Neurosurgical Oncology and Skull Base Surgery

What is Neurosurgical Oncology?

Neurosurgical Oncology, also known as Surgical Neuro-Oncology, is the surgical management of tumors involving the brain and spine. The more common term for this field is “brain tumor surgery,” though it does include surgery for tumors involving the spine. This latter area is also referred to as Spinal Oncology.

Most brain tumors require a neurosurgeon who is fellowship-trained and board-certified. These features are important because as you would expect, brain tumors are rare and can be complex. Not all neurosurgeons have a specialty focus on brain tumors.

At Westchester Medical Center, we have a dedicated neurosurgical oncologist, Simon Hanft, MD, FAANS, who performs among the most brain tumor operations in the Tri-State Area. In addition to Dr. Hanft, we have a dedicated group of physicians who manage other aspects of brain tumor care.  

Although the surgery is extremely important and is the first step for patients with a brain tumor diagnosis, the next steps in your care are equally essential. These include radiation, which is managed by our radiation oncology group; chemotherapy and clinical trials, which are coordinated by our neuro-oncology team; social work; rehabilitation; and close, long-term follow-up.

Westchester Medical Center offers an integrated approach to the treatment of patients with brain tumors. Patients can receive all the necessary care under one roof. These physicians communicate about each patient so the plan is focused, clear, and patient-specific. You need individualized care for your diagnosis, and the team at Westchester Medical Center can provide this level of dedication. It is our goal to make sure that patients with brain tumors and their family members are completely integrated into the care plan and decision-making process. Our personalized approach is an antidote to the assembly-line medicine that can frustrate brain tumor patients at other institutions.

Precise, Cutting-Edge Care, Close to Home

WMC is the first institution nationally and remains the only institution in New York state to offer Omniscient, an advanced fibertracking system that goes beyond fMRI capability. Omniscient provides a personalized brain map for each patient, thereby allowing the neurosurgeon to visualize critical brain networks and their relationship to the brain tumor before surgery is even performed. It is a major technological leap in individualized brain mapping and precision brain medicine. By more thoroughly displaying these networks, our neurosurgeons are better equipped to plan a safe surgical approach to brain tumor removal.

At WMC we offer GammaTile brachytherapy, a novel implantable radiation solution for brain tumors. Traditionally, after aggressive brain tumors are removed, the patient then undergoes radiation to the cavity in order to prevent local tumor regrowth. This radiation can be a challenge for patients as it requires repeat visits to the hospital and itself can be physically draining.  

With GammaTile, our neurosurgeons are able to implant small seeds containing radiation within the tumor cavity right at the time of surgery. This provides focused, targeted radiation delivery to the immediate surrounding brain tissue. No need for days or even weeks of radiation. GammaTile is available for aggressive tumors such as glioblastoma and metastases. WMC is also part of a national clinical trial that closely follows patients undergoing GammaTile implantation to determine efficacy compared to standard radiation regimens. We are extremely optimistic that GammaTile will end up replacing traditional radiation for certain brain tumors.

WMC has demonstrated a major commitment to the treatment of patients with brain tumors. These include the latest machine for providing targeted radiation, the Truebeam. This machine uses a highly accurate, frame-less approach to treating brain tumors that otherwise would require a traditional brain surgery with opening of the skull. Also known as radiosurgery, or stereotactic radiosurgery (SRS), the Truebeam is utilized by both the radiation oncologist and neurosurgeon to target and treat brain tumors through a bloodless, incision-less approach that is much easier on patients.

Inside the operating room, WMC is the only hospital in the county featuring an exoscope, a new tool that allows for extraordinarily high-definition visualization of brain tumors. WMC is also the first hospital in Westchester to use Gleolan, a fluorescent agent that selectively illuminates brain tumor cells allowing for more complete tumor removal. This is especially useful in glioblastoma surgery, where this particularly aggressive tumor can be difficult to remove entirely due to its similarity to the surrounding brain. (Learn more.) WMC is also equipped to perform awake craniotomies, an essential but oftentimes intimidating approach for patients who would understandably prefer to be asleep for their operation. But in select cases, particularly for tumors involving the language areas of the brain, our team can perform the surgery with the patient awake for only the most important moments so as to ensure maximal safe tumor removal.

