For many types of tumors, especially those that are very large and/or rapidly growing, surgery is the first choice for treatment. Surgery to remove a brain tumor is very complex due to the delicate nature of the brain. Since the normal brain tissue controls all normal functions (including thought, speech, hearing, sight, feeling and movement), it is critical that the neurosurgeon spare as much normal tissue as possible while removing as much tumor as possible. Using the state of the art diagnostic tools mentioned above, the neurosurgeon can plan out the pathway for tumor removal well in advance of the surgery. Neurosurgeons at the WKNI also have advanced surgical tools for use during surgery to assure the best possible outcome. These unique tools are discussed below.

Intraoperative Computerized Tomography
Another new technology available to WKNI neurosurgeons is the Intraoperative Computerized Tomography (CT) scanner. This portable CT scanner is used right in the surgical suite to help the surgeon monitor the changes in anatomy that occur during surgery. There is a great amount of shifting and movement of the brain tissue during surgery and, at times, it can be difficult to determine tumor from normal tissue. With the Intraoperative CT, the surgeon can immediately scan the patient's brain at any time during surgery to view how the brain has shifted and to reassess his or her approach. In addition, the patient can be monitored via the CT for potential bleeding or other complications. Moreover, the surgeon has an immediate idea of the success of the operation based on the amount of tumor that was removed (the percentage of tumor resection). Prior to receiving this technology, the patient would need to be moved to Radiology to be scanned after surgery was completed, thereby losing any opportunity to modify the surgical techniques. The Intraoperative CT is another invaluable tool that is unique in the Dayton area to the WKNI.

Gliadel Wafers
At the WKNI, neurosurgeons and oncologists work closely together to decide the best course of treatment for each individual patient. For some tumors, the combined use of surgery, chemotherapy and other modalities may be the best option. Neurosurgeons have the option to use implantable chemotherapy wafers for the treatment of certain tumors. These wafers (called "Gliadel Wafers") are implanted directly at the site of the tumor during the brain surgery. They then slowly release potent chemotherapy agents (BCNU or carmustine) at the site where the tumor was removed to kill any remaining tumor cells that may still be present.

Gliasite Radiation Therapy System
The Gliasite Radiation Therapy System is an implanted radiation delivery device system. It is a radiopaque tube with a balloon and an infusion port. The balloon is placed into the resected tumor bed at the time of surgery while the infusion port is just under the scalp. The balloon is filled with Iotrex I, a liquid radiation solution, by the radiation physician for a specific period of time. The resected tumor bed and the surrounding tissue are directly treated with radiation.

The prescribed period of treatment time or dwell time is generally 3-7 days. The patient may be treated as an outpatient if specific radiation safety guidelines can be followed, otherwise the patient may be admitted to the hospital for the treatment. Once the Iotrex solution is withdrawn from the balloon the patient may go home.

The delivery device system may be removed if the patient desires with a small surgical procedure or it may be stay inside the brain. If the device stays in the brain, the patient generally doesn’t experience any discomfort. The patient will continue follow up care with MRI or CT scans to determine effect of the treatment.