Clinical subspecialties

Neurosurgery

Surgery is usually required to establish the diagnosis of a brain tumor. It is also provided to alleviate symptoms of bleeding, spinal fluid flow obstruction, or to halt tumor-associated seizure activity. Surgery can be curative of brain tumors such as meningioma, acoustic Schwannoma or pituitary adenoma.

Biopsy

A tissue diagnosis of a brain tumor is usually required before a treatment plan can be drafted. Stereotactic biopsy uses a guiding system that allows accurate targeting of brain tumors based upon coordinates obtained by CT or MRI. A probe is passed through a small drill hole which retrieves cylindrical samples 1 cm in length and 1-2 mm in diameter. The procedure is safe and most patients can be discharged the day following the procedure. A neuropathologist provides immediate analysis of tissue to confirm the tumor.

Resection

A number of brain tumors can be cured by complete surgical resection (grade I gliomas such as ganglioglioma, papilloma of the choroids plexus, pleomorphic xanthroastrocytoma, pilocytic astrocytoma of the cerebellum, dysembryoblastic neuroepithelial tumor, pituitary adenoma, meningioma). In patients with malignant gliomas, complete tumor removal is associated with a better response to post-surgical treatments (radiation, chemotherapy) and an improved outcome.
Neurosurgeons have benefited from dramatic advances in imaging technologies (functional MRI, MR spectroscopy, PET) and surgical techniques that enable them to accurately diagnose, pinpoint and remove tumors that were previously considered inoperable or that could not be completely removed. These advanced procedures are available through the services of the specialists at Yale where continuing research and teaching activities enhance the patient experience and improve both the length and quality of life of those with a brain tumor.