Stanford Brain Tumor Center

The Stanford Brain Tumor Center combines multidisciplinary clinical care and a strong research program in an effort to facilitate rapid transfer of basic scientific findings into clinical protocols for patients with tumors of the brain, skull base and spine. The Center has innovative clinical initiatives organized under the auspices of the Stanford Neuro-Oncology Program; the Stanford Pediatric Brain Tumor Program, the Stanford Skull Base Surgery Program, the Stanford Tumor Radiosurgery Program, the Stanford Spinal Tumor Program and the Stanford Neuro-Endocrinology Program.

Diseases treated in the Center include both benign and malignant tumors of the brain, spinal cord, skull base, and spine in adults and children. Targeted pathologies include primary parenchymal tumors (including gliomas, craniopharyngiomas, germ cell tumors, and lymphomas), metastatic tumors (including parenchymal, leptomenngeal, and osseous lesions) and tumors of the skull base (including meningiomas, osseous and cartilagenous tumors, pituitary adenomas, acoustic neuromas and glomus tumors).

Minimally invasive therapies, such as radiosurgery, are a particular strength. Studies of innovative treatment currently underway include the following:

Fractionated radiosurgery for acoustic neuromas
Timozodamide for adult malignat gliomas
Oxygenation agents as radiosensitizers
Combination chemotherapy for pediatric tumors

Brain tumors, or neurological complications of other cancers, often have profound implications for patients and their families. Caring for patients with neuro-oncological disease is a complex task that requires input from many specialists.

To meet these challenges, the Stanford Neuro-Oncology Program has developed an interdisciplinary team whose goals are the following:

To provide a specific and accurate diagnosis
To communicate to the patient and the patient's family the nature, treatment options, and possible outcomes of the disease
To offer both conventional and experimental treatments
To optimize the quality of each patient's life
To assist the patient and the patient's family in coping with the disease

The Department maintains an active pediatric tumor practice at the Lucille Salter Packard Children's Hospital. Here, advanced multimodality therapy for a wide varienty of brain tumors in children is offered in a collaborative multidisciplinary Pediatric Neuro-Oncology Clinic.

Basic science research efforts within the Department include investigation of the following:

The regulatory mechanism of tumor angiogenesis
Tumor angiogenesis as a target for gene therapy
Gene therapy involving insertion of tumor suppressor genes
Tumor cell invasion and establishment of therapeutic neuronal grafts
The utility of bio-chips and cybo-technology in degenerative diseases.

Specialties

Acoustic neuroma

Acoustic neuroma (sometimes termed a neurolemmoma or schwannoma) is a benign (non-cancerous) tissue growth that arises on the eighth cranial nerve leading from the brain to the inner ear. This nerve has two distinct parts, one part associated with transmitting sound and the other sending balance information to the brain from the inner ear. These pathways, along with the facial nerve, lie adjacent to each other as they pass through a bony canal called the internal auditory canal. This canal is approximately 2 cm (0.8 inches) long and it is here that acoustic neuromas originate from the sheath surrounding the eighth nerve. The facial nerve provides motion of the muscles of facial expression.

Acoustic neuromas usually grow slowly over a period of years. They expand in size at their site of origin and when large can displace normal brain tissue. The brain is not invaded by the tumor, but the tumor pushes the brain as it enlarges. The slowly enlarging tumor protrudes from the internal auditory canal into an area behind the temporal bone called the cerebellopontine angle. The tumor now assumes a pear shape with the small end in the internal auditory canal. Larger tumors can press on another nerve in the area (the trigeminal nerve) which is the nerve of facial sensation. Vital functions to sustain life can be threatened when large tumors cause severe pressure on the brainstem and cerebellum part of the brain.

Tumors are typically described as small (less than 1.5 cm), medium (1.5 cm to 2.5 cm) or large (more than 2.5 cm).

Courtesy of Acoustic Neuroma Association

Anaplastic astrocytoma

Anaplastic astrocytomas or grade II fibrillary astrocytomas are intermediate in pathological characteristics and rapidity of growth between astrocytomas and glioblastomas. Anaplastic astrocytomas occur predominantly in the cerebral hemispheres of middle aged adults. Headaches, depressed mentation, and focal neurologic deficits are more common and seizures somewhat less common than with non-anaplastic astrocytomas. Most of these tumors enhance on contrast MRI scans. The preferred treatment is the surgical removal of as much tumor as is safely possible, followed by a six-week course of radiation therapy. Chemotherapy, usually with a nitrosourea, is often indicated, particularly for tumors that recur. Radiosurgery is sometimes considered for residual or recurrent tumor that appears focally contained. Despite such therapies, these tumors frequently recur in a life-threatening manner between two and five years after initial treatment.

Arachnoid cyst

Arachnoid cysts are collections of CSF cerebrospinal fluid contained within the arachnoidal lining of the brain. They represent approximately one percent of brain mass lesions. Most common in infants, they may also present in adulthood. In infants, they cause head enlargement or signs of obstructive hydrocephalus such as headache, lethargy, double vision, and developmental delay. In adults, they are more likely to cause seizures, particularly those of the middle cranial fossa. Arachnoid cysts are readily seen on CT and MRI scans as non-enhancing cystic masses of near CSF density/intensity. Treatment options include fenestration of the cyst into normal CSF pathways, either endoscopically or by open craniotomy, or shunting of the cyst and/or ventricles into the peritoneal cavity. Successful cystic opening or fluid diversion is usually effective treatment.

Astrocytoma brain tumor

Astrocytomas include a large group of gliomas whose predominant cell type resembles an astrocyte. Over half of all brain gliomas are astrocytic. They arise from and expand within the brain and almost never spread to other parts of the body. Astrocytomas are graded from grade I to IV depending on the presence of features implying rapid growth such as irregular cell structures, cells actively dividing, and abnormally formed blood vessels. Astrocytomas usually become clinically evident by virtue of seizure, headache, or focal neurologic deficits such as speech difficulty, motor weakness, and visual loss. Magnetic resonance imaging shows them to be a mass that replaces normal brain. Lower grade tumors are less likely to enhance (turn white) with intravenous contrast agents than are higher-grade tumors. Surgery is often indicated: to establish the diagnosis pathologically; to alleviate mass effects causing neurologic symptoms and deficits; to remove as much tumor as is safely possible in order to decrease the chance of lower grade tumors progressing to more malignant forms. Surgery is also performed to improve the safety and efficacy of other treatments such as radiation therapy, radiosurgery, and chemotherapy.

Stanford Brain Tumor Center

Successful treatment of brain tumors leads to a longer, better quality of life. At the Stanford Brain Tumor Center, our doctors are at the forefront of the latest, successful brain tumor diagnosis, treatment and clinical trials options.

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Brain Tumor Lab Tour 2018

We wanted to give patients and advocates a first-hand look at how we study brain tumors, so we invited them to tour two of our labs. Scientists in Dr. Melanie Hayden-Gephart's lab and Dr. Gordon Li's lab, guided our guests through interactive stations, that showed how research to better understand how brain tumors work, and how to stop them, is conducted.