South Florida’s Premier Brain Cancer Center
The diagnosis may be devastating and life halting but we’ve treated enough patients to know that brain cancer is not always a terminal illness. We achieved complete cancer remission is thousands of patients using a variety of surgical and nonsurgical techniques including radiation therapy, chemotherapy, and tumor resection surgery (craniotomy).
Brain Tumor Survivors
When every other treatment hasn’t worked and it seems like there are no options left, we commit ourselves to your care. Our treatment options are extremely effective, lead to phenomenal recuperation, and in some cases reduce symptomatology immediately following treatment. We seek to offer the easiest way to treat the patient's problem. For example, the Gamma Knife® is a non-invasive outpatient procedure with minimal side effects used for the treatment of brain cancer and replaces traditional open surgical approaches which require breaking the skull.
"Come in the morning, and be back home in the afternoon"
The aim of brain cancer treatment is to control tumor growth and eventually eliminate all cancer cells. You will have a multidisciplinary team of medical professionals working to achieve this goal, these may include oncologists, neurosurgeons, pharmacists, nutritional counselors, and rehab specialists.
Your treatment options will be largely determined by :
- Your medical history
- The tumor type and grade (growth rate)
- Tumor size and location
The three types of treatment for a brain tumor include:
Over 5,000 Brain Tumor Survivors
The Miami Neuroscience Center at Larkin has successfully treated thousands of benign, malignant, low-grade, and high-grade tumors in adults and children. To see a full list of the tumors we've treated and our treatment results click here or schedule a consultation to learn more.
Surgical Treatments for Brain Tumors
Resection of Brain Tumor
A brain tumor resection involves the removal of the whole tumor or part of the tumor. It may also involve the removal of some tissue that surrounds the brain tumor to ensure that residual cancer cells are extracted and do not grow back. Often brain tumor surgery is coupled with radiation or chemotherapy to fully eradicate the cancer. Brain surgery can be used when the tumor is easily accessible and distinguishable from the other areas of the brain. The neurosurgeons at our center are skilled in the removal of tumors in the brain and spinal cord and will perform your procedure.
In order to surgically extract the brain tumor the neurosurgeon must perform a craniotomy. During a craniotomy, our surgeon uses a specially designed tool to remove a bone flap (a section of your skull) which will provide surgical access to your brain. The piece of bone is reattached with titanium plates and screws once the surgery has been completed. A craniotomy can be performed while you are awake or asleep.
- Awake Craniotomy: Staying conscious or partially conscious during brain tumor resection can help our neurosurgeon identify and preserve brain functions which the tumor may be affecting, such as speech, movement, and sensation. Your head will be fixated during the surgery but our neuroanesthesiologist will help you feel as comfortable as possible. Our neurosurgeon will ask you questions, such as counting numbers (assessing speech), identifying a picture (assessing vision), or raising a finger (assessing movement). This will help him to understand the motor and cognitive functions surrounding the tumor and avoid damaging vital tissue in your brain. Awake brain surgery is painless because the brain does not have sensory nerve fibers (nociceptors) and the anesthesiologist ensures that the scalp is numbed.
- Asleep craniotomy: In this case, you will undergo the complete surgery under anesthesia.
There are different types of craniotomy related to the areas of the skull which needs to be removed to access the brain tumor. These include:
- Pterional craniotomy: Also sometimes called frontotemporal craniotomy, this procedure is used to treat tumors such as meningiomas and pituitary adenomas. The surgeon accesses the brain by removing a portion of the frontal and temporal bones (located at the front and side of the skull).
- Frontal craniotomy: This procedure allows access to the anterior cranial fossa (the area where the brain’s frontal lobes are located) both sides of the orbital roof, and the front of the optic chiasm (the area where the optic nerves overlap, forming an X shape) by removing the frontal bone.
- Temporal craniotomy: This procedure allows access to the middle cranial fossa and upper petroclival region by removing the temporal bone.
- Suboccipital craniotomy: This approach allows access to the rear cranial fossa by removing the occipital bone.
Craniotomy Risks and Complications
Possible risks and complications of this type of surgery include:
- Intracranial bleeding
- Fluid build-up in the brain
After craniotomy surgery you will be monitored closely for 24 hours and your head will remain elevated to reduce the risk of pressure within your skull. Following your procedure you may be required to take medications, such as anti-seizure drugs or steroid medications to reduce swelling in your brain. Your hospital stay may range between 2 to 14 days, although patients generally go home within 2-3 days following a craniotomy The duration will depend on the type of craniotomy, surgical complications, age of the patient, and comorbidities of the patient. The external sutures used to close the incision can be removed about a week after surgery. You may experience fatigue and headaches for several weeks after the surgery. It can take up to five weeks to completely recover.
