The Neuro-oncology program at WVU Medicine offers innovative, specialized treatments to patients with primary and secondary tumors of the brain and spine. Brain tumors can be benign, which means there are no cancer cells, or malignant, with cancer cells that grow quickly.

Common Symptoms
Brain and spinal tumors can cause many symptoms. Some of the most common are:

• headaches, usually worse in the morning
• nausea and vomiting
• changes in your ability to talk, hear, or see
• problems with balance or walking
• problems with thinking or memory
• muscle jerking or twitching
• numbness or tingling in arms or legs

Neuro-oncology Surgery
Surgical treatments for patients with brain tumors include the use of computer-guided navigation systems in the operating room. Procedures such as Gamma Knife radiosurgery (a highly precise form of radiation therapy) enable tumor removal through smaller openings while minimizing the irritation of surrounding brain tissue.

These techniques have greatly reduced the risk of surgery, improved patient comfort, and shortened hospital stays to frequently less than three days.

Surgical treatments occasionally involve the cooperation of other surgical disciplines, such as otolaryngology, oculoplastics, and plastic surgery when the tumors involve the ears, sinuses, or eyes.

What to Expect as a New Patient
When you come to WVU Hospitals for diagnosis and treatment, you will be evaluated by our team of experts from multiple departments.

We want to make your visits to WVU as convenient as possible. When you visit our clinic, you may meet with various team members on the same day so you won’t have to make multiple trips.

• You will also need to bring your complete radiology files and any pathology slides from previous biopsies.
• Rehabilitation will be a part of your treatment program when you come to us for care. We also provide educational materials and counseling sessions to you and your family. We want you to understand your condition and know the relative risks and potential benefits of the various treatment options available to you.

Gamma Knife Radiosurgery
The Gamma Knife is an advanced tool for the treatment of benign and malignant tumors, arteriovenous malformations (AVMs), facial pain, and other functional brain disorders.

Lasting Freedom from Seizures: Less than five percent of epilepsy patients can expect freedom from seizures through medication after they have tried a few unsuccessful anti-seizure drugs. By contrast, surgery for many types of epilepsy can help well over 70 percent of those patients achieve complete seizure freedom and even more will be either seizure-free or significantly improved. Yet, surgery is under-utilized.

At WVU’s Epilepsy Center, we have found that patients suffer with medically intractable (difficult to control) seizures for 24 years before they have surgery, which is typical of national figures. But for most patients, we can determine if their epilepsy is difficult to treat within just a few years of seizure onset and through trials of two or three standard anti-seizure drugs.

Patients with persisting and disabling seizures have less chance for a long and healthy life. However, according to one large study (Sperling et al. JAMA. 1996), patients who become seizure-free as a result of surgery reduce their risk of death and injury to that of the general population. Timely surgical intervention for intractable epilepsy can save lives as well as improve the quality of life.

On average, over 52 surgical procedures for epilepsy are performed per year. Average breakdown:

• 32 craniotomies for epilepsy
• 12 vagus nerve stimulators
• 8 intracranial electrode placements

Surgery Types
There are two goals for surgery in treating epilepsy:

Goal of the Cure – Procedures that remove epileptogenic tissue. This surgery seeks to completely eliminate seizures.

Goal of Pallitation – Procedures that interrupt nerve pathways of seizures. The goal of palliation (which means relief) is to decrease the frequency and severity of seizures.

Goal of the Cure
Lesionectomy- Many patients with recurring seizures have small lesions that clearly cause the seizures. A lesionectomy removes those lesions and usually has excellent results.

Temporal lobe surgery-The majority of surgeries involve the temporal lobe of the brain. In a study of our patients, 73 percent were seizure free after temporal lobe surgery, and 96 percent were either seizure free or significantly improved.

Extra-temporal lobe surgery- Surgery for extra-temporal lobe epilepsy is less common than temporal lobe surgery. If no definite lesion is identified, the success rates may not be as high. Despite this, the opportunity for seizure freedom through surgery far exceeds the chance of stopping seizures with medicine alone.

Hemispherectomy- This procedure is most commonly performed in children with severe and widespread epilepsies. Functional hemispherectomy is one of the most successful surgical procedures for treating widespread and catastrophic epilepsy, with the majority of patients able to realize seizure freedom.

Goal of Palliation (relief)
Corpus callosotomy- Sectioning of the corpus callosum may be beneficial for partial seizures. In addition, uncontrolled generalized seizures, especially drop attacks, have an excellent chance of being eliminated with this surgery. Anterior 2/3 callosotomy is usually sufficient to stop drop attacks and the most violent generalized convulsions.

