The goal of the Neurosurgery department is to eliminate all tumors of the nervous system, including those of the brain, spine, spinal cord, skull base, and peripheral and cranial nerves, through compassionate and expert neurosurgical care, pioneering research, education, and outreach. The Neurosurgery department at MD Anderson is considered one of the best neurosurgical programs in the country. We treat patients from all over the world and are dedicated to research-driven innovations that revolutionize patient care.
The Neurosurgery department is comprised of clinical operations, educational programs, and ground-breaking research efforts. These pillars support our collaborations with multi-disciplinary teams in the mission to eliminate cancer.
Neurosurgical Cases (Fiscal Year 2023)
Total Neurosurgical Cases
Skull Base Cases
Stereotactic Radiosurgery Cases
- The Cranial section is devoted to the treatment of primary and metastatic tumors of the brain in both adults and children, including glioblastomas, astrocytomas, oligodendrogliomas, brain metastases, intraventricular tumors, pineal region tumors, thalamic and brainstem tumors, using state-of-the-art approaches such as awake craniotomy, intraoperative brain mapping, intraoperative MRI, laser interstitial thermal therapy (LITT), as well as Gamma Knife Radiosurgery and endovascular neurosurgical oncology.
- The Skull Base section focuses on both open and endoscopic surgical procedures for complex tumors of the skull base, including specialized programs in meningiomas, acoustic neuromas, pituitary tumors, chordomas/chondrosarcomas and malignant skull base tumors. In addition to best-in-class surgical approaches, our surgeons are experts in Gamma Knife Radiosurgery treatments for skull base tumors.
- The Spine section manages all types of tumors of the spine, spinal cord, and peripheral nerves with unique expertise in primary tumors of the spine, particularly primary tumors of the sacrum, as well as metastatic spine tumors, intradural and intramedullary tumors. Our surgeons have specialized expertise in advanced technologies such as image-guided surgery, including minimally invasive spine stabilization and spinal LITT, which our surgeons pioneered at MD Anderson. In addition, there are specialized programs in peripheral nerve tumors and cancer pain management.
Within each of our specialties, neurosurgery patients receive care from a multidisciplinary team that includes highly skilled neurosurgeons, medical oncologists and radiation oncologists who provide personalized care and treatment plans. Our advanced practice providers support our neurosurgeons with dedicated inpatient and outpatient teams.
Our advanced operating technologies include the BrainSuite, a specialized operating room with a large bore Siemens Espree (1.5-tesla magnet) MRI and an image-guided management system; the Intraoperative CT Suite, which houses intraoperative computerized tomography within the operating room; and a Hybrid Operating Room with Biplane Endovascular Technology that provides high-definition, real-time, 3D-imaging of brain and tumor blood vessels. Our team also provides the full range of stereotactic radiosurgery with a specialized program in Gamma Knife Radiosurgery.
Our clinical research team manages multiple clinical interventional trials, prospective observational studies and laboratory study protocols. The clinical research team also oversees a valuable database dedicated to collecting and storing data related to neurosurgical cases, which provides extensive information for research and operational purposes.
Our basic and translational research scientists are housed in the Basic Science Research Building with state-of-the-art laboratory technologies. Our scientists explore the basic biological mechanisms underlying the development and growth of primary and metastatic CNS tumors and novel therapeutics for CNS tumors, including oncolytic viruses, targeted agents, immunotherapies and combinatorial approaches with radiation and standard chemotherapy. Our multidisciplinary research teams are funded through multiple federal and state grants, including the NIH-funded Brain Cancer SPORE, and support through the MD Anderson Glioblastoma Moon Shot.
2023–2024 Neurosurgical Oncology Fellows
From left to right:
Scott Seaman, M.D. - Skull Base Fellow
Victoria Clark, M.D., Ph.D.
Matei Banu, M.D.
Evan Bander, M.D.
Neurosurgical Oncology Fellowship
Our Neurosurgical Oncology Fellowship, established in 1991, trains young neurosurgeons to become world-class neurosurgical oncologists and currently offers four neurosurgical oncology fellowship positions and one specialized skull base fellowship position each year. We have trained over 80 fellows, many of whom are presently leading major neurosurgical oncology programs across the country and around the world.
Neurosurgery clinical faculty members are widely recognized for their expertise in primary and metastatic brain tumor surgery, pituitary adenoma surgery, skull base surgery, spinal reconstructive surgery, surgical procedures for pain management, pediatric neurosurgery and stereotactic surgery. The department performs over 1,900 brain, spine and skull base surgeries yearly.
Learn more about the Neurosurgical Oncology Fellowship.
Neurosurgical Residency Program
MD Anderson is one of five hospitals that receive residents from the Baylor College of Medicine Neurosurgery Residency Program.