Non-Surgical Options for Brain Tumors
Because no two brain tumors are exactly the same, your treatment plan will be designed to suit your unique needs, which may mean you need a stand-alone radiation treatment, or you may need radiation treatment combined with chemotherapy. We perform the following types of radiation therapy:
Gamma Knife Radiosurgery
Gamma Knife is a form of minimally-invasive stereotactic radiosurgery, in which no incisions are made into the brain. Gamma knife surgery uses specially designed equipment to focus 192 fine beams of Cobalt 60 generated radiation directly at a brain tumor within a target range of submillimeter accuracy. An individual beam causes no harm to healthy tissue in the brain but the combined force where the beams meet, delivers a strong dose of radiation to the tumor.
Because Gamma Knife is a minimally invasive treatment, it is safer than other forms of neurosurgery. Gamma knife radiotherapy is often the best intervention if:
- Other forms of treatment have not worked on their own such as conventional radiation therapy or chemotherapy.
- Our neurosurgeon cannot surgically access your brain tumor because it is in a difficult location to operate and performing surgery might risk damaging healthy brain tissue and essential brain functions.
- Because of your age or other health conditions, you are unable to undergo surgical options.
Gamma knife radiosurgery is a quick and painless outpatient procedure. The entire Gamma knife process from your arrival to discharge (including pre and post-operative care) can take between 2-4 hours. First, a medal frame is placed to your head and you will undergo imaging studies to map the location of the tumor. After the physicist and neurosurgeon have programmed the brain tumor coordinates you will lie within the patient positioning system (PPS). This ensures that the radiation is targeted precisely. The radiation is delivered through a cone-shaped cylinder, which is positioned around your head. The targeted radiation damages the cells within the brain tumor, preventing them from reproducing. It may also cause cell death and shrinkage of the tumor. Due to the precision and design of the gamma knife the surrounding healthy tissue remains unharmed. Depending on the type and location of the tumor, the success rate may be as high as 90 percent. This form of treatment is particularly effective for tumors less than three centimeters in diameter.
Gamma knife surgery is considered one of thea safest forms of treatment for a brain tumor. Possible risks and complications include:
- Swelling in the brain
- Mild nausea
Recovery from gamma knife radiosurgery is usually quite quick. You may notice slight hair loss at the site of the treatment and also numbness of the scalp for a couple of weeks. Our doctor will prescribe anti-inflammatory steroid medications for 10 days following the procedure.
Conventional Radiation Therapy
This is the most commonly used form of radiation therapy for brain tumors. The procedure involves delivering precise and accurate doses of radiotherapy by means of a computer-controlled x-ray device. Exposure to healthy tissue is minimized.
How often you receive radiation therapy treatments will depend on the size and location of the tumor and how quickly it is growing. Typically, you will have the therapy five day each week for a period of 3-6 weeks.
3-dimensional Conformal Radiation Therapy (3D-CRT)
3D-CRT is a cutting-edge technique that uses imaging technology to conform radiation beams to the shape of a three-dimensional image of the brain tumor enabling precise radiation delivery.
Intensity Modulated Radiation Therapy (IMRT)
Another advanced mode of radiation therapy, IMRT uses a linear accelerator to produce photon beams (X-Rays) on a range of intensities to eradicate the tumor. As the machine rotates around the patient, the beams can conform to the shape of the tumor.
Radiation Treatment Referrals
In some cases, our medical team will refer patients to other physicians and cancer centers within the Larkin network. These circumstances may include:
- Treatment of secondary tumors or primary body tumors which have metastasized
- When cyberknife treatment for the body is required. This is a painless, non-invasive treatment that delivers a single, focused dose of radiation to a tumor.
Chemotherapy is another option for the treatment of brain tumors. It is often used in combination with other treatments (also called adjuvant therapy) such brain surgery or radiation therapy. Chemotherapy can be used to treat rapidly-growing tumors or a tumor which has returned after previous treatment. Cancer cells grow and reproduce quickly so chemotherapy works by slowing down or stopping the division of cancer cells and preventing them from spreading.
Chemotherapy drugs can be given:
- Via IV directly into a vein
- As an oral medication
- Directly into the brain using an ommaya reservoir (see description below).
If multiple treatments are required, you may need a port-a-cath to make treatment easier. A port-a-cath is an implantable device, usually placed under the skin of your upper arm or chest under local anesthetic.
