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Another high-tech tool of today’s operating rooms is the laser, which destroys tumor cells with intense heat. Used in addition to or in place of scalpels, lasers can reach a tumor embedded deep within the brain. They also are valuable in attacking hard tumors that cannot be removed by suction as well as tumors that break apart too easily. Neurosurgeons continue to discover novel ways to identify and attack tumors. Photodynamic therapy involves injecting a photosensitizing drug into a vein or artery prior to surgery. During the operation, the tumor cells appear fluorescent, giving neurosurgeons a relatively easy target in which to aim the laser.

Brain tumors are attacked in a number of ways, but surgery is usually the first step for tumors that can be removed without damaging vital neurological functions. A tumor will recur if any tumor cells are left behind, so neurosurgeons attempt to remove the entire tumor if possible. Radiation therapy (not to be confused with stereotactic radiosurgery) and chemotherapy are used as secondary treatments for tumors in which surgery was not completely successful

or for which surgery is too risky. A new chemotherapy agent Temodar, is given orally and much less likely to

produce side effects than traditional chemotherapy treatments. Neurosurgeons have made advances over the last decade in refining “molecular” techniques for treating tumors. These include gene therapy in which engineered viruses deliver toxic agents into tumor cells or deliver genes that help impede the growth of the tumor cells. Another molecular technique is toxin therapy, which attacks the tumor cells. The challenge of these therapies is to find effective ways for delivering the agents into the brain. One common method is convection- enhanced delivery in which small agents are delivered to large regions of the brain. Another new approach is the use of chemotherapy wafers, implanted directly into the cavity left after a tumor is removed. Advances in the diagnosis and treatment of brain tumors are expected to continue in the next decade. It wasn’t so long ago that a brain tumor diagnosis meant little hope for treatment and recovery

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