Steve’s Adaptive Hybrid Surgery for a Brain Tumor

When Steve went to his doctor for a toothache, he didn’t think much of it. For years, he had various aches – a toothache, puffiness in his face – that he would treat for the pain and they would go away. Eventually though, a combination of numbness on the side of his face, his gums and his tongue brought him to the dentist. But his teeth were fine and the dentist referred Steve to an ear, nose and throat specialist to do an MRI to double-check. The MRI revealed a tumor about the size of a golf ball.

By the time Steve met Orin Bloch, MD, at Northwestern Memorial Hospital, he was in trouble. The tumor had grown and was compressing his brain, causing headaches, facial pain and difficulty chewing. If untreated, he could permanently lose his hearing and balance. Untreated, he could develop difficulty walking and with daily function. Steve received radiation therapy before coming to Northwestern Memorial Hospital, but symptoms began to worsen. The need to act to preserve Steve’s everyday life was urgent.

Steve loves spending time with his family, loves playing drums in his band, loves traveling for work and in every single case, his brain tumor changed the shape of his everyday. “My brain tumor took me out of my social stuff, my band stuff and work as well,” Steve remembered. “I tried to maintain as much as I could, but my symptoms weren’t allowing me to do that.”

“I got nauseous, I was vomiting all the time,” Steve remembered. “Plus, the headaches and the numbness of the side of my head. Dr. Bloch took one look at it and said, the tumor is not shrinking, it’s growing. That’s why your symptoms are getting worse. He said it can get worse and worse to the point that I could have real serious problems.”

In most cases, benign tumors like Steve’s can be left alone with periodic observation. The small ones you can radiate. But when the patient is symptomatic, like Steve was, they really need to be removed with surgery.

“The traditional approach would be to operate until the tumor is entirely removed or until no more can be safely removed,” Dr. Bloch explained. “It’s a matter of the surgeon’s expertise.”

Yet, even with the highest level of expertise, patients can still experience surgical complications ranging from hearing loss and numbness to, in extreme cases, brain stem injury. And so the approach to these types of tumors has evolved. Now, neurosurgeons are more comfortable using a combination of surgery to reduce the size of the tumor and radiation to control what’s left.

Striking this balance can be difficult. “If you try to operate until you’ve reduced the tumor to a good size to be controlled by radiation and then give the radiation, you’re not really sure in the operating room whether you’ve achieved your goal,” Dr. Bloch explained. “Because you don’t have information in the operating room about what’s actually being left as you’re operating or what the radiation dose plan would look like for that tumor.”

Dr. Bloch proposed adaptive hybrid surgery. A technique developed at Northwestern Memorial Hospital, at the time of Steve’s surgery, Dr. Bloch and his team were the only ones in the country who had the technology. Adaptive hybrid surgery uses new tools to combine surgical imaging in the operating room with the information a radiation oncologist uses after the operation.

“Now, as we’re actually doing the operation, we can estimate how much tumor is left, generate a radiation plan, look at how much radiation dose the tumor is receiving and the structures around it are receiving,” Dr. Bloch explained. “We can decide at any moment, in real time, whether it’s safe to stop and treat the patient with radiation, and what the outcome would be or whether we should continue operating.”

Other centers have adopted the technique, but no one has comparable experience with it. And Northwestern Medicine has expanded on it, too, incorporating intraoperative CT scanning that fuses the CT scan data with the adaptive hybrid surgery data for an even more accurate assessment in the operating room. With or without the new technology, operating on tumors requires someone with considerable surgical expertise, someone who does a lot of these. Northwestern Memorial Hospital is one of the highest volume brain tumor centers in the country.

Being a high-volume hospital does not, however, take away from the personal care. “The hospital was big and the nurse came down and walked us through the whole thing, she probably had many other things to do but she made you feel very relaxed in a big hospital. I can’t say enough about the staff there, they just made you feel so comfortable. They made you feel like you were the only patient there.”

Steve remembers how the surgeons and nurses came to visit after his surgery and checked in at his follow-ups. And he could be seeing them again soon – in a rather more festive environment. The next time his band plays downtown, his care team is planning an outing to see the show.