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additiona l surger y," says Dr. Hoeprich. " Wit h i-M R I, we ca n obt a i n i ma ges to check for residua l tumor while the patient is sti l l under a nesthesia , a nd then, if needed, continue the surgery." Awa ke cra n iotomy w it h la ng ua ge mapping is a nother technique that ca n be per formed for tumors close to the speech or motor a reas. This procedure is per for med w it h t he a ssist a nce of specia lized a nesthesiolog ists. " We ma ke our skin incision a nd open up the sku l l a nd the coverings of the bra in, t hen we wa ke up t he patient ," Dr. Hoeprich explains. "Once the patient is awa ke, we per form direct cor tica l stimulation for mapping." E l e c t r o c o r t i c o g r a p h y ( E C o G ) involves placing electrodes directly on or in the cerebra l cor tex to record electri- cal activity and to map with stimulation, for example, language structures — both receptive a nd productive. " We ca n a lso look for a nd map motor function a nd other a reas to determine if we ca n resect a tumor sa fely without causing a sig nif ica nt def icit a f ter sur- ger y," says Dr. Hoeprich. ADVANCED RADIOTHERAPY Stereotactic radiosurger y wa s intro- duced t o Su m m it Cou nt y by A k ron Genera l four years ago, when it insta lled it s G a m ma K n i fe Per fex ion s yst em . R a d iosu rger y is h ig h ly ef fective for t r e a t i n g a v a r i e t y o f i n t e r c r a n i a l tumors, particularly metastatic tumors. "Radiosurger y is a bit of a misnomer," says Dr. Missios. "It does not require any actua l incision. But it is a ver y precise way of del iver i n g ra d iation i nto t he bra in a nd focusing this radiation only on the area where the tumor is located." " W hile radiosurger y does not involve surger y, a neurosurgeon does lead the r a d i o s u r ge r y t e a m ," D r. Ho e pr i c h ex pl a i n s . " It 's a t h ree -per son t ea m which includes a neurosurgeon, a radia- tion oncologist and a medica l physicist. Akron General's 3 Tesla MRI enables specialized imaging, called diffusion tensor imaging, of white matter fibers below the surface of the brain. This enables the neurosurgeon to evaluate preoperatively where a tumor sits in relation to various structures and various communication pathways within the brain. IMAGE COURTESY OF SYMEON MISSIOS, MD Prior to the introduction of this tech- nolog y, the only way to deliver radiation to the bra in was via whole bra in radia- tion, a technique which is still utilized for cer ta in patients. It requires da i ly sessions for t wo to t hree weeks, a nd side effects ca n include fatig ue, shor t- term memor y a nd cog nitive def icits. In compa r ison, radiosurger y ca n be accomplished in a single session, a nd patients are spared from that morbidity. " T he a c t u a l len g t h of t r e a t ment t i me ca n va r y. It ca n be a s shor t a s 20 minutes or a s long a s t wo to three hours depending on how ma ny tumors a re being treated," says Dr. Missios. "Frequently patients who are diagnosed with meta static bra in tumors have to undergo chemotherapy for their sys- temic prima r y disease a f ter the bra in d isea se is cont rol led . Ga m ma k n i fe radiosurger y a l lows for a si ng le day treatment a nd then chemotherapy ca n beg in the nex t day." While mostly used for metastatic brain tumors, radiosurgery can be indicated for a number of pathologies, including meningiomas which arise from the lin- ing of the surface of the brain, benign tumors that grow in the pituitary and the cavernous sinus, and some malignant primary tumors. It can also be used to treat arterio-venous malformations in the brain which can predispose to brain hemorrhage. Both Dr. Hoeprich and Dr. Missios believe the GammaKnife, as well as the other advanced technologies available at Akron General, make a big di–erence for their patients. "We have state-of-the-art technology, and this gives us state-of-the-art ability to treat our patients safely and e–ectively," says Dr. Hoeprich. "The hospital has been very receptive to integrating the newest most advanced technologies," adds Dr. Missios, "and I foresee this continuing in the future." For more information about diag- n o s i n g a n d t re a t i n g b ra i n t u m o r s at Cleveland Clinic Akron G eneral's N e u r o s c i e n c e I n s t i t u t e , v i s i t akrongeneral.org/neuro. To refer a patient to D r. Mark Hoeprich or D r. Symeon Missios, call 330-344-3100. ■ M D N E W S .C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N n M AY/J U N E 2 016 1 7