Dr. Frederick Lang
Our neurosurgeons perform more complex surgeries on brain tumor patients than any hospital in the nation. The Cranial section manages all brain tumor types including gliomas (glioblastomas, astrocytomas, oligodendrogliomas), intraventricular tumors, pineal region tumors, thalamic and brainstem region tumors, hemangioblastomas, ependymomas and meningiomas. Additionally, our neurosurgeons treat patients with brain metastases, who require advanced treatment approaches provided through a dedicated Brain Metastasis Clinic. Brain tumor treatment involves a multidisciplinary approach which includes surgery, radiation therapy, chemotherapy and targeted therapy. Our team uses cutting-edge technology, including Gamma Knife Radiosurgery, the iMRI Suite, laser interstitial thermal therapy (LITT), 5-ALA fluorescent technique to maximize tumor resections, specialized brain mapping including awake craniotomy and electrocorticography techniques carefully planned with patient's lifestyle in mind. All these interventions have resulted in superior oncological outcomes and improved survival for the patients. Our surgeons are also actively involved in recruiting patients to clinical trials to provide comprehensive surgical care that fits their specific tumor type and location.
Cranial cases (including skull base) by fiscal year
- 2018: 1,447
- 2019: 1,636
- 2020: 1,275
- 2021: 1,362
- 2022: 1,289
Ian E. McCutcheon, M.D., FRCS(C)
Surgery of pituitary neoplasms, spinal and brain tumors, neurofibromatosis, Gamma Knife Radiosurgery
Christopher A. Alvarez-Breckenridge, M.D., Ph.D.
Surgery for primary and metastatic brain tumors, immunotherapy, Gamma Knife Radiosurgery
Jeffrey S. Weinberg, M.D.
Professor and Deputy Chairman
Vice Chair of Clinical Operations
Primary and metastatic brain tumors, pediatric brain tumors, computer-assisted surgery for biopsy and tumor resection, surgery for tumors in eloquent brain regions, Gamma Knife Radiosurgery
Sujit Prabhu, M.D., FRCS (Ed)
Surgery for primary and metastatic brain tumors, surgery for tumors in eloquent brain regions, brain mapping, laser interstitial thermal therapy, Gamma Knife Radiosurgery
Betty Kim, M.D., Ph.D.
Primary and metastatic brain tumors, nanomedicine and immunotherapy for brain tumors, Gamma Knife Radiosurgery
Chibawanye I. Ene, M.D., Ph.D.
Surgery for primary and metastatic brain tumors in eloquent brain regions, Laser interstitial thermal therapy, Gamma Knife Radiosurgery, viral and macrophage therapies for brain tumors.
Al-Holou WN, Suki D, Hodges TR, Everson RG, Freeman J, Ferguson SD, McCutcheon IE, Prabhu SS, Weinberg JS, Sawaya R, Lang FF. Circumferential sulcus-guided resection technique for improved outcomes of low-grade gliomas. J Neurosurg. 2022 Jan 7:1-11. doi: 10.3171/2021.9.JNS21718. Epub ahead of print. PMID: 34996044.
Low grade gliomas (LGGs) can infiltrate the functional brain, which make resection of these tumors technically challenging. While pre-operative and intraoperative imaging and awake mapping techniques have facilitated improved resection, the ideal surgical technique for resecting LGGs is not defined.
While most neurosurgeons use an intralesional or piecemeal approach (PMR) to resect LGGs, our neurosurgeons at MD Anderson have increasingly used a circumferential or sulcus-guided resection (SGR) technique. In PMR, the resection remains within the tumor, whereas in the SGR, the edges of the tumor are defined using the surrounding sulci as a guide and the tumor is resected circumferentially at its interface with the brain, without entering the core of the tumor. In this article, a detailed description of SGR is provided. It also includes the results of a study that evaluated the extent of resection and associated surgical complications with SGR and PMR for LGGs in 519 patients, with 208 in the SGR group and 311 in the PMR group. Both univariate and multivariate analysis demonstrated that SGR resulted in greater extent of resection compared with PMR, and that smaller tumor volumes were associated with a greater extent of resection.
The results of this study demonstrated that SGR was at least as safe as PMR with no significant differences between the groups in terms of neurological complications. While a larger study with more extensive analysis is needed to evaluate survival benefit after SGR, this study supports the idea that SGR should be considered for LGGs, including in eloquent brain regions, because it is associated with a higher rate of complete resection.
