Brain Tumor Center
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John Wayne Cancer Institute

PATIENT-CENTERED FOCUS: A multidisciplinary team approach providing tailored diagnostic and treatment plans 

EXPERIENCE, INNOVATION and RESEARCH: One of the largest series of keyhole and endoscopic surgeries world-wide; extensive academic publications; ongoing clinical trials and brain tumor genomics research   

CONSISTENT QUALITY CARE: Saint John’s Health Center is the only hospital in California to receive Healthgrade® America’s 50 Best Award™ 7 years in a row   

TECHNOLOGY: State-of-the-art operating suite dedicated to endoscopic and keyhole neurosurgery 

 

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The Saint John’s Health Center Brain Tumor Center [BTC] & Pituitary Disorders Program provides comprehensive care for patients with brain, skull base and pituitary tumors, including both benign and malignant brain tumors, skull base tumors, pituitary adenomas as well as related problems such as pituitary hormonal failure (hypopituitarism), cerebrospinal fluid leaks (CSF leaks), intraventricular tumors, spinal cord tumors and hydrocephalus. We also treat cranial nerve syndomes including trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia.

Our Specialists in Neurosurgery, Head & Neck Surgery (ENT), Endocrinology, Medical and Neuro-Oncology, Radiation-Oncology, Neuro-Ophthalmology, Interventional Neuroradiology and Neuropathology offer a multidisciplinary approach to these disorders. With expertise in minimally invasive keyhole and endonasal endoscopic surgery, stereotactic radiation treatment, cutting-edge cancer treatments, genomic sequencing and hormone replacement therapy, we provide individualized care for these complex problems.

Through collaboration with the John Wayne Cancer Institute and Saint John’s Health Center, the BTC also conducts Translational Research, Clinical Trials, Continuing Medical Education, Neurosurgical Fellowship Training and provides Patient Education and Support.

Specific disorders we treat include primary brain & skull base tumors: pituitary adenomas (including acromegaly, Cushing’s disease, endocrine-inactive adenoma, prolactinoma, recurrent and residual adenoma, pituitary apoplexy) clival chordoma, chondrosarcoma, colloid cyst, craniopharyngioma, epidermoid cyst, glioma (including low grade astrocytoma, choroid plexus papilloma, oligodendroglioma, anaplastic astrocytoma and glioblastoma multiforme), hemangioblastomas, CNS lymphoma, meningioma (including typical, atypical and anaplastic), olfactory neuroblastoma (esthesioneuroblastoma), sinonasal carcinoma, Rathke’s cleft cyst.

We also treat many patients with metastatic brain tumors including those arising from breast cancer, colon cancer, lung cancer, ovarian cancer, renal cancer, thyroid cancer and from metastatic melanoma.

Surgery for brain tumors, skull base tumors and pituitary adenomas is a highly specialized area of neurosurgery that continues to rapidly evolve. At the BTC, we incorporate cutting edge technology and instrumentation with proven surgical experience to make surgery safer, less invasive and more effective. These advanced technologies include MRI fiber tractography, functional MRI, surgical navigation (GPS), evoked potential monitoring, ultrasound for tumor localization and the Doppler probe for blood vessel localization.

Given these major advances over the last decade, most brain and skull base tumors can now be removed via a keyhole approach through a small craniotomy (bony opening in the skull) or the nostrils. The ideal approach is determined by the specific tumor anatomy in each patient. These include the endonasal endoscopic (through the nostrils), supra-orbital (through the eyebrow), retromastoid (behind the ear), mini-pterional route (in front of the ear) and other keyhole and conventional craniotomies. Regardless of the route chosen, our goals are to maximize tumor removal and minimize manipulation of critical structures, thereby avoiding complications and patient disfigurement, while promoting a more rapid, complete and less painful recovery. Notably, endoscopic and other keyhole approaches are technically demanding, require specialized instrumentation and are not appropriate for all brain tumors. Consequently, there remains a role for conventional larger craniotomies especially when the tumor itself has created a path through the brain or bone. Our BTC Director, Dr. Daniel Kelly has extensive experience with both conventional and keyhole approaches totaling over 4000 such procedures over the past 20 years. This large experience allows us to provide a truly tailored approach best suited for each patient.

Specific keyhole approaches are selected based on tumor type, size and location. The endonasal endoscopic approach (via the nostrils) is used for pituitary adenomas, craniopharyngiomas, chordomas, Rathke’s cleft cysts, sinus carcinomas, olfactory neuroblastomas and midline meningiomas. The supraorbital eyebrow craniotomy is used for meningiomas, craniopharyngiomas and other tumors near the optic nerves and pituitary gland, as well as gliomas and metastatic brain tumors in the frontal and temporal lobes. The retromastoid craniotomy (behind the ear) is used for acoustic and trigeminal schwannomas, meningiomas, epidermoid tumors, and tumors of the cerebellum such as hemangioblastomas and metastatic brain tumors. The transfalcine and transtentorial approaches are typically used for intra-axial brain tumors such as metastases and gliomas that are covered by eloquent / critical cortex. Other keyhole & conventional craniotomies are used for large meningiomas, gliomas (astrocytomas, ependymomas, oligodendrogliomas, intraventricular tumors) and some metastatic brain tumors.