The Unit of Neurosurgery and Oncology deals with the surgical treatment of intrinsic, extrinsic, primary and metastatic tumors of the central nervous system. Next to the treatment of brain tumors, the Unit is also involved in the surgical treatment of brain lesions associated with drug-resistant epilepsy and epilepsy.
The unit specializes in the treatment of intrinsic tumors (gliomas), especially those in low-grade malignancy, which is one of the points of reference for treatment at national, European and international level.
The treatment is based on the concept of surgical treatment according to functional limitations (functional neuro-oncology), in which surgical resection has as a limit on the detection surface of the brain (cortical), and of the functional areas and their connections within the brain (subcortical level). Thanks to this method (brain mapping and monitoring), one can remove extensively vast brain tumors, localized in critical areas of the brain, while maintaining the functional integrity of the patient.
The basis of this method is the study, in the pre-operative and intraoperative process, of the functioning of the brain of the individual patient through the use of neuropsychology, resonance imaging methods and intraoperative PET advanced imaging methods, and intraoperative neurophysiology. The brain of each patient is unique and its functional organization (its operation) depends on the history of the patient, and it is the result of a series of circuits (networks) that connect various brain areas between them in both cerebral hemispheres. These networks operate in series and each function depends on their degree of functional organization. When a tumor develops in the brain, it interferes with the proper functioning of the system, and the brain adapts to the presence of the tumor and to its growth, by varying the degree of functional organization of the various network systems. This adaptability and compensation, called brain plasticity, is used by the surgeon to effectively remove the tumor and at the same time to maintain the functional integrity of the patient.
The first step to understand the degree of plasticity is the study of brain functioning through neuropsychology and imaging methods. Neuropsychology provides the surgeon with information about the operation and organization of the various functional networks in the brain through a refined and extended examination (neuropsychological assessment) and therefore determines the degree of plasticity. Information obtained with neuropsychology, are integrated with those obtained from imaging methods (functional resonance, fMRI, and tractography, DTI) and PET scans.
At the time of surgery, the surgeon identifies the functions (motor, language, visual, visuospatial, and cognitive) on the surface of the brain and within the network due to intraoperative neurophysiology (the brain works with electricity) and neuropsychology (in this case the patient is awake), and the surgeon is supported in this by intraoperative imaging methods (CT, Ultrasound, Neuronavigation).
Thanks to this method (brain mapping and monitoring), one can perform extensive surgical resection, if possible, even beyond the borders or edges of the tumor revealed by the images (so-called supratotal resection), whilst maintaining the long-term functional integrity of the patient. The rationale of this approach is that tumor cells are also present beyond the edges of the tumor highlighted in resonance images, and the use of these methods allows their safe and effective removal, without altering the functionality of the patient. The larger the tumor resection, the more successful and greater the period of control of the disease is.
A large resection is possible with the expert surgeons of neuro-oncology, functional neurophysiologists and neuropsychologists who are dedicated and work together both before surgery and in the operating room to achieve the objective of extending the maximum surgical resection and maintain the functional integrity of the patient. The presence of anaesthesiologists in the operating room with wide experience of anaesthesia techniques for brain mapping further ensures the success of the procedures. The group of oncological neurosurgery has performed more than 2,000 operations using techniques of brain mapping and monitoring and it is one of the groups and world leaders in the use of such methods in the resection of tumors and lesions associated with epilepsy. The same methods can also be used with the same effectiveness and safety in the resection of metastatic tumors, extrinsic tumors (meningiomas) and vascular lesions such as cavernous angioma, located in a critical area.
The activity of the group of oncological neurosurgery is integrated with that of the group of the neuro-oncology unit at the Cancer Center, as a part of a multidisciplinary treatment process. The multidisciplinary neuro-oncology group brings together the expertise of neurosurgeons, radiotherapists, oncologists, neuro-oncologists, neurologists, neuroradiologists, nuclear medicine physicians, and neuropathologists, relying on the principle that the multidisciplinary approach increases the effectiveness and safety of treatment. The group has defined paths of treatment according to the disease, and every patient is addressed in a specific location based on the type of cancer (histology and molecular structure), type of surgery, age and neurological clinical performance of the patient.