It has a history as one of the largest and most respected neurosurgery training programs in the U.S.
The residency program was founded and nationally accredited in 1958 and has been continuously funded and accredited yearly.
Learn more about the Baylor College of Medicine Neurosurgery Residency Program.
This state-of-the-art technology improves patient care and meets the evolving needs of MD Anderson’s surgical, interventional radiology and cardiology needs.
The biplane uses rotating cameras to provide high-definition imaging to produce real-time, three-dimensional images of blood vessels and soft tissue. After the body is injected with contrast fluid, the biplane can provide specific localization of a disease or lesion.
The biplane is incredibly precise, making surgery even safer and allowing patients to experience faster recovery. Having the unit in the OR provides for hybrid open surgical and angiographic procedures.
A specialized operating room with intraoperative computerized tomography (IOCT) opened at MD Anderson in the spring of 2016. Our spine surgeons helped design the IOCT suite, complete with a custom surgical table and mobile CT scanner that can move on rails to scan the patient in the operating position during surgery. The technology in this room allows our spine surgeons to operate with even better accuracy.
The Brainsuite® is a neurological operating room with a large bore Siemens Espree (1.5-tesla magnet) MRI and an image-guided management system to give surgeons an improved perspective on the progress of complex neurological surgeries. It is only one of two such systems in the state of Texas. The Brainsuite® can help reduce the need for patients to undergo additional surgeries.
The Neurosurgery department at MD Anderson run dozens of clinical trials for brain, spine and skull base tumors, including newly diagnosed and recurrent glioblastoma.
We also have clinical trials for brain metastases and leptomeningeal disease.
Headaches, seizures and weakness throughout the body can all be potential brain tumor symptoms. Because these symptoms can also be signs of other conditions, how do you know the difference between a common headache and something more serious?
What is a brain tumor?
A brain tumor is an abnormal growth of cells in the brain that might be benign (non-cancerous) or malignant (cancerous). When people think about brain tumors, they most likely think it’s anything that occurs inside the head.
The way brain tumors are categorized depends on where they are in the skull. “Tumors are typically named by the cells that they derive from,” Weinberg says. “For example, astrocytoma is a type of cancer that can occur in the brain or spinal cord. It begins in cells called astrocytes that support nerve cells.”
What are common brain tumor signs and symptoms?
There are a few common brain tumor symptoms. These include:
Red flags include headaches that:
- won't go away after you try over-the-counter pain medication
- make you vomit
- wake you up in the middle of the night
- are worse when you lie flat
“If you have a headache and notice other neurologic symptoms, such as weakness or feeling uncoordinated, these are all warning signs that something may be going on that warrants medical attention,” Weathers says. “It might not mean that it’s a brain tumor, but it’s a sign that you should see a doctor urgently.
A seizure can be related to many different types of diagnoses. For a brain tumor, a seizure might occur because the tumor is irritating that part of the brain. Seizures also vary in how they present. “A seizure doesn’t have to be a big event where someone loses consciousness and shakes all over,” Weathers says. “It can be more subtle than that.” A seizure might target a certain part of the body and cause tingling in the arm or leg, confusion, or trouble speaking.
Changes related to motor function of the brain
Depending on the location of the brain tumor, it ight affect the motor function of the brain. Some people might experience weakness of the face, arms or legs. If a tumor involves a sensory area, a patient may experience numbness.
“The person could also have difficulty speaking, understanding or both,” Weathers says. “And very rarely, if a tumor involves the back part of the brain near the brainstem, they can present with incoordination. This includes difficulty with balance, either with walking or using the arms and legs.”
“If there’s pressure on the cranial nerves, you’re going to have dysfunction from what that nerve does,” Weinberg says. “An acoustic neuroma might present itself through ringing in the ear or weakness of the face. You can have pressure on the nerve that controls the tongue, so your tongue might not stick out straight. Pituitary tumors might cause blind spots. You can have an eye movement disability, and sometimes patients won’t be able to look straight up.”
Are symptoms different for malignant versus benign brain tumors?
Unfortunately, there is no specific symptom that confirms whether someone has a brain tumor, whether it be malignant or benign.
Sometimes, low-grade tumors, such as oligodendrogliomas, have a higher tendency to present with a seizure versus a high-grade tumor such as a glioblastoma, says Weathers. If a tumor is growing rapidly, the patient may experience new headaches that cause nausea and vomiting.
- Related: Glioblastoma symptoms
When should I contact you’re my doctor if I start to notice brain tumor symptoms?
Reach out to your primary care doctor when a symptom is new and different.
“All of these symptoms might be caused by something different, but if symptoms like a headache continue to become more painful or severe over the course of a few weeks, it deserves to be looked at,” Weinberg says.
