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Siteman’s innovations in brain tumor surgery are advancing treatment

Washington University School of Medicine

Siteman is a nationally renowned leader in brain tumor treatment. Experts at our Brain Tumor Center have developed some of the latest innovations in brain tumor surgery to optimize patient outcomes. 

Which patients might be in need of brain tumor surgery?

Eric Leuthardt, MD, inserts a small laser probe with the assistance of an intraoperative robotic system.

Brain tumors – whether benign or malignant – can cause serious health issues and may be life-threatening. Benign tumors do not spread and are non-cancerous. That said, they can still grow and put pressure on the inside of the skull. Malignant tumors, on the other hand, are cancerous and grow quickly, invading surrounding brain tissue. Benign tumors have clearly defined edges and aren’t typically deep within the brain tissue. For this reason, they are easier to remove as long as they’re in a spot that a neurosurgeon can easily reach.

Doctors typically perform surgery to remove all or part of a brain tumor. However, there are cases in which surgery may not be the best treatment option. For instance, if the tumor is benign, small and not causing problems, your doctor may simply recommend observation with regular MRIs. Additionally, your doctor may recommend other treatment options if:

  • The tumor is close to other vital structures
  • You can’t undergo surgery for other health reasons

Age and brain tumor surgery

Pediatric brain tumor surgery is different from brain tumor surgery in adults. Most treatment plans for pediatric brain tumors require surgery, or at least a biopsy. Radiation therapy may follow surgery, but treatment teams usually avoid this for children under the age of 3. This is because radiation can interfere with brain development. Children who go through brain tumor treatment may experience long-term cognitive and motor problems.

The types of brain tumors in adults differ from those found in children. Most adult brain tumors are metastatic (the result of cancer that has spread from elsewhere in the body). In contrast, most pediatric brain tumors are primary (originating in the brain and not always cancerous). Children with brain tumors generally have a better prognosis than adults with a similar condition.

If you have fears about your brain tumor surgery, you’re not alone

If you have found out that you have a brain tumor and your doctor has recommended surgery, you are likely feeling a wave of emotions. Learning that you need to have brain surgery can be particularly frightening and there are many concerns you may have. Some common fears brain tumor patients have prior to surgery include:

  • Scarring
  • Loss of hair
  • Loss of motor function
  • Reduced mental capacity
  • Emotional and/or behavioral changes

It’s natural to have fears about brain tumor surgery. After all, the brain is what makes us who we are. While you may be feeling afraid, you can take comfort in knowing that Washington University neurosurgeons are national leaders in performing image-guided and minimally invasive procedures that minimize tissue damage and pose fewer risks to patients. As a brain tumor patient at Siteman, know that you will be in expert hands.

“GPS for the brain, endoscopy, intraoperative MRI, plus all of the newest imaging technologies. There is no other department out there that has all of these tools under one roof.” – Dr. Albert Kim

The Siteman approach to brain surgery

Washington University Physicians at Siteman have pioneered innovative brain tumor surgery techniques. By combining their expertise with state-of-the-art technology, they give patients the best possible chances for positive outcomes. Our experts perform the following brain surgeries:

  • Awake craniotomy: our neurosurgeons have developed advanced brain mapping techniques, including intraoperative cortical stimulation mapping and cortical physiology. Surgical teams use these techniques with awake craniotomy. Advanced brain mapping makes it possible to perform more aggressive surgery in sensitive areas while preserving function.
  • Intraoperative MRI: our neurosurgeons use intraoperative imaging and neuronavigational techniques in order to perform safer and more precise maximal brain tumor resection. Neurosurgeons at Barnes-Jewish Hospital have performed more intraoperative MRIs than those at any other hospital in the United States.
  • Fluorescence-guided surgery: our neurosurgeons were among the first in the United States to use 5-ALA, a fluorescent agent that improves visualization of certain brain tumors. The major advantage of 5-ALA is that information is immediately and continuously available to the surgical team.

