may not.”

Highly targeted stereotactic radiosurgery

Dr. Hage: “Radiation depends on what type of tumor we’re dealing with, once the tumor is removed and sent to the lab for analysis. If it’s metastatic cancer, we will have to radiate the tumor bed even if we remove the entire tumor. Or, if some tumor has been left behind, radiation is needed. We use a machine to deliver radiation with focused accuracy at just the site that needs to be radiated. We do this in conjunction with our radiation oncology team. We help them plan, determining exactly where to deliver the radiation, because we don’t want to radiate areas that don’t need it.”

Endoscopic endonasal surgery to remove anterior, skull base tumors

Dr. Imbarrato: “We have a great relationship with an ENT provider who does a lot of anterior, skull base work through the sinuses. Through that, we’ve taken out huge tumors without an incision. It’s all endoscopic and endonasal. Using cameras, we go through the nose and dissect through those passageways and remove the tumor that way.”

Open communication with patients and strong collaboration with providers

Dr. Imbarrato: “There’s so much more to being a good surgeon than techniques. We communicate with patients and providers to help the patient decide the best decision for their healthcare. We ask for and welcome other providers’ input pre-op and post-op. Sometimes masses are more appropriate for radiation or medication, so this collaborative approach helps to maximize good outcomes and minimize the chance of complications.”

Collaboration with the whole care team from pre-op to post-op

Dr. Imbarrato: “I’m proud of what we’re able to do as a team from the preoperative side of things with office care, all the way to postoperative care. We can’t do anything without the solid core of our team. They help to minimize the chance of complications and help to give patients a level of comfort as we proceed through surgery.”