Clifford Solomon, MD answers frequently asked questions about neurosurgery and brain tumors.
Dr. Solomon is a spine and neurosurgeon, director of the UM Baltimore Washington Spine and Neuroscience Center and clinical assistant professor of neurosurgery at the University of Maryland School of Medicine.
What is neurosurgery?
A neurosurgeon is a doctor who went to college, then four years of medial school then 6-7 years of post college training to be come a neurosurgery-- you do about grade 27 school. After those years, you have the ability and the privilege of being able to operate on people, on the brain and spinal cord, and take care of problems that affect the brain, spinal cord, and nervous system, to help people feel better, hopefully cure them, and improve quality of life and prolong life.
These are patients who have problems--either tumors or degenerative problems. Some they are born with. These problems impact their daily life--whether they can't see--we recently had a patient with a brain tumor where they couldn't see. We carefully took the brain tumor off the nerve to the eye. A lot of people come to see me who have arm or leg pain. When they've exhausted conservative measures -- my feeling is that the best surgery is no surgery--and aren't getting better. we can take pressure off a nerve. And hopefully they'll feel better quite quickly and be able to go on with their life.
How are brain tumors different from other tumors?
Brain Tumors are different than any other tumor in the body. If you have ea tumor in your arm, that tumor may be cancerous or benign. And there, it's very clear cut. But you can have a tumor in the brain that's not a cancer, and yet it' deep in the brain--I had someone recently that came from Ecuador with a young girl with a deep-seated tumor in the brain stem. The tumor itself was benign, but where it was, you could say it was malignant. It was extremely dangerous to get to it, so dangerous that everybody said she was going to die from it. She had previous surgery in her home country, and we were lucky to sneak in to the brain, take it out, and she woke right up and her symptoms were gone.
The terms "benign" and "cancerous" are very different when it comes to what we do in neurosurgery. Even a benign tumor in the spinal cord or brain, just by location, can be very treacherous. The good news is a lot of tumors we take out as neurosurgeon are benign. Unfortunately, some tumors are malignant, and even if we do a beautiful job taking the tumor out, patients sometimes need other therapies and the tumors may come back. That's why there's so much emphasis now on research and trying to figure out how to cure these cancerous tumors. It's always a wonderful day when we take out a benign tumor and the patient is cured.
What are the risk of brain surgery?
Benign brain tumors sometimes are in the brain or spinal cord in an area that's easy to get to. Then the question is, is the tumor or mass bothering the patient. If it's not doing anything to somebody daily, I tell patients the best brain surgery we do is no brain surgery. But if it's a tumor that's taking up mass or space and putting pressure on structures, we often recommend it comes out. Or if the tumor is growing on repetitive serial scans. In the old days, we didn't have a way to image the brain so well, but now we have a beautiful way to monitor tumors.
I'm a very conservative surgeon, very un-knife happy. My feeling is if something is in someone’s brain or spinal cord and starts to grow, and they have a lot of life in them and are young, we should sneak in and take the tumor out. The idea is, the patient goes home quickly and get on with their lives.
How can neurosurgery help people with Parkinson's Disease?
There are other things we do in neurosurgery that help people with very disabling conditions. Parkinson's is a disease of the brain where the nerves just don't work right in regulating your hand motions, your leg motions, your speech. People present with a mask face, their hands has a prolonged tremor all the time. Patients may get rigid when they walk, their minds aren't as sharp,. Neurosurgery lately has come up with wonderful breakthroughs with patients who have failed medical therapy. Medicines haven't resolved their tremors. Sometimes, we can go into the brain and insert an electrode attached to a box. The box gets hidden under the skin, and when it is turned on, the patient's tremor is remarkably reduced or gone. Patients can feed or clothe themselves, or can walk beautifully. It's quite remarkable, though it's not a cure-all. It's for people with the worst of the worst of the disease, but its remarkable to see when this procedure is done.
What is Deep Brain Stimulation?
Deep brain stimulation is the ability to take a wire and put it deep into the brain very precisely, very gently to stimulate the brain. Many years ago, there were procedures done to oblate or destroy parts of the brain. That never sat well with people, breaking the brain to fix it. This idea is to stimulate the brain to stop a problem, like Parkinson's disease. We can put a deep brain stimulator into the thalamus, a deep structure within the brain, a kind of waste station, for movement. When the stimulator is turned on, the tremor will go away. Deep brain stimulation has been used for depression, and in trials for severe pain. It's a huge thing to have someone go through brain surgery, but for pain that is devastating, these kinds of procedures can have amazing results.
What are the latest developments in brain surgery?
Neurosurgery is really seeing a renaissance in medicine. Neurosurgery has always been fascinating, since its roots in Baltimore at Johns Hopkins. Neurosurgery has gotten so precise with such high-tech equipment, that if you marry the equipment with high touch approach, the results you can get are incredible. We can do brain surgery where the tumor is in a very eloquent area of the brain--an area that controls speech or motor, where harm could be done if we're not extremely careful. Now, the way we do these surgeries if a patient has to have surgery in a dangerous area, we will do the surgery awake. For the right patient, it's amazing that it doesn't hurt. There are very few parts of the procedure that cause pain, and the brain itself doesn't have pain fibers on it.
When we make our entry into the brain, that can hurt, and we make sure we numb the patient. Patients tolerate these procedures amazingly well. We do more of these every year, getting patients from all over the world. The idea is to sneak in with them awake, talking to the neurologist and doing tests while we take out the tumor. That way, we can do it in the safest way possible.
The other technology that's coming rapidly is interoperative MRI. That's the ability to do brain surgery when we have an MRI scan right after the surgery is done, at the same time, in the same place. We take out the tumor, you go into the MRI scanner in the operating room, take a picture to prove the tumor is gone, and be done. That technology is rapidly approaching and will be here as a wonderful technology for patients to enjoy.