How will my doctor determine if I have a brain tumor?
Your primary care doctor will most likely evaluate you in person to look for anything abnormal. This evaluation might include imaging tests, such as a CT scan or MRI. If there’s an urgent need for care, such as extreme headaches or a seizure, you may need to go to an emergency room for evaluation.
Brain tumor symptoms can overlap with symptoms related to other medical conditions. Experiencing any of these symptoms does not necessarily mean you have a brain tumor, but it’s important to see a doctor to determine
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Meningiomas are a primary central nervous system tumor that make up 38% of all primary intracranial tumors. They are typically benign and often go undetected for many years. Even though these types of tumors grow slowly over time, they can become life-threatening.
Neurosurgeon and meningioma expert Franco DeMonte, M.D., breaks down what you should know and what to look out for.
What is a meningioma?
A meningioma is a tumor that forms on the outside membranes that cover the brain and spinal cord. These membranes are called meninges. Meningiomas usually do not invade the brain but press on the brain or spinal cord as they grow. They can occasionally grow outward and cause the skull to thicken.
The vast majority of meningiomas are benign. About 20% show more aggressive growth, and 3% or less are cancerous. When making an official diagnosis, a physician will determine the tumor grade. The grades are based on how abnormal the tumor cells look under a microscope and how quickly the tumor might grow, spread or come back after treatment.
“Grade 1 meningiomas are the least likely to reoccur and least likely to have an aggressive growth pattern. They’re also the most common type of meningioma,” DeMonte says. “As you get to a Grade 2, the tumor is more likely to reoccur after it has been removed and may have a more aggressive growth pattern. A Grade 3 meningioma will most likely regrow. This grade is cancerous and the most aggressive and difficult to treat.”
What are symptoms of meningioma?
While some patients will not experience any symptoms, others might have:
- personality changes,
- weakness or numbness of the face or limbs, and/or
- vision changes.
These meningioma symptoms depend on the tumor’s location. As meningiomas get closer to the nerve, the tumor can affect certain senses, including sight, hearing, taste or smell. If you’re experiencing symptoms or have any cause for concern, reach out to your primary care physician. If you’re having trouble with your vision, see an ophthalmologist.
How common are meningiomas?
Meningiomas are more common than people might think. “Let’s take the Houston metropolitan area, for example. We know that for every 100,000 MRIs done between 300 to 900 meningiomas will be diagnosed. Even taking the low number, 21,000 Houstonians will be diagnosed with a meningioma,” DeMonte says. “That’s a lot of people.”
How are people typically diagnosed with meningioma?
Most patients are diagnosed through imaging tests. Often, someone will get an MRI or CT scan for another reason, and their results will show a mass. DeMonte says that an MRI with contrast dye is best for detecting meningiomas. In some circumstances, meningiomas cannot be seen without contrast. The gadolinium-based dye identifies meningiomas with ease and provides an accurate image and diagnosis.
How is meningioma typically treated?
Once you’ve been diagnosed with a meningioma, your care team will personalize your treatment plan based on the tumor grade and symptoms. If a tumor appears to be benign and does not press on the brain or cause symptoms, observation is typically recommended. “If the patient has a small tumor that is not in a critical location and under an inch in diameter, we almost always start with observation,” DeMonte says.
Treatment will be needed if the tumor begins to grow or cause symptoms. For most healthy adults, surgery is the next step. A neurosurgeon will perform a craniotomy to safely remove the brain tumor.
However, surgery might not be the best option for meningiomas in certain locations, and additional treatments are available. “We tend not to operate if you have a meningioma in a location like the cavernous sinus, because surgery brings more risks,” DeMonte says. “We don’t want to risk operating and causing cranial nerve damage. For those patients, we recommend radiation, and if the tumor is small enough, stereotactic radiosurgery.”
If a tumor comes back or if the tumor cannot be fully removed with surgery, patients may undergo radiation therapy to destroy tumor cells and stop them from growing. Chemotherapy is also used to treat meningiomas that come back after surgery and radiation.
While many patients only need surgery, it is important to seek care at a cancer center like MD Anderson that offers multidisciplinary care and sees a large number of meningiomas. That way, your team of experts can work together to coordinate your care and ensure all aspects of your care are supported. “It’s best to go somewhere that can do it all,” says DeMonte.
Will I need continuous care after meningioma treatment?
If you need surgery, recovery time will vary depending on the size and location of the meningioma. Most patients have their energy back at six weeks, and tissues are completely healed around three months.
For patients who only need observation, how often you visit your doctor will depend on your health care needs.