Cranial Cases Fiscal Year 2022
Stereotactical Radiosurgery Cases
Our skull base team is widely recognized for its extensive experience and surgical expertise. Our surgeons have been at the forefront of surgical advancements in open and endoscopic skull base surgery. For every patient, the team considers whether an open, endoscopic or combination approach will be most effective based on the specific tumor type and location. Providing expertly performed surgery, often as part of a carefully constructed, personalized multimodal care plan, is critical in optimizing our patients' outcomes.
The skull base section manages complex tumors of the skull base, including meningiomas, acoustic neuromas (also known as vestibular schwannomas), trigeminal schwannomas, jugular schwannomas, paragangliomas, glomus tumors, craniopharyngiomas, pituitary tumors, and several types of malignant skull base tumors including chordomas, chondrosarcomas, and sinonasal cancers. The most common skull base tumor locations include the intratemporal fossa, jugular foramen, clivus, foramen magnum, sella turcica, anterior cranial fossa, petrous apex, middle cranial fossa, temporal bone, posterior fossa, sinonasal tract, nasopharynx, orbit, parapharyngeal space, cavernous sinus, cerebellopontine angle and cranial nerves.
Our team utilizes several advanced technologies, including Gamma Knife Radiosurgery, virtual reality surgical planning, proton therapy, a hybrid operating room with intraoperative angiography and intraoperative MRI, endoscopic surgical suites, exoscopic technology and molecular diagnostics.
Skull base tumor cases by fiscal year
- 2018: 187
- 2019: 208
- 2020: 174
- 2021: 195
- 2022: 184
J Neurosurg. 2021 Oct 8:1-9. doi: 10.3171/2021.5.JNS21772. Epub ahead of print. PMID: 34624857
Tumors that arise in the nasal cavity and the paranasal sinuses often involve the antior skull base and may extend intracranially. These malignancies have been managed using a variety of surgical approaches, with a more recent shift towards the incorporation of endoscopic surgical techniques.
The long-term clinical outcomes and risks associated with surgical management of sionasal tumors extending to the anterior skull base have not been extensively studied. In this study led by Dr. DeMonte, the authors evaluated the clinical outcomes in 225 patients who were treated at MD Anderson over a period of 28 years for these types of tumors.
To account for differences in the surgical techniquest and adjuvant multimodal therapies used over time, patients were stratified by the time period (decade) during which they were treated. Interestingly, while the frequency of higher-stage disease at the time of surgery increased over time, median overall survival remained stable. The rate of major complications significantly decreased from the first to the third decade studied. The use of a lumbar drain was a significant predictor of complications.
Overall, this study found that the surgical management of sinonasal malignancies with anterior skull base involvement was safe, and that the safety of surgery has improved over time most likely due to the increased use of endoscopic surgical techniques and the avoidance of the routine use of lumbar spinal drains.
Skull Base Fiscal Year 2022
Total Skull Base Cases
Stereotactic Radiosurgery Cases
Skull Base: Pituitary Tumor Program
We provide comprehensive surgical care for the whole range of neuroendocrine tumors and cysts growing from the pituitary gland and for tumors growing from structures next to the pituitary that can affect it secondarily. These include pituitary adenomas (those that secrete hormones and those that do not), craniopharyngiomas, pituitary carcinomas, metastases to the pituitary from cancers elsewhere in the body, meningiomas, chordomas and Rathke’s cleft cysts. We aim to control and cure these tumors to improve patients’ hormone function, protect their vision, and thus enhance their quality of life safely and with compassion.
Our surgeons have 40 years of experience between them and have operated on more than 2,000 patients with pituitary pathology during their careers. We believe in providing safe, effective and expert care for our patients with neuroendocrine tumors, and work hard to maintain good communication with referring physicians about their patients. Our excellent clinical outcomes and extensive record of publications on pituitary disease are foundational to maintaining MD Anderson as a center of excellence for pituitary tumor care.
Pituitary tumor cases by fiscal year
- 2018: 85
- 2019: 72
- 2020: 58
- 2021: 91
- 2022: 81
Santos-Pinheiro F, Penas-Prado M, Kamiya-Matsuoka C, Waguespack SG, Mahajan A, Brown PD, Shah KB, Fuller GN, McCutcheon IE. Treatment and long-term outcomes in pituitary carcinoma: a cohort study. Eur J Endocrinol. 2019 Oct;181(4):397-407. doi:10.1530/EJE-18-0795. PMID: 31349217.
