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Consult

Clinician-to-Clinician Update
To schedule a consultation, referral or appointment:

Neuro ICU/Surgical ICU and Neurosciences Unit
East Bank Hospital - M Health Fairview University of Minnesota Medical Center
500 Harvard St. SE
Minneapolis, MN 55455 

Neurosurgery Clinic
M Health Fairview Clinics and Surgery Center - Minneapolis
909 Fulton St. SE, Floor 3
Minneapolis, MN 55455 

To find all M Health Fairview neurosurgery locations,  go here.

To find brain and central nervous system cancer locations, go here

Surgical Advances in Addressing Glioblastoma and Other Brain Cancers

Tumors of the central nervous system are the leading cause of cancer deaths in women under 20 and in men younger than 40.1 In glioblastoma, the most common form of  brain tumor in adults, the median patient survival is about  14 months2, despite advances in medical and radiation therapies.3 Current clinical trials of immunotherapies and surgical techniques hold promise for these patients.

Standard-of-care treatment for glioblastoma entails surgical resection followed by concurrent radiation therapy and the chemotherapy temozolomide.2,4 Temozolomide is also used for treatment of other forms of brain cancer, including low-grade astrocytomas. The effectiveness of many chemotherapies against brain cancer, however, is limited due to the blood-brain barrier. Another approach being explored, laser ablation of brain tumors through the use of robotic surgical systems has been shown to disrupt this barrier, which would improve the effectiveness of chemotherapies.5 

Effective surgical treatment relies on real-time visualization of the tumor and normal surrounding brain tissue. The physical configuration of the tumor and the brain, however, changes as the surgical procedure is performed, posing a major treatment challenge. For instance, as the tumor is removed, the surrounding brain collapses into the area of resection. The connectivity of the brain, or how different regions of the brain communicate with one another, also changes during surgery. Understanding these changes in real time will help support safer and more effective surgery. 

IMRIS
The multiroom neurosurgery suite at M Health Fairview
University of Minnesota Medical Center. The 3T MRI
in the suite travels on a track to the operating rooms
and enables intraoperative MRIs.
Photo ©2019 Fairview Health Services.
New surgical suites with real-time MRI imaging address these challenges. The intraoperative MRI surgical suite recently opened at M Health Fairview University of Minnesota Medical Center (IMRIS, Minnetonka, MN) features a mobile 3-Tesla MRI that moves on a track from diagnostic to surgical locations within the suite. The 3-Tesla magnet MRI, the most advanced intraoperative imaging currently available, lets neurosurgeons review in real time the changes that occur during procedures, allowing surgeons to make adjustments to maximize the effectiveness of the surgery. The suite’s rooms are customized for separate procedures, including laser ablation, embolization, or endovascular procedures. The arrangement of adjoining rooms within the surgical suite (currently 3, with a fourth to be added) is expected to ensure safety and enable multistage procedures in one setting. 

Surgical suites may also become the setting for deployment of medical treatments for brain cancers. One multicenter clinical trial is testing a combination immunotherapy for glioblastoma that employs a surgical injection of a modified oncolytic adenovirus in combination with the checkpoint inhibitor pembrolizumab.6 The intraoperative MRI enables accurate injection into the tumor and provides information on how the modified virus is distributed throughout the tumor. The virus DNX-2401 is designed to stimulate host immune response, which is subsequently magnified by treatment with the checkpoint inhibitor pembrolizumab. (For further discussion, see Case Study.) M Health Fairview University of Minnesota Medical Center is the only facility in Minnesota offering this clinical trial. 

References

  1. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34 doi: 10.103322/caac.21551
  2. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma.  N Engl J Med. 2005;352:987-996. doi: 10.10586/NEJMoa043330
  3. Venur VA, Karivedu V, Ahlumalia MS. Systemic therapy for  brain metastases. Handb Clin Neurol. 2018;149:137-153  doi: 10.1016/B978-0-12-811161-1.00011-6
  4. Rønning PA, Helseth E, Meling TR, Johannesen TB. A populationbased study on the effect of temozolomide in the treatment of glioblastoma multiforme. Neuro Oncol. 2012;14:1178-1184 doi: 10.1093/neuonc/nos153
  5. Leuthardt E.C., Duan C, Kim MJ, et al. Hyperthermic laser ablation of recurrent glioblastoma leads to temporary disruption of the peritumoral blood brain barrier. PLoS One. February 24, 2016https://doi.org/10.1371/journal.pone.0148613
  6. A Phase II, Multi-Center, Open-Label Study of a Conditionally Replicative Adenovirus (DNX-2401) with Pembrolizumab (Keytruda®) for Recurrent Glioblastoma or Gliosarcoma  (CAPTIVE/KEYNOTE-192) NCT02798406


When to refer

M Health Fairview physicians have extensive experience in using advanced technologies for diagnosing and treating brain conditions, including brain metastases, malignant or benign tumors, arteriovenous malformations, and other conditions benefiting from laser ablation, implantable devices, or other surgical procedures. Our specialists work closely as a multidisciplinary team to treat patients and are nationally known for their work in treating brain disorders. M Health Fairview imaging services has been a leader for more than 75 years in diagnostic imaging. 

Our team members include radiation oncologists, neurosurgeons, radiologists, neuro-oncologists, neurologists, medical oncologists, pathologists, nurses, and other staff members. The multidisciplinary team works to bring the latest interventions and clinical research findings to patient care. Team members convene a multidisciplinary neuroconference to discuss potential treatments and determine the best options for each patient. 

Multiple treatment options are available and include state-of-the-art diagnostic imaging and surgical suites, latest-generation stereotactic radiosurgery and radiotherapies, and new surgical approaches and medical therapies. M Health Fairview University of Minnesota Medical Center employs the newest-generation of Gamma Knife—the Gamma Knife Icon—a stereotactic radiosurgery system that enables multiple, smaller-dose treatments and includes less-invasive patientpositioning devices. The center also offers a new surgical suite that incorporates a mobile 3-Tesla MRI system that can travel to each of the suite’s operating rooms, allowing real-time imaging during procedures. The suite’s operating rooms are dedicated to separate surgical procedures, while a separate room is used for diagnostic imaging. Designed to enhance neurosurgery outcomes, the suite brings the most sophisticated intraoperative imaging to each of its operating rooms. M Health Fairview is also engaged in multiple clinical trials of treatments for brain cancer and other brain tumors. 

To learn more about the neurosurgery suite, go here

To find current clinical trials available through  M Health providers, visit studyfinder.umn.edu.

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