Some chemotherapy drugs are unable to enter the brain due to the blood-brain barrier. This is a semi-permeable membrane that keeps blood circulating in the brain separated from fluid in the central nervous system. In some cases, chemotherapy medication may be given directly into the cerebrospinal fluid using an ommaya reservoir which is implanted under the scalp.
Usually, you will have chemotherapy treatments in cycles. For example, you may have chemotherapy for a few days every month. This allows you time to recover from any side effects you may be experiencing. Your course of chemotherapy may last between one and four months.
Types of Chemotherapy
The type of chemotherapy drug you receive will depend on several factors including the type of tumor, your current state of health, how quickly the tumor is growing, and if the tumor has come back after initial treatment. Here are some of the chemotherapy treatments we use:
- Avastin Therapy: Avastin (bevacizumab) is approved for the treatment of malignant brain tumors, particularly recurrent glioblastoma multiforme (GBM), which is the most aggressive and fatal forms of primary brain cancer. It is taken intravenously over a period of 30-90 minutes. The drug works by shrinking the tumor. Combining Avastin therapy with Sprycel (dasatinib) can also stop GBM from metastasizing.
- Temodar Therapy: Temodar (temozolomide) is an oral chemotherapy medication. It is used to treat GBM and astrocytomas. The drug works by preventing cancer cells from producing DNA and reproducing. Combined with radiation therapy, this drug may slow down the growth of the tumor and increase life expectancy.
Taking the anti-the seizure drug valproic acid may extend the life expectancy of brain cancer patients who are undergoing chemotherapy. Combined with temozolomide and radiation therapy, valproic acid has been shown to inhibit the growth of GBM.
Side Effects of Chemotherapy
Chemotherapy drugs are designed to kill fast-growing cancer cells. Because of this, they can also affect healthy cells, which can lead to side effects. Our doctors can prescribe you medications to help manage some of these side effects. Which side effects you may encounter will depend on which drugs you are taking, how much of the drug you take, and how often you take it. Possible side effects include:
- Increased risk of infection
- Nausea and vomiting
- Memory or cognitive problems (sometimes called chemo brain)
- Hair loss
- Damage to cells in the mouth and digestive tract
- Digestive issues and loss of appetite
- Difficulty breathing
Recovery From Chemotherapy
Most of the side effects you experience during chemotherapy will disappear once you have completed the treatment. You will usually start feeling normal again after 2-3 months. However, some may take longer to resolve or may never resolve. If you notice lingering symptoms, talk with our doctors to help you manage them.
The Cancer Center at Larkin provides cancer treatment options including chemotherapy, immunotherapy, and endocrine therapy. It is our goal at the Miami Neuroscience Center to provide our patients with a full continuum of cancer care, easing their burdens as well as developing a strong network of communication and feedback on the path to remission.
Follow-up Care For Brain Tumor
One of the main objectives of follow-up care for brain cancer is to keep a look-out to see if the cancer recurs. In some instances, a tumor may come back if small groups of unidentified cancer cells remain in the body. These can grow over time until a patient experiences brain tumor symptoms or they are revealed by a test.
Typically, you will have follow-up appointments with our doctors every few months. The frequency of your appointments will depend on the type, grade, and size of tumor you had and the treatment you received.
Our doctors may recommend rehabilitation therapy to help you readjust and regain some skills which may have been affected by treatment. Rehab may include in-home or outpatient therapy. Our doctors can also recommend counseling services and in-home care assistance if they are needed.
- Cancer Research UK, “Surgery for brain tumours” November 2019.
- AO Foundation, “Access osteotomy - Frontal craniotomy” https://www2.aofoundation.org/wps/portal/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAzMjfULsh0VAbWjLW0!/?approach=Frontal%20craniotomy&bone=&classification=&implantstype=&method=&redfix_url=&segment=&showPage=approach&treatment=&contentUrl=/srg/96/04-Approaches/X500-FrontalCraniotmy.jsp
- State of Victoria, “Craniotomy” March 2014.
- Simon Hanft, MD, MPhil; Jonathan P Miller, MD, “Craniotomy Periprocedural Care” WebMD LLC, December 2017. https://emedicine.medscape.com/article/1890449-periprocedure#b8
- National Brain Tumor Society, “Avastin Web FAQs and Overview” http://blog.braintumor.org/files/public-docs/avastin-web-faqs-and-overview-final.pdf
- Chemocare, “Avastin” http://chemocare.com/chemotherapy/drug-info/avastin.aspx