Contact Us

Appointments and Information

Westchester Medical Center Brain and Spine Institute
19 Bradhurst Avenue, Suite 3850S
Hawthorne, NY 10532

Phone: 914.493.2363
Fax: 914.493.2505

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Success Stories

Seeing Brain Tumors In a New Light

Minimally Invasive Brain Tumor Surgery

The main goal in brain tumor surgery is an ongoing effort to maximize tumor removal while minimizing pain and neurologic deficits. Minimally invasive brain tumor surgery helps to reduce the amount of postoperative pain and allows patients to heal rapidly and return to their normal lives. Learn more below about a few of the minimally invasive technologies available at WMC.

Laser Ablation

Endoscope 

Tubular Retractor System

Conditions We Treat

• Glioblastoma (GBM)
• Low grade glioma (astrocytoma and oligodendroglioma)
  
• Meningioma
  
• Pituitary region tumors (adenomas, acromegaly, Cushing’s Disease, craniopharyngiomas)
  
• Acoustic neuroma (also known as vestibular schwannoma)
  
• Tumors of the spinal canal (schwannoma, meningioma, ependymoma)

Skull Base Surgery

Treating Skull Base Tumors

Skull base tumors are a rare subset of brain tumors that are located at various points along the floor of the skull. These are overwhelmingly benign tumors, such as meningiomas and schwannomas, but the operations to access such tumors can be lengthy and challenging. At Westchester Medical Center, we offer multiple options for treating these tumors, including non-surgical options such as focused radiation (also known as radiosurgery). For those tumors that require surgery, we utilize highly advanced technology to assist our surgeons in optimizing tumor removal while minimizing injury to important surrounding structures. We also collaborate and work closely with our neurotology partner from ENT, Katrina Stidham, MD, primarily for tumors known as acoustic neuromas (vestibular schwannomas).

Our goal remains singular: achieving the best possible patient outcomes. We take pride in our judgment and judicious usage of the available technology. We resist the process of shoehorning patients into one treatment approach. We do our best to tailor our recommendations to each patient. The result is an individualized approach for your specific tumor.

Skull Base Tumor Treatment Options

Orbeye 4K 3D Exoscope: Westchester Medical Center is the only hospital north of Manhattan to feature this innovative intraoperative microscope. The exoscope, which provides the best form of tumor visualization with 3D displays in the operating room, has improved our ability to see the tumor and its relationship to adjacent tissue and vessels.

BrainPath and Vycor: These are two tubular retractor systems in use at WMC. Both systems utilize small tubes that can be guided through brain tissue directly toward a deep-seated brain mass. Instead of boring through brain matter, these tubes delicately displace the normal brain tissue thereby allowing a clear and safe corridor to the brain tumor. These options allow us to truly offer minimally invasive brain tumor surgery in select cases.

Minimally Invasive Craniotomy: For certain skull base tumors, we offer a series of smaller operations that can access the tumor while sparing the patient a more traditional long incision and large skull opening. For example, a meningioma along the skull base floor may be accessible through what is termed an “eyebrow” craniotomy where a very small incision is placed along a portion of the top of the eyebrow. This provides an excellent cosmetic result and avoids much of the pain associated with traditional operations.

Modifications of Traditional Craniotomy: Certain large tumors still require large operations. However, we are among the few institutions nationally that can achieve these results using hair-sparing incisions where no hair is shaved for the operation. In addition, we often secure our incisions with absorbable sutures, leading to better cosmetic results and no requirement for uncomfortable staple removals in the office following surgery.

