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Brain Matters: When brain surgery is nothing more than a bad hair day

July 3, 2012

Michael Brant-Zawadzki, MD, FACR
You may have seen an “infotainment” TV piece of some third world psychic surgeon removing tumors with his bare hands and not leaving a scar, often accompanied by a gory picture of some bloody handful of stuff.
Ask Kathy H., a now 50- something mother of four. She knows the difference between real brain surgery and the knifeless kind. Her breast cancer thought cured, it spread to her brain 11 years ago. A lemon-sized tumor was resected from a part of the right brain where it hid undetected until causing a seizure. Then came the others.
The brain sucks…blood, that is. For a small part of the body, it takes up fully a fifth of all the blood the heart pumps every minute. With cancer cells flowing in the bloodstream, the brain will see more than its share. Some take up residence there, hiding from the immune system and even chemo, which doesn’t easily penetrate a unique protective screen – the blood brain barrier.
Having metastatic brain tumors used to spell impending death for 90 percent of such patients. Rapidly growing, such tumors eventually endanger vital life functions controlled by the brain. Cutting single tumors out is possible, but surgical footprints can damage nearby vital structures.

Multiple surgeries risk more damage. Very large doses of radiation to the entire head can control some cases, but may produce undesirable loss of mental faculties in a significant number of people.
Now imagine creating a life-size hologram of the brain, metastases included. Then imagine taking a sharp number two pencil (or a computer mouse outliner), tracing the outer edges of the tumors inside the hologram, flipping a switch, and having the outlined tumors vaporize without harming the nearby tissue. Many tumors: one flip of the switch. Done!
Imagination turns to reality with what is called stereotactic radiosurgery using the Gamma Knife. It’s like going to a fancy hair salon. You park 50 feet from the treatment room and are met by your nurse navigator who helps the neurosurgeon attach a Hannibal Lechter-like frame to your head (messing up your hair). Then an MRI brain scan is done, the MRI computer transmitting the hologram of your framed brain to the Gamma Knife couch that you lie on. The frame’s dimensions serve to precisely compare its outside dimensions with those inside your skull.
The couch is slid into a giant computerized helmet containing the vaporizing gamma rays, each one harmless.
But when all are automatically focused on the tumors precisely drawn within your brain’s computerized “virtual” hologram by the neurosurgeon, their concentrated energy obliterates the tumor, while sparing nearby brain.
Today, if the cancer in the rest of the body is controlled, 80 percent or more of patients with metastatic brain tumors can live their normal lives for lots of years.
Ask Kathy.
She is now an 11-year survivor of 23 brain tumors treated, and she just danced at her daughter’s wedding. Driving up in the morning to cure your six or more brain tumors, no scalpel, all virtual, cancer really gone, and getting home in time for a celebratory lunch with only some mussed hair to show for it?
Now that’s the type of psychic surgery in which I can believe.
Dr. Michael Brant-Zawadzki is executive medical director of the Hoag Hospital Neurosciences Institute.