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We've all heard someone quip, "After all, this isn't brain surgery!"

The same could be said for the innovative treatment options being used in the Brain & Spine Tumor Center at Saint Thomas BrainLAB … at least not brain surgery as usual.

Under the leadership of Steven Abram, MD, who directs the center, the use of a high-precision X-Ray Based Patient Positioning System has transformed the treatment of brain tumors, improving outcomes and shortening recovery times.

A collaboration of the Dan Rudy Cancer Center and Saint Thomas Neurosciences Institute, the Saint Thomas Brain & Spine Tumor Center provides advanced care for the treatment of brain and spinal cord tumors from an inter-disciplinary group of specialists in radiation oncology, medical oncology, neurosurgery, neurology and pathology, as well as other support staff.

Saint Thomas is the only facility in Middle Tennessee using Novalis Shaped Beam Surgery, one of the most accurate and advanced approaches to stereotactic radiosurgery and radiotherapy. The system integrates all planning and treatment steps needed for high precision irradiation and provides precise localization of the tumor within the patient's body, an exact definition of its shape and size, and application of the treatment beams from many different directions to keep exposure of healthy tissue to a minimum.

The procedure is virtually painless and usually performed on an outpatient basis, allowing patients to return home the same day. Often one treatment session is sufficient.

When Abram was given the charge to develop the BrainLAB in the late 1990s, he did due diligence to determine the best equipment available, knowing that radiosurgery would be the cornerstone of the program. Saint Thomas was the 15th center in the nation to select the Novalis system, which is now used in more than 40 centers in the United States and 75 international locations.

"Even as a young guy aspiring to be neurosurgeon, as new technologies became available, I latched onto them and was excited by the potential they offered," Abram said, "I am convinced that the future of neurosurgery lies in being able to fine tune our access to the deepest lesions in the brain and use that ability for functional neurosurgery."

Radiation is one of the most common cancer treatment options offered today because it can shrink a tumor or reduce the tumor's ability to grow. Although it is called radiosurgery, no surgery in the conventional sense is performed.

New developments in brain and spine imagining technology have made it possible for physicians to create computer-guided maps of the tumor site and then pinpoint tumors for treatment, which is most beneficial if the maximum dose can be applied exclusively to the tumor itself and not to surrounding healthy tissue or critical structure.

Stereotactic radiosurgery, usually used for brain tumors, targets the tumor by taking all three dimensions into account. Routinely used at hospitals throughout the world, stereotactic radiosurgery systems provide highly accurate treatment of brain tumors by using the bone structure of the patient's head as a stable reference to precisely target tumors with focused high-energy photon beams from many different directions.

The challenge of these radiosurgery treatments for other parts of the body is to precisely position the high-energy beams. Difficulties come with the fact that external skin markers typically used to position the patient have no stable geometrical relation to the position of the internal tumor, and natural skin shifts can lead to inaccuracies of up to 1.5 centimeters in the dose application, resulting in high irradiation of the normal tissue surrounding the tumor.

With the BrainLAB system, high precision treatment of tumors outside the head, such as spinal tumors, can be performed with millimeter accuracy. Two x-ray sources embedded in the floor of the treatment room and two x-ray detectors mounted on the ceiling opposite these sources assure the accuracy of the position of the images of the patient's internal anatomy are taken seconds before the actual treatments. With these images, the position of the patient and the internal location of the tumor can be precisely determined.

Abram's enthusiasm about how far his field has come is immediately evident. He said we now have the ability to functionally eradicate face pain with neurosurgery, and he is excited about expanding protocols to perform very precise lesions that are as effective as the current use of implants and stimulation methods.

Of current capabilities, he added, "We can use data from the operating room for post-op radiation planning and develop treatment platforms in post operative therapy that allows us to impact patient outcomes in so many profound ways. It is mind boggling to think of the long term benefits that we can realize."

He continued, "Our imagination is the only limit to how we will utilize technology to help patients. This is tantamount to how they felt in Silicon Valley as they realized the potential of software. It is truly the last major frontier in medicine —we are on the cusp of a revolution just taking shape now."

Abram, who grew up in the San Francisco Bay area, did his undergraduate work at Stanford where he earned a BA in human biology before entering Loyola-Strich School of Medicine in Chicago. A neurosurgical internship and residency at Vanderbilt brought him to Nashville.

Abram, his wife and four children –– ranging in ages from seven to 16 –– enjoy family-oriented activities, especially traveling together, when he can take time off from the BrainLAB and his practice.

As exciting as the future is for neurosurgeons, Abrams recognizes it will take a collaborative effort to fully realize technology's promise.

"The challenge is to forge partnerships with research and development so the possibilities of this new technology can come to the forefront," he concluded. "The challenges are not for lack of excitement in the possible."

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