About 100,000 Americans have brain tumors, including about 17,000 who are diagnosed with primary brain tumors, and at least 80,000 more diagnosed with metastatic tumors that have spread to the brain from elsewhere in the body. Brain tumors are the second fastest growing cause of cancer death among those over the age of 65. Unlike lung cancer and melanoma, which are the first and third on that list, there are no known lifestyle or behavioral changes that will reduce the risk of developing a brain tumor.

About half of primary brain tumors are benign; they grow very slowly and don’t invade surrounding tissues, but if they are left undiagnosed, they may present a very serious threat to surrounding vital brain structures. Accurate diagnosis and prompt treatment are essential for these as well as for malignant aggressively growing tumors.

Successful treatment of brain tumors usually involves removal or destruction of the tumor without damaging adjacent normal brain tissue; the usual methods of treatment are surgery or surgery combined with radiation.

Neurosurgeons have benefited from dramatic advances in imaging technologies and surgical techniques that enable them to accurately diagnose, pinpoint and remove tumors that were previously considered inoperable or that could not be completely removed. These advanced procedures are available through the services of the specialists at Yale where continuing research and teaching activities enhance the patient experience and improve both the length and quality of life of those with a brain tumor.

Patient-Focused Care
Yale’s neuro-oncology program puts together all of the components critical to managing patients with brain tumors: comprehensive evaluation and diagnosis, leading edge treatment options, thorough follow-up and psychosocial support. Patients are welcome whether they are newly diagnosed or have already received extensive treatment.

Calls from referring physicians, patients or their families are handled by an experienced clinical care coordinator. The coordinator ensures that appropriate appointments are made quickly. New patients with brain tumors are usually seen in the oncology clinic of the Yale Cancer Center within a couple of days. The care coordinator also acts as the patient’s interface with the various medical specialists who are called into play in each treatment plan.

The patient is the focus of all of the diagnosis and treatment skills Yale’s interdisciplinary team of specialists brings to the service. Neuro-oncology surgeons, radiation oncologists, neuroradiologists, medical oncologists, neurologists, neuropathologists and others meet weekly at a Tumor Board Conference to arrive at the most appropriate treatment plan for each individual. Because the Yale Cancer Center is an academic referral center, the teams of specialists have an opportunity to treat the rarest as well as the most common cancers. Because of the center’s research and teaching mission, its practitioners are well acquainted with the most advanced treatment methods. Patients benefit from that knowledge and from specialized resources such as a dedicated neurological intensive care unit and the latest imaging technologies.

Yale neurosurgeons maintain a close working relationship with physicians practicing in the community. They welcome referrals and supply physicians with regular reports on diagnostic findings and treatment recommendations.

Neuro-Imaging Resources: A Window on the Brain
New imaging technologies have revolutionized both brain tumor surgery and radiation therapy. The neurosurgical oncology group is skilled in suchtechniques as positron emission tomography (PET), frameless-based stereotaxis and functional magnetic resonance imaging to ensure the most accurate diagnostic biopsies and maximal resection of benign and malignant primary and metastatic brain tumors.

Functional magnetic resonance imaging (fMRI) allows physicians to map areas of the brain associated with vital functions such as speech, vision, hearing, taste, touch and voluntary movement. Sensory and motor activities alter the flow of blood and the use of oxygen in the areas of the brain involved in these functions, producing signals that can be detected by the MRI scanner. A functional MRI assessment before surgery clearly shows the differences in brain organization from one person to another and can be critical in determining the best surgical approach.

Gamma knife surgery makes it possible to deliver hundreds of powerful, highly focused radiation beams to tiny targets such as tumors without harming any other brain structures. The procedure is also painless and free of surgical complications such as infection and hemorrhage. The precision of this technique spares important parts of the brain that have historically been subject to injury with conventional radiation therapy.

Skull Base Neurosurgery
Yale neurosurgeons treat patients with a variety of lesions close to the base of the skull. Benign and malignant tumors, pituitary tumors and acoustic neuromas are approached in complex paths through the nose, the ear, the face, including the orbit of the eye, and the mouth, by removing parts of the bone around these structures. This allows our team to reach difficult areas of access without injuring the brain. Our skull base surgeons have radically improved the chances for cure, shortened recovery time, and restored normal lifestyles to people who were often left with no hope for treatment.

Program Director
Joseph M. Piepmeier, M.D., professor and vice chairman of Neurosurgery, directs Yale’s Neuro-Oncology Program. Dr. Piepmeier received his M.D. from the University of Tennessee. He completed his neurosurgical residency at Yale-New Haven Hospital. He has been on the teaching staff of the Yale School of Medicine since 1982.

Dr. Piepmeier has been a visiting professor at several medical schools in the United States, Canada, Europe and Japan. He has published numerous scientific papers; has lectured widely and is active in several national organizations, including service as past chairman of the Joint Section on Tumors of the American Association of Neurological Surgeons/Congress of NeurologicalSurgeons. He serves on the editorial board of Neurosurgery and as editor-in-chief of the Journal of Neuro-Oncology.

Support for Patients and Families
A monthly support group meeting for brain tumor patients and their families provides continuing emotional and educational support to those living with a diagnosis of brain cancer. Patients have an opportunity to learn first-hand from others who have experienced similar surgeries and therapies. It provides an informal setting to talk, listen and learn more about what resources are available.

Contact Information
Betsy D’Andrea
Neuro-oncology Care Coordinator
203-785-2791

The Michael S. Voynick Lecture in Neuro-oncology
In 1997 the Michael S. Voynick Lecture was established through the generosity of Irene Voynick in honor of Michael S Voynick. This award is presented annually to recognize clinicians and scientists who have made lasting contributions to the treatment of patients with brain tumors.
Past award recipients include Charles Wilson, M.D. (San Francisco, CA), Jerome Posner, M.D. (New York, NY) and Greg Cairncross, M.D.(London, Ontario, Canada). The award and is presented during a keynote address by the award recipient. The Voynick Lecture was established in collaboration with the Yale Section of Neuro-oncology and is administered by Joseph M. Piepmeier, M.D who selects the recipient.

The Voynick Visiting Fellowship in the Section of Neuro-oncology
The Section of Neuro-oncology has received a generous contribution from Irene Voynick to establish an endowed fellowship for visiting scholars. This fellowship is directed toward funding visiting clinicians from international medical centers to train in the evaluation and treatment of patients with brain tumors. It is anticipated that the visiting fellowships will be used to establish ongoing collaborative relationships between the Yale Section on Neuro-oncology and foreign centers. Interested applicants should contact Joseph M. Piepmeier, M.D.

Gift from the Section of Neuro-oncology of the Department of Neurosurgery to the Yale Historical Medical Library
Through the generosity of an anonymous donor, the Section of Neuro-oncology is pleased to announce that a unique collection of medical documents have been donated to the Yale Medical Historical Library. This collection of 54 articles and addresses, written by Harvey Cushing, M.D. between 1905 and 1933, includes essential papers in the development of neurosurgery in the United States. Dr. Cushing, an eminent neurosurgeon, was also an ardent book collector and co-founder of the Yale Historical Medical Library. Accompanying the collection is a rare note signed by Sir William Osler, the Regius Professor of Medicine at Oxford. Written in 1910, this note congratulates the publisher on completion of the latest textbook of Osler, The Principles And Practice Of Medicine. This valuable material will be cataloged and preserved for use by the Yale medical community and historians.

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