Pituitary carcinoma is a rare neuro-endocrine tumor which has historically been difficult to manage. Typically, surgery, radiation therapy or a combination of both are recommended and chemotherapy is used if surgery or radiation is not possible. Unfortunately, response to therapy is not long-term and the disease recurs in many patients, with poor prognosis.
In this article, the authors conducted a retrospective review of 17 adult patients with pituitary carcinoma who were seen over a 22-year period at The University of Texas MD Anderson Cancer Center. These patients had received multiple types of treatment for their pituitary carcinoma including surgery, radiation and chemotherapy.
The study evaluated the time that it took for the patients to have a recurrence or progression of their tumor after each type of treatment. In this group of patients, the median time between diagnosis and first recurrence of the disease was longer in patients who were treated with the chemotherapeutic agent temolozolomide (TMZ) up front.
Additionally, based on their analysis, combination therapy with surgery, radiation and chemotherapy (particularly TMZ) may result in prolonged survival. The authors conclude that management of pituitary carcinoma with multidisciplinary care and multimodality therapy, particularly therapy including TMZ, is beneficial.
Our spine surgeons are widely recognized for their extensive experience and expertise, performing more spine tumor surgeries than any other hospital in the nation. Known for our innovation, we utilize advanced technologies including intraoperative imaging, spinal navigation, laser interstitial thermal therapy (LITT), and minimally invasive techniques to optimize outcomes for each individual patient. Many of these advances have been developed and optimized at M.D. Anderson. Moreover, we collaborate extensively with colleagues in plastic surgery, vascular surgery, colorectal surgery, orthopedic surgery, and head and neck surgery to bring multidisciplinary surgical expertise to our complex patient population.
Beyond the operating room, we work hand-in-hand with our radiation oncologists, medical oncologists, pain management specialists, and physiatrists. We recognize that expertly performed surgery is only one part of the carefully designed, personalized, multimodal plan of care needed to offer the best results for our patients.
The spine section treats patients with primary and metastatic tumors of the spinal column, spinal cord, and peripheral nerves. Primary bone tumors include hemangioma, aneurysmal bone cyst, osteoblastoma, giant cell tumor, chordoma, chondrosarcoma, osteosarcoma, Ewing’s sarcoma, and soft tissue sarcomas. We specialize in techniques of en bloc resection (removing the tumor in one piece) needed to provide patients with malignant bone tumors the best chance of cure. Tumors of the intradural space (including the spinal cord) include meningioma, schwannoma, neurofibroma, ependymoma, astrocytoma, and hemangioblastoma. We also have a world-class program for treating spinal metastases (tumors that have spread to the spine from other organs including the breast, kidney, lung, colon, prostate, etc.).
In collaboration with our radiation oncologists, we have built one of the busiest spinal stereotactic radiosurgery programs in the world. This technology allows us to deliver high-dose, focused, conformal radiation to spine tumors, improving our ability to treat symptoms and protect neurologic function. Used in conjunction with our minimally invasive stabilization techniques, laser interstitial thermal therapy, and vertebral augmentation, we are able to treat spinal metastases with fewer complications and shorter hospital stays, allowing our patients to return to an active life.
Spine tumor cases by fiscal year
- 2018: 253
- 2019: 264
- 2020: 233
- 2021: 263
- 2022: 207
Laurence D. Rhines,
Professor | Director, Spine Tumor Program
Surgery for primary and metastatic spinal tumors, spine stereotactic radiosurgery
Claudio Tatsui, M.D.
Surgery for spine and spine tumors, application of local delivery technologies to the treatment of brain and spinal tumors, laser interstitial thermal therapy for spine
Outcomes of Surgery for Sacral Chordoma and Impact of Complications: A Report of 50 Consecutive Patients With Long-Term Follow-Up. Zuckerman SL, Lee SH, Chang GJ, Walsh GL, Mehran RJ, Gokaslan ZL, Rao G, Tatsui CE, Rhines LD Global Spine J. 2021 Jun;11(5):740-750. doi: 10.1177/21925682211011444. PMID: 34047643; PMCID: PMC8165918.
Sacral chordomas are primary bone tumors found along the axial skeleton, most commonly arising in the sacrococcygeal region.
While en bloc resection is the preferred treatment for sacral chordomas due to the limited response of these tumors to radiation and chemotherapy, the large size of many sacral chordomas at diagnosis and complex anatomy of the sacropelvic region often make this approach difficult and increase the risk of surgical complications. As such, it is important to identify whether perioperative factors, such as surgical complications, predict postsurgical outcomes in these patients.