Radiosurgery: WMC offers stereotactic radiosurgery (“SRS”) as an alternative to open surgery for many skull base tumors. Neurosurgery has evolved over the last 10-20 years in how these tumors have been viewed. Fortunately, many skull base tumors can be effectively treated using radiosurgery, thereby sparing patients the ordeal of undergoing open surgery. Since we offer both SRS and open surgery, we can honestly and appropriately steer patients to the right option. We are able to preserve an unbiased approach to these tumors because we have the capability of providing both treatments.

Our radiosurgical platform is the TrueBeam, a highly accurate machine that does not require placement of an uncomfortable head frame during the treatment. Patient comfort is optimized while treatment times remain brief. These tumors can often be treated in one session only – meaning one morning or afternoon – and without hair loss that is typically associated with brain radiation. These are not radiation treatments that require weeks and weeks of daily therapy.

Pituitary Tumor Treatment Options

Westchester Medical Center is home to one of the only comprehensive treatment programs in New York for tumors of the pituitary gland. The pituitary tumor program is among the busiest in the state. These unique tumors require a team approach due to their varied impact on the brain and body. Depending on the type of pituitary tumor, patients may be a candidate for surgery, radiation, medication, or even observation.

The foundation of this team is the partnership of neurosurgeon Simon Hanft, MD, and ENT head/neck surgeon Matthew Kim, MD. These two surgeons partner for all pituitary operations, which has become the standard in the treatment of these tumors. The surgery for these tumors is nearly always performed through the nose, using a small, high-definition camera known as the endoscope. This device allows the surgeons to access even large and complicated pituitary tumors without having to perform large openings through the skull. The images from the endoscope are displayed to the surgeons in the operating room, thus enabling them to safely identify and remove the tumor away from the important surrounding structures.

For those tumors that warrant medical treatment only, we work closely with our endocrinology service at WMC. Our endocrinologists are also always involved in the post-operative management of patients with pituitary tumors due to potential endocrine issues that may develop.

In certain cases we offer TrueBeam radiosurgery for the tumors - a non-invasive form of focused radiation that can selectively target these tumors while sparing nearby critical tissue. This incision-less and frameless approach is done on an outpatient basis in close conjunction with our radiation oncology group.

Techniques and Technology 

Our Providers

Our comprehensive care team is dedicated to providing the most up-to-date evaluation, personalized multidisciplinary treatments and continuity of care for patients with brain and spine tumors. To best serve your needs, our specialists meet patients in a multidisciplinary clinic that allows the opportunity to collaboratively develop individualized treatment and care plans.

Simon Hanft, MD
Section Chief, Neurosurgical Oncology, Westchester Medical Center
Assistant Professor, Neurosurgery, New York Medical College

• Neurological Surgery

Aviva Berkowitz, MD
Attending Physician, Radiation Medicine

• Radiation Oncology

Chirag Gandhi, MD
Chair of Neurosurgery
Endovascular and Cerebrovascular Neurosurgeon
Neurosurgical Oncology

• Neuroendovascular Surgery
• Open Cerebralvascular Surgery
• Neurological Surgery

George Kleinman, MD
Associate Professor of Pathology and Medicine

• Pathology, Anatomic Pathology
• Pathology, Neuropathology

Keith Meritz, MD
Attending Physician, Radiation Medicine

• Radiation Oncology

Carrie Muh, MD
Division Chief, Pediatric Neurosurgery,
Surgical Director of Pediatric Epilepsy Program,
Surgical Director of Pediatric Neuro-vascular Program,
Surgical Co-Director of Craniofacial Program

• Pediatrics, Pediatric Neurosurgery

Christine Pellegrino, MD

• Internal Medicine, Medical Oncology

Jared Pisapia, MD
Attending Pediatric Neurosurgeon,
Surgical Director of Pediatric Neuro-Oncology Program,
Surgical Director of Peripheral Nerve Surgery Program,
Surgical Co-Director of Craniofacial Program

• Pediatrics, Pediatric Neurosurgery

Synphen Wu, MD
Attending Physician
Assistant Professor, New York Medical College

• Neurology