“Some people come in to get checked every 12 months, and some come every three or six months. Then it might turn into once a year or every other year if the tumor has not progressed,” DeMonte says. “I have meningioma patients that I’ve followed for 25 years. We never have to manage those tumors. As time goes on, the frequency of visits decreases unless we catch something on their scans.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
To help you navigate your diagnosis and questions, neurosurgeon Jeffrey Weinberg, M.D., and neuro-oncologist Shiao-Pei Weathers, M.D., break down the most commonly searched questions about brain tumors.
How many types of brain tumors are there?
There are 120 types of brain tumors described in the master neuro-pathology handbook, according to the World Health Organization. While there are many different types of brain tumors, most are extremely rare.
“The types of brain tumors that Dr. Weinberg and I see most often are gliomas and specifically glioblastomas,” Weathers says. “They are not only the most common, but also the most aggressive.”
The Central Brain Tumor Registry of the United States shows that the three most common brain tumor diagnoses include meningioma, glioblastoma and tumors of the pituitary gland. Most pituitary tumors are non-cancerous growths.
- Related topic: Brain tumor symptoms
What causes brain tumors?
Tumors are caused by changes in the DNA of cells. When cells start dividing in a manner that is not controllable, this causes a mass.
Weinberg explains it like this: “Imagine your desk covered with salt, and then sprinkle pepper on top of the salt,” he says. “Those tiny pepper flakes scattered throughout are the tumor cells that have walked away from the mass. The difficulty in treating a tumor is not the mass. I can remove it through surgery. The hard part is treating the tumor cells that are left behind, where chemotherapy has difficulty getting to.”
Often, patients worry that everyday items, like cell phones and hair dye, cause brain tumors. These different exposures might seem toxic, but have not been proven to cause brain tumors. Weathers confirms that the only known risk factor for developing a brain tumor is previous exposure to ionizing radiation. “This might apply to patients who were diagnosed with leukemia at a younger age who underwent radiation treatment to the brain. As a result of that direct radiation exposure to their brain as a child, they are at high risk for developing a secondary brain tumor.”
Some rare genetic cancer syndromes, such as Li-Fraumeni Syndrome, also increase the risk of a brain tumor diagnosis in addition to other cancer diagnoses.
How common is a brain tumor diagnosis?
A brain tumor diagnosis is considered rare compared to other cancer types. “Most general oncology practices in the community may only see a few patients with a diagnosis such as a glioblastoma a year,” says Weathers.
About 700,000 Americans are living with a primary brain tumor, according to the Central Brain Tumor Registry of the United States. Approximately 70% of all brain tumors are benign (non-cancerous), and 30% are malignant (cancerous).
If I have a brain tumor, can I pass it on to my children?
Brain tumors, in general, are not hereditary, unless you have a rare hereditary cancer syndrome like Li-Fraumeni Syndrome. “The overwhelming majority of brain tumors are sporadic or random without risk of passing the diagnosis to your children,” says Weathers.
What treatment options are available for patients with a brain tumor diagnosis?
Treatment depends on the type of brain tumor, as well as the tumor size and location.
“For a newly diagnosed tumor, first we determine the actual tumor type. This can be identified through a biopsy or preferably surgery to safely remove as much of the tumor as possible,” says Weinberg. “If we cannot perform a resection safely or cannot remove enough of the tumor, we will confirm the diagnosis through a biopsy.”
The three most common treatments are surgery, radiation therapy and chemotherapy. For patients who are diagnosed with gliomas or glioblastoma, MD Anderson offers many clinical trial options, which give patients access to cutting-edge treatments such as laser interstitial thermal therapy (LITT) and targeted therapies that aren’t widely available yet.
What should I look for when deciding where to seek brain tumor treatment?
Every patient who visits MD Anderson’s Brain and Spine Center for brain tumor treatment receives personalized care from the nation’s top brain tumor experts. We have one of the most active programs in the country for treatment of benign and malignant brain tumors.
“Because brain tumors are rare, you need a team with the highest level of expertise,” says Weathers. “Brain tumors often carry a poor prognosis, so it matters where you go first for treatment. I tell patients that it can make a big difference in the long run to come some place like MD Anderson from the beginning. We have a dedicated multidisciplinary team of more than 70 highly trained brain tumor experts who will work together to develop a personalized treatment plan for your specific case.”
Weinberg adds: “It might be your first time dealing with a brain tumor, but it’s not ours.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Academic Office: 713-792-2400
Brain and Spine Center: 713-792-6600
The Neurosurgery department is located on the 7th floor of the John Mendelsohn Faculty Center. Get customized directions using our Access system.
1400 Holcombe Boulevard
Room FC7.2000, Unit 442
Houston, TX 77030-4009
The University of Texas MD Anderson Cancer Center
P.O. Box 301402-442
Houston, TX 77230-1402