Multiple subpial transections (MSTs)- While the most effective treatment for partial seizures has been removal of the seizure focus (location), this is not an appropriate option when that region of the brain performs functions such as speech or sensorimotor tasks. In MST, the surgeon makes parallel cuts through the cortex to permanently disrupt neural networks that may be causing seizure activity.

Vagus Nerve Stimulation VNS- can be used for patients with partial or generalized seizures and who have no opportunity for a curative surgery. The vagus nerve stimulator is implanted under the skin of the chest. A wire from the device runs under the skin and is attached to the vagus nerve in the left side of the neck. The device electrically stimulates the vagus nerve periodically at a rate that is adjustable. The surgery usually requires no overnight stay. With VNS, approximately half of patients can expect a 50 percent or greater reduction in seizure frequency.

More than 30 different diseases, affecting almost 40 million Americans, are identified as neurological movement disorders. These disorders, which include Parkinson’s disease, essential tremor, myokymia, and restless leg syndrome, range from mild to severe, are usually chronic, sometimes progressive, and seldom curable.

Although many movement disorders are not life threatening, they can significantly impair patients’ ability to function well and independently. Depression and other mental problems are often associated with movement disorders.

At WVU, patients with movement disorders receive treatment aimed at improving quality of life. Our neurologists who specialize in movement disorders work together with experts from all related fields including neurosurgery, neuropsychology, neuropsychiatry, physical and occupational therapy, and otolaryngology to help patients regain optimal motor control of their bodies.

WVU neurologists perform the initial assessment of patients who present with difficulties related to muscle movement, and, in some cases, may be the only specialists that patients need to see. When surgical intervention is indicated, patients are referred to WVU’s staff of skilled neurosurgeons, who work closely with our neurologists to develop appropriate treatment plans.

Most patients can find significant relief with modern treatments, including medications, surgery, injections, physical therapy, and implantable devices.

Movement disorders originate deep in the brain. They affect both children and adults. The symptoms vary widely, making diagnosis sometimes difficult. Causes are often unknown but may include genetic and environmental factors, injury to the brain such as stroke, the side effects of medications, and others.

WVU Medicine’s J.W. Ruby Memorial Hospital is the only hospital in North Central West Virginia to offer advanced, minimally invasive treatment for:

• Brain aneurysms
• Strokes
• Carotid artery disease
• Head, neck and spine disorders

Using neuroimaging, our physicians create individualized treatment plans designed to help each patient have the best outcome possible. Our treatment protocols are based on the latest evidence, including research conducted at our own medical center. The neurointerventional team is available around the clock for emergency stroke and aneurysm care, striving to begin treatment as quickly as possible.

Our endovascular approach to care helps patients avoid major open surgery and recover faster than traditional neurosurgeries. Our patients often return home the day after their procedure and can return to their normal activities within just a few days.

Learn more about our Neurointerventional Radiology Department

WVU Medicine neurosurgeons provide advanced care to adults and children with disorders of the:

• spine and spinal cord
• brain, carotid, and vertebral arteries
• pituitary gland
• cranial and spinal nerves
• autonomic nervous system

Expert treatment is given for spinal degenerative disease, herniated discs, spinal stenosis, neoplasms, and trauma. Our faculty includes skilled surgeons at the forefront of new techniques in skull-base surgery, advanced stroke care, epilepsy surgery, pediatric neurosurgery, neuro-oncology, pain, and functional disorders.

State-of-the-art technology
WVU Medicine’s Center for Advanced Imaging offers state-of-the-art equipment that enables surgeons to diagnose and treat problems with a high degree of accuracy. This includes PET and a 3-Tesla MRI, which are twice as powerful as former MRIs. Three-dimensional angiography allows for better visualizations of complex aneurysms. Other technologies include a surgical aspirator and an 80-watt laser.

The Gamma Knife uses focused radiation to destroy lesions with pinpoint accuracy, while avoiding damage to surrounding tissue.

Advanced techniques
Our surgeons are skilled in the latest microsurgical techniques to treat aneurysms and AVMs, as well as pituitary, acoustic, and skull-base tumors in difficult-to-reach areas. Working with interventional neuro-radiologists, some lesions can be treated via blood vessels using catheters.

Patients can benefit from new advanced treatments, including those in clinical trials. Treatments we perform include:

• Surgery for spine trauma
• Microsurgery of the brain and spine including the use of computer and endoscopic guidance
• Treatment for benign and malignant brain tumors
• Surgery for acoustic neuromas
• Surgery for pituitary disorders
• Surgery for spinal cord tumors
• Surgery for hydrocephalus
• Surgery for epilepsy
• Dorsal root entry zone lesions
• Cranial-facial reconstruction
• Deep brain spinal cord, vagal nerve, and peripheral nerve stimulation
• Surgery for trigeminal neuralgia

Our pediatric neurosurgery program provides state-of-the-art care for infants, children, and adolescents with problems of the brain and spine. As a major pediatric healthcare center, we offer the latest techniques, therapies, and clinical trials.

