Within the UW Medicine system, every type of tumor is treated, including gliomas, astrocytomas, glioblastomas, meningiomas, acoustic neuromas, schwannomas, pituitary adenomas, chondromas, medulloblastomas, ependymomas, and esthesioneuroblastomas. Our experience with tumors is the largest in the Pacific Northwest and one of the largest in the US.

Each hospital within the UW Medicine system has the latest technology in diagnosing and treating tumors of the nervous system. For example, high-resolution MRI scanning of the peripheral nervous system, developed at the University of Washington, is capable of identifying tumors that other MRI scanners miss.

In the case of brain tumors, surgery has three goals:

1. verify a diagnosis
2. decrease the effects caused by the pressure of the tumor mass within the skull
3. safely remove as much of the tumor as possible.

Surgical tools include intra-operative CT scanning, stereotactic biopsy frames (developed by a UW Medicine physician), brain mapping and 3D frameless navigational systems.  For those patients requiring radiation, there is the Gamma Knife Center at Harborview Medical Center and LINAC and proton beam therapy at the UW Medical Center.

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For most patients, an MRI scan is administered the day they arrive for surgery.  An intra-operative ultrasound is used in conjunction with the operating microscope and the MRI-based intra-operative navigation system to look at the brain.

Figure 1 shows the ultrasound being used to delineate the tumor prior to opening the coverings of the brain (the dura).

Figure 2 shows a combination ultrasound and vascular Doppler image of the tumor. This enables visualization of the tumor and the surrounding blood vessels.

From the MRI scanner, the patient is transferred to the pre-operative area, where an IV is administered under the care of an operating room nurse and anesthesiologist. From there, the patient is taken into the operating room.

The patient is then placed under anesthesia. Motor mapping and sensory mapping can be performed with the patient under general anesthesia.

Some mapping, such as language mapping, require the patient to be awake during the mapping. In such cases, the patient is kept under anesthesia (asleep) except during the mapping part of the procedure.

(For more on mapping, see Functional Brain Mapping)

Usually, medications are tried before surgery, which is considered the treatment of last resort.

Brain tumors usually require surgery. This may be a biopsy to obtain a definitive diagnosis, or a larger operation to remove the tumor.

The surgical treatment of epilepsy is undertaken to remove the area of the brain where seizures begin. Tumor patients cared for by UW Medicine are evaluated by a multi-disciplinary team of specialists.

Each patient’s case is reviewed by this team at our weekly Neuro-Oncology Tumor Board meetings in order to determine the best treatment plan for each patient.

The prognosis for brain tumors depends on the type of tumor and grade of malignancy. For some tumors, surgery is curative. For others, it is part of a multi-step treatment program. For some brain tumors, surgery is curative. Others require additional therapies after surgery to address invading tumor cells.

For the most malignant brain tumors, surgery is the first step of an aggressive, multi-step treatment.

Following epilepsy surgery, patients who are seizure-free can begin the process of stopping anti-convulsant medication six months after surgery. Patients who remain seizure-free at two years rarely have recurrent seizures.

Surgical risks will vary depending on the size, location and type of  tumor.  However, advances in technology and diagnostic accuracy now enable surgeons to work precisely and with amazing efficiency and reliability. 

Surgical incisions have been reduced to an absolute minimum. Also, smaller incisions, less tissue trauma, and better surgical planning have significantly reduced the risk of brain surgery.