Minimally invasive brain tumor surgery

Brain tumor patients recover faster, have fewer scars and experience less pain with minimally invasive procedures than they would with other types of surgery. These procedures involve the use of novel technologies to reduce the size and number of incisions while improving precision and accuracy. Siteman offers several types of minimally invasive surgery:

  • Keyhole surgery: the principle of keyhole surgery is to use the smallest possible incision to assess tumors. The surgical team may make the incision on the eyebrow or eyelid and can do so in a cosmetically pleasing way, even for deep-seated or large tumors. Our neurosurgeons often combine these keyhole approaches with thin tubular scopes (called endoscopes). This increases visualization of the tumor and critical brain structures. Recovery is typically faster with these approaches compared to traditional surgeries.
  • Robot-assisted surgery: our neurosurgeons use the advanced ROSA ONE ® Brain to perform safe and precise surgeries through a tiny 4.5 mm hole in the skull. Advanced robotic systems provide greater control and precision while reaching very small areas deep inside the brain.
  • Transsphenoidal surgery: the Washington University Pituitary Center provides patients with access to multidisciplinary specialists and the most advanced technology available to treat pituitary tumors. Our neurosurgeons are skilled at inserting endoscopes into the nose to carefully remove tumors. No incisions are involved and the procedure doesn’t leave any scars on the patient’s face or head.
  • Gamma Knife radiosurgery: Siteman houses the only Gamma Knife in eastern Missouri. Our neurosurgeons perform procedures using the Gamma Knife Icon, the newest and most sophisticated machine available. The procedure requires only one to five treatment sessions at most. Because of this, brain tumor patients come to us from all over the region. Our neurosurgeons have performed more than 5,000 procedures to date.
  • MRI-guided neurosurgical laser ablation: Washington University neurosurgeon Eric Leuthardt, MD, director of the Brain Laser Center and director of the Center for Innovation in Neuroscience and Technology, pioneered the use of the Monteris NeuroBlate® System. This FDA-approved system is an MRI-guided, high-intensity laser probe specifically designed for the treatment of hard-to-access or surgically inoperable brain tumors. The system’s hallmark feature is its ability to use MRI to guide the probe and precisely target laser-generated heat directly into a tumor. This procedure kills cancer cells while sparing surrounding brain tissue. Recovery is generally much quicker than with open surgery.

Brain tumor treatment team

Siteman’s brain tumor treatment team comprises Washington University experts from a wide range of disciplines. Their multidisciplinary approach is what allows them to create the safest, most effective and most personalized brain tumor treatment plans. Our specialists combine their diverse expertise to ensure that each and every brain tumor patient receives only the most exceptional care.

Meet some of the doctors on the brain tumor treatment team:

Albert Kim, MD, PhD


Dr. Kim is Director of the Siteman Brain Tumor Center, Surgical Director of the Pituitary Center, Professor of Neurosurgery, Genetics and Developmental Biology at Washington University School of Medicine, and Co-Leader of the Neurorestorative Therapy Group at the Hope Center for Neurological Disorders. His clinical expertise is brain tumors, skull-base tumors, laser interstitial thermal therapy and Gamma Knife radiation therapy. Dr. Kim is a nationally recognized brain tumor surgeon and researcher who uses multidisciplinary approaches, from genetics and biochemistry to cell biology and preclinical in vivo brain tumor models, to discover new brain tumor treatments.


Eric Leuthardt, MD

Eric Leuthardt, MD

Dr. Leuthardt is Director of the Siteman Brain Laser Center, Director of the Center for Innovation in Neuroscience and Technology, Chief of the Division of Neurotechnology, and Professor of Neurological Surgery and Neuroscience at Washington University School of Medicine. His clinical expertise is neuro-oncology, brain tumors, minimally invasive laser surgery, brain tumors requiring motor and awake speech mapping, surgical treatment of epilepsy and Gamma Knife radiation therapy. Dr. Leuthardt is nationally renowned for his expertise as both a physician and a researcher. He has received numerous accolades for his work in the field of neuroprosthetics and neurosurgical devices, establishing him as a distinguished scientist, neurosurgeon and inventor.


You’ve been diagnosed with a brain tumor. Now what?

If you have received a brain tumor diagnosis, you may be feeling a great deal of fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychological services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

If you are experiencing symptoms and are worried that they might point to a brain tumor, please make an appointment with your primary care provider. If you have received a brain tumor diagnosis and are looking for a second opinion, or if you are exploring treatment options, Siteman is here for you. Please call us at 800-600-3606 to schedule an appointment.