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Attacking Brain Tumors in the OR and the Laboratory

The brain tumors Albert Kim, MD, PhD, sees are often the most difficult to treat. As a physician-scientist, he attacks them on two fronts—the operating room and the laboratory.

As a Washington University skull base and oncologic neurosurgeon at Barnes-Jewish Hospital and the Siteman Cancer Center, Kim’s expertise is in treating tumors located deep in hard-to-access parts of the brain.

“With brain tumors, it’s as much about location as it is about being benign or malignant since the brain controls so much of what we do, controls so much of who we are,” Kim says.

Advances in technology have made surgery safer and more precise, he adds. At Barnes-Jewish Hospital, these advances include neuronavigation, which helps neurosurgeons plan surgery and allows them to make smaller incisions to reach the tumor. The Monteris stereotactic guidance system is essentially GPS designed to guide surgeons through the brain.

Barnes-Jewish Hospital is one of the few centers in the United States with intraoperative MRI (iMRI). By generating images during a procedure, this technology allows surgeons to better judge tumor margins. It also reduces the frequency of the patient’s need to have another surgery.

“It’s common with a tumor resection that a post-op MRI shows a small margin of tumor remaining that requires neurosurgeons to perform another surgery,” Kim says. “But with intraoperative MRI, we can scan patients while they’re still in the OR and take care of any issues immediately.”

He says since brain tumor location is so important, he evaluates surgery using a risk-benefit analysis. “We achieve a better benefit ratio with intraoperative MRI. The advantage of this technology is we can monitor the critical structures around the tumor and take more of the tumor out.”

Advances in mapping brain function, spearheaded by neurosurgeons at Washington University, also have made tumor surgery safer.

In addition to leading technology available in the neurosurgery suites at Barnes-Jewish Hospital, the skilled staff and multidisciplinary support from Siteman oncologists and radiologists are optimal for treating patients with complex issues, Kim says.

“Patients with brain tumors often have other preoperative conditions that require the help of other physicians, such as internists and cardiologists, to make sure patients can withstand the treatment.”

Despite technological and treatment advances, many brain cancers are still not curable, Kim adds. This drives Kim to study brain tumors on a molecular level in his lab. Currently, he is looking at the role of stem cells in tumor growth.

“My focus in the past has been on development of the brain,” he says. “I want to take advantage of what we know about how the brain develops to confront malignant tumors of the brain. As devastating as brain tumors can be, it’s an exciting time. It’s a time of hope.”

More information about the treatment of brain tumors at Barnes-Jewish Hospital is available here.

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