Conditions we treat include:

• Pediatric brain, spinal cord, and skull base tumors
• Aneurysms
• Epilepsy
• Pediatric brain, spinal cord, and peripheral nerve tumors
• Cerebral and spinovascular discorders
• Arteriovenous malformation (AVM)
• Hydrocephalus
• Chiari malformations
• Craniofacial disorders and craniosynostosis
• Spinal and cranial dysraphisms (Spina Bifida)
• Head, spine trauma, and concussions
• Prenatal diagnosis of centeral nervous system (CNS) disorders
• Congenital malformations of the brain and spine
• Moyamoya
• Syringohydromyelia
• Spinal deformity and instability
• Spinal cord injury
• Cavernous malformation
• Tethered cord
• Spasticity

Children in need of neurosurgery are treated by a team of multidisciplinary pediatric specialists including:

• Neurology
• Neuro-oncology
• Otolaryngology
• Plastic Surgery
• Orthopaedics
• Urology

In addition to the neurosurgery clinics, we provide services in other specialty clinics:

• Myelo Clinic (Spina Bifida)
• Craniofacial Program Clinic
• Abnormal Head Shape Clinic
• Spasticity/CP Clinic

The WVU Medicine Children’s Center for Spina Bifida serves children with spina bifida, myelomeningocele, and other forms of myelodysplasia as well as related congenital conditions, such as Chiari malformation, tethered spinal cord syndrome, and associated hydrocephalus.

The WVU Medicine Children’s Craniofacial Program treats infants and children with plagiocephaly, craniosynostosis, oculoauricular verterbral spectrum, microtia, and other rare conditions.

The WVU Epilepsy Center provides care for pediatric patients with seizure disorders and offers hope to those who have not been helped through medication. Our team of neurosurgeons, neurologists, radiologists, neuropsychologists, and other epilepsy experts diagnose and evaluate patients as possible candidates for surgery, which is often an effective option when medications fail.

The skull base surgery team specializes in treating complex medical conditions involving lesions at the base of the skull. These include tumors, congenital anomalies, and infectious or inflammatory conditions. Because of the many important structures located in this area, cranial base lesions have long been some of the most difficult challenges for neurosurgeons and their patients.

Our surgeons are skilled in the most advanced techniques and the latest technologies, and we can offer help for conditions that previously may have been considered untreatable. We take a multidisciplinary approach to diagnosis and treatment, bringing together the insights of neurosurgeons, otolaryngologists, ophthalmologists, plastic surgeons, interventional neuroradiologists, radiation oncologists, and other skilled professionals to provide the most advanced and comprehensive care.

We treat patients with the following types of lesions in the cranial base region:

• Aneurysms
• Stroke requiring vascular bypass
• Pituitary tumors
• Acoustic tumors
• Meningiomas of the cranial base, including olfactory groove, cavernous sinus, petrous apex, and foramen magnum
• Tumors of the clivus including chordoma
• Tumors of the orbit
• Tumors of the nasal sinuses extending toward the brain

Excellent outcomes
WVU surgeons are skilled in the latest minimally invasive surgical techniques and use of endoscopic approaches that provide for safer tumor removal and enhanced patient comfort. The goal is to maximize safe and effective treatment of lesions, while at the same time achieving excellent cosmetic outcomes.

State-of-the-Art Surgical Technology
State-of-the-art technology makes cranial base surgery possible. Our team approach is vital to providing the very best care and achieving the best possible outcomes for our patients.

State-of-the-art diagnostics
Advances in diagnostic technology have greatly increased physicians’ ability to pinpoint problems in the cranial base and to develop a precise treatment plan. We use the latest imaging technologies, including PET, 3.0 Tesla MRI, high resolution CT angiography, SPECT, and others that provide highly accurate images of the brain. While in the operating room, computerized image guidance allows our surgeons to visualize the operative area precisely.

Sophisticated neuro-monitoring enables surgeons to carefully follow the brain’s functioning even while a patient is asleep. These include:

• electroencephalography
• somatosensory-evoked potentials
• brainstem auditory evoked responses
• intraoperative microsurgical Doppler
• high-resolution cerebral angiography

Highly advanced treatment
New minimally invasive instruments, some developed by our own faculty, facilitate treatment of lesions in the most difficult-to-reach areas of the brain. The Center offers multi-faceted approaches to treating cranial base disorders, ranging from medical and surgical management to neurointerventional techniques, reconstructive surgery, and advanced radiation therapy including the use of the Gamma Knife.