Report of the IBTA 2019 Fourth Biennial World Summit of Brain Tumour Patient Advocates
Neurosurgeon Dr Edjah Nduom from the National Institutes of Health, Bethesda,
A comprehensive review of state of-the-art neurosurgical approaches was
Maryland, USA
described by Dr Nduom
DR Edjah Nduom is a neurosurgical oncologist in the Surgical Neurology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) at NIH. He gave delegates an overview of what is new and exciting in the field of neurosurgery. Dr Nduom began by reviewing the standard treatment for glioblastoma, before moving on to the role of surgery in the treatment of brain tumours.
“It’s very rare that a patient shows up in the Emergency Department and immediately needs surgery within 24 hours,” said Dr Nduom. “In most cases there is time to match the patient with the right surgeon.” He explained that initial patient management often involves dexamethasone, a corticosteroid (for reducing swelling the brain due to the tumour) and anti-epileptic drugs for patients who have experienced a seizure (there is no good data to support seizure prophylaxis before surgical resection), before referring the patient to a high-volume centre for surgical management.
What are the reasons for surgery? Dr Nduom explained that the main reasons to perform surgery on brain tumours are: to find out what to treat, to cure the disease (for benign lesions), to safely reduce the amount of disease, and for clinical trials. “Neurosurgery can cure some benign tumours completely, while radiation and drugs can be more effective on less disease,” said Dr Nduom.
Who should perform surgery on CNS tumours? Dr Nduom said that the field of neurosurgery in the US has changed and board certification is now divided into subspecialties such as tumour, spine, vascular, trauma/critical care, functional and pediatrics. Even brain tumour surgeons can be sub subspecialised, for example, glioma/intra-axial tumour surgeons, open skull base surgeons, anterior/endoscopic skull base surgeons and spine tumour surgeons.
How is surgery performed on CNS tumours? Dr Nduom explained: “We aim for maximal safe resection. The patients should be closely the same as they were before they came into the hospital for surgery.” New technological advances and techniques are assisting the neurosurgeon in achieving maximum resections and better outcomes.
Frameless stereotactic neuronavigation Frameless stereotactic neuronavigation uses a set of computerassisted technologies to guide the neurosurgeon during surgery and can be described as “GPS for the brain”. This is now coming close to the standard of care in the United States where it is available at most centres.
Intraoperative Neuromonitoring Intraoperative neuromonitoring procedures include: cortical mapping, subcortical mapping and continuous EEG. “Neuromonitoring is very personnel heavy but actually not expensive,” Dr Nduom remarked.
Intraoperative Imaging The brain often shifts during surgery. Intraoperative ultrasound and intraoperative MRI create real time images during the surgery, giving the surgeon the most accurate information throughout the procedure. In intraoperative MRI set ups, the neurosurgeon is performing the operation inside the MRI coil. However Dr Nduom said very few centres have intraoperative MRI and his centre uses 57