How Brain and Spine Tumor Care is Advancing

By Ansley Franco

Tumors of the brain and spine often go undetected until symptoms become difficult to ignore. But for University of Alabama at Birmingham neurosurgeon Phillip Cezayirli, MD the story often begins with something as routine as a headache. It ends with an MRI revealing a far more serious concern.

“The most common brain and spine tumors we see in our practice are metastatic,” he said, referring to tumors that originate in other parts of the body—often the lungs, breasts, or kidneys—and migrate to the brain or spine. Primary tumors, like meningiomas, gliomas, schwannomas, and pituitary tumors, are also common, though many are discovered incidentally. 

“Someone has a headache, and they finally get imaging, typically a CT scan first, and then usually an MRI after, and they find that they have a tumor,” Cezayirli said.

One reason for the increase in incidental findings is that imaging itself has improved drastically. CT and MRI scans now offer ultra-high resolution, down to 0.1 millimeters, or about 100 microns, which approaches the size of a single cell. Imaging technology has advanced to the point where the goal is no longer to see below 100 microns. The challenge now is waiting for screen resolution to catch up so that those details can be displayed.

Another update in software is NeuroQuant. This technology utilizes AI to segment the brain and track changes in volume over time. It was originally developed for Alzheimer’s, but is now used to detect and monitor brain tumors. Other platforms like Vis.AI and Rapid.AI can do similar work for lung and brain CT scans to flag subtle lesions that might be overlooked by the human eye.

“Artificial intelligence and machine learning are getting so good that they can alert us to a lesion that maybe we didn’t know about or see,” Cezayirli said.

Improved detection is only a portion of the advances in care that tumor patients can receive. Once a tumor is discovered, newer treatment options are expanding what’s possible for people, often without invasive surgery.

Among the biggest breakthroughs are ipilimumab plus nivolumab, also known as ipi-nivo. These are types of targeted immunotherapy that work by blocking certain proteins and help your immune system find and kill cancer. The combination has shown success in treating metastatic melanoma brain tumors.

Surgical approaches are evolving, as well. Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that uses a small needle probe to heat and destroy tumors deep in the brain. The incision is so small that patients often heal quickly and can begin chemotherapy or radiation much sooner.

“The thought is you can do a biopsy at the same time with the LITT. Since it’s such a tiny incision, it heals fast. The odds of having issues from that are fairly low, so they can get the radiation and chemotherapy much faster. Soon they could use it for spine tumors, as well,” Cezayirli said.

In other cases, intraoperative radiation therapy (IORT) is being used for brain and spine tumors. This method allows radiation to be delivered during surgery, directly into the tumor site. “You remove the tumor and you put the radiation in, but the radiation is so minimal that only the area that you want to treat gets radiation,” Cezayirli said.

For patients undergoing tumor resection, GammaTiles, which are small radiation-emitting implants, can be left in the brain after surgery to continue treating the area over the following weeks.

“It allows us to put one-by-one centimeter and two-by-two centimeter pledges into the area of the tumor we resected. We leave it in there and it produces radiation over the next few weeks, and we do that at the end of the resection,” Cezayirli said. “These allow people to get the radiation faster, rather than having to wait for them to heal after resection. They’re working on implications beyond the brain.”

Sharper scans, smarter software and more targeted therapies have introduced a new wave of care for the outcome of patients’ who are diagnosed with brain and spine tumors.