A series of 50 patients who underwent en bloc resection of a sacral chordoma at MD Anderson Cancer Center from January 1995 to June 2016, was reviewed. After a median of 5.3 years of follow-up, our team, led by Laurence Rhines, M.D., found that while negative margin resection was associated with a decreased risk of local recurrence, major complications and reoperation did not significantly impact overall survival, local recurrence, or functional outcome.
Therefore, it appears that the inherently high surgical morbidity associated with these invasive operations does not adversely alter the trajectory of survival and recurrence.
Spine Cases Fiscal Year 2022
Total Spine Cases
Spine Peripheral Nerve Tumor Program
We provide safe, compassionate, careful and effective surgical care for patients with all varieties of tumors arising in peripheral nerves. This includes benign nerve sheath tumors such as neurofibromas and schwannomas that are associated with the genetic syndromes neurofibromatosis and schwannomatosis, more aggressive, malignant nerve sheath tumors such as malignant peripheral nerve sheath tumors (MPNST), perineuromas, ganglioneuromas, desmoid tumors, neuromuscular choristomas, intraneural ganglion cysts and neuromas. We aim to control and cure these tumors to reduce patients’ symptoms, including pain, weakness and numbness, and in so doing, enhance their quality of life.
Our two surgeons specializing in peripheral nerve surgery serve a clinic that follows 1,600 patients, the largest in North America. Many of these patients require surgical care on multiple occasions. We operate in all areas of the body to remove nerve tumors while sparing the nerve of origin and employ intraoperative nerve monitoring. When needed, we are adept at restorative surgery (including nerve grafts, nerve transfers and regenerative peripheral nerve interface). Our excellent clinical outcomes, wide-ranging publications on nerve tumors and collaborative care involving a neurologist who coordinates medical care for these patients make this a center of excellence without peer in this country.
We are leaders in education on surgical techniques for treating peripheral nerve tumors, done both didactically and through directed participation in clinical care. We participate actively in postgraduate education through lectures in national and international forums and our involvement in hands-on courses and workshops. Our innovative clinical trial protocols and basic research in this area make us a unique venue to learn the principles and nuances of serving patients with simple and complex nerve tumors, whether benign or malignant in character.
Peripheral nerve tumor cases by fiscal year
- 2018: 29
- 2019: 28
- 2020: 22
- 2021: 21
- 2022: 40
E. McCutcheon, M.D., FRCS(C)
Professor | Director, Peripheral Nerve Tumor Program
Surgery of peripheral nerve tumors, neurofibromatosis, pituitary neoplasms, spinal and brain tumors, Gamma Knife Radiosurgery
Robert North, M.D., Ph.D.
Brachial plexus and peripheral nerve tumors, nerve reconstruction, nerve transfers for functional restoration, nerve entrapments including carpal tunnel syndrome, cubital tunnel syndrome, and peroneal neuropathy
Landry JP, Schertz KL, Chiang YJ, Bhalla AD, Yi M, Keung EZ, Scally CP, Feig BW, Hunt KK, Roland CL, Guadagnolo A, Bishop AJ, Lazar AJ, Slopis JM, McCutcheon IE, Torres KE. Comparison of Cancer Prevalence in Patients With Neurofibromatosis Type 1 at an Academic Cancer Center vs in the General Population From 1985 to 2020. JAMA Netw Open. 2021 Mar 1;4(3):e210945. doi: 10.1001/jamanetworkopen.2021.0945. PMID: 33734413; PMCID: PMC7974640.
Neurofibromatosis type 1 (NF1) is a complex genetic disorder which can result in the development of benign and malignant tumors. Although it is known that NF1 is associated with the development of tumors, the risk of developing specific types of tumors in those patients with NF1 is not known.
This large study of patients diagnosed with NF1 between 1985 and 2020 was conducted to determine the prevalence of specific tumor types in NF1 patients, collect information on how their disease was treated or managed and what their clinical outcomes were.
This study found that patients with NF1 develop tumors more frequently and at a younger age than the general population, and the most common tumor types were low grade gliomas, malignant peripheral nerve sheath tumors (MPNST), breast cancer, pheochromocytoma, gastrointestinal stromal tumors (GIST) and melanoma. NF1 patients with undifferentiated pleomorphic sarcoma, high grade gliomas, MPNST, ovarian carcinoma and melanoma had significantly lower disease specific survival rates when compared with patients who developed other types of tumors.
The findings from this study may be useful for follow up and counseling of NF-1 patients and supports a multidisciplinary approach to NF1 patient care.