In brain tumor treatment

The future of epilepsy surgery for tumors depends largely on the development and practical applications of current research trends. In the operating room, the use of robotics and real-time MRI continues to decrease mortality and morbidity. Further research on invasive EEG monitoring and electrocorticography should improve the guidance of surgical resection and enhance postoperative seizure freedom. The inception of intraoperative image-guided neurosurgery has further optimized the ability to achieve the greatest area of resection and assess for potential complications.182,183 Such technology could be applied to functional magnetic resonance imaging (fMRI) so that eloquent cortex can be more precisely identified during surgery.

A cure for primary brain tumors and metastatic disease awaits developments outside the operating room. Current trends include the use of:184

• boronated compounds, which may spare normal cells
• radioactive compounds attached to “cancer-seeking” molecules
• gene therapy
• antiangiogenesis therapy
• immunotherapy

Although at this time such technology has not made a definitive impact on treatment, one must only consider what doctors of a century ago would have thought about the medical and surgical progress that has occurred since the early twentieth century.

Adapted from: Mangano FT, McBride AE, and Schneider SJ. Brain tumors and epilepsy. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;175–194.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised March 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.