Treatment Options

Gamma Knife

Imagine undergoing brain surgery for multiple tumors as an outpatient with a single treatment episode, a brief recovery period and no incision or pain. The Gamma Knife Center at Hoag Hospital is the only Orange County facility providing this valuable treatment option for patients with disease variety of brain tumors.

Hoag Gamma Knife Center has drawn patients from throughout the country and even across the world, treating benign and malignant brain tumors, vascular malformations, trigeminal neuralgia and Parkinson’s disease. And since the Center’s opening in 1997, Hoag was one of the earliest, and has become one of the strongest and most accomplished Gamma Knife programs in the United States.

Unsurpassed expertise is what sets the Center apart—and this experience is directly reflected in its impressive outcomes. Currently, the multidisciplinary team of specialists perform more than 200 radiosurgeries at Hoag Gamma Knife Center annually, offering patients a noninvasive and effective therapy for treating brain disease.


When surgical intervention is necessary, Hoag neurosurgeons employ image-guidance, which provides enhanced navigation using computer-generated 3D images of brain anatomy. Augmented reality allows virtual simulation of the surgical approach prior to the actual procedure, allowing the surgeon to choose the optimal approach with no surprises that otherwise can cause an unwanted extension of the surgical procedure, or even a second one. The augmented reality approach is then brought into the OR to increase speed and safety. This enhanced technology allows for smaller incisions and less tissue dissection, shorter anesthesia times, and overall better outcomes.

Hoag neurosurgeons also specialize in awake craniotomy. During this procedure, functional mapping is performed using electrodes to stimulate the brain tissue around the tumor in order to identify critical areas to be avoided during surgery. This allows the surgeon to reduce operative risk, while maximizing the volume of tumor that can be removed.

During surgery, the full armamentarium of advanced technological equipment further assists in identifying the parts of the brain critical for motor, sensory, speech, visual and memory functions. These two technologies combined mean neurosurgeons can remove more tumor with less impact to the patient.

Minimally Invasive Techniques

Whenever possible, Hoag neurosurgeons employ minimally invasive brain surgery (MIBS) techniques. Our specialists have access to some of the most advanced technology available to assist in MIBS, including biomedical electronics, sophisticated neuro-navigation systems, computers, videos, neuro-endoscopic equipment and microsurgical tools. MIBS reduces complications previously associated with complex neurosurgery, lowers operative mortality, while increasing the accuracy of tumor removal and allowing for faster recovery with less trauma and emotional stress.

Endoscopic Neurosurgery

For the removal of pituitary and certain other tumors, Hoag neurosurgeons specialize in minimally invasive endoscopic neurosurgery, as opposed to the traditional, invasive approach. In this advanced specialized procedure, an endoscope is placed through the nose, instead of making an incision through the gum or the skull. The scope is carefully maneuvered to the back of the nose and through a natural opening into the skull base that provides access to the pituitary gland. This technique provides superior visualization of the operative site, while offering patients a much more comfortable procedure with significantly less risk for complications.

Neuro-Oncology Clinic

A crucial component of our program is the Neuro-Oncology Clinic where state-of-the-art treatment is available for patients with cancers of the brain and nervous system. Physicians Santosh Kesari, M.D., and Jose Carrillo, M.D., provide sub-specialized care for patients who are diagnosed with malignant brain tumors, oversee the course and co-manage the full spectrum of conventional therapies and their potential side effects, as well as offer the latest cutting-edge clinical trials available anywhere. For example, the implementation of reflex tumor molecular genomic profiling for brain tumor patients has resulted in the identification of molecular targets to help our neuro-oncologists direct therapy.

Radiation Oncology

In addition to Gamma Knife Radiosurgery, Hoag offers the full array of radiation oncology technology for brain tumor patients. Stereotactic Radiotherapy, Intensity Modulated Radiation Therapy and other methodologies are offered by our brain tumor subspecialized Radiation Oncologists.

In summary, our program offers a unique and multidisciplinary treatment approach including neurosurgeons, neuro-oncologists, radiation oncologists, neuropathologists and neuroradiologists designing a course of treatment that is unique and comprehensive for each patient.