Cavernous Sinus Hemangioma
Cerebellopontine Angle Epidermoid Tumor
Acoustic Neuroma (Vestibular Schwannona)
Malignant Glioma (Anaplastic Astorytoma)
Malignant Glioma (Glioblastoma Multiforme)
Acoustic Neuroma (Vestibular Schwannona)
Pituitary Adenoma
Chondrosarcoma of the Cavernous Sinus

Cavernous Sinus Hemangioma

The enlarged white area on the right side of this MRI scan represents a cavernous hemangioma of the cavernous sinus. The cavernous sinus is the most vascular and anatomically difficult area in the brain in which to operate.

Cavernous hemangiomas in this area can grow to large sizes and cause deficits in the cranial nerves resulting in double vision or facial numbness. Tumors in this area, however, can also represent metastatic cancer.

This patient's cavernous hemangioma was completely resected without postoperative deficit.

Cerebellopontine Angle Epidermoid Tumor

The dark mass on the right side of this MRI scan is a cerebellopontine angle epidermoid tumor. These are benign tumors but can be invasive and surround many of the cranial nerves in the brainstem.

These pictures demonstrate how much this particular tumor, which is extraordinarily large, has displaced brainstem which controls the patient's heart rate and their ability to breathe.

Few surgeons have been able to completely resect these lesions and although these tumors are benign, frequent recurrence can be a dangerous problem.

This patient's tumor was completely resected and all of her many preoperative neurological deficits returned to normal.

Acoustic Neuroma (Vestibular Schwannoma)

The large white mass on the right side of this MRI scan represents a classic vestibular schwannoma, also referred to as an acoustic neuroma. These are benign tumors of the nerves that control balance and often present with hearing loss.

The major difficulty in removing these tumors is that the nerve that controls facial movement can often be damaged during the surgery leading to an unpleasant cosmetic deformity.

This large vestibular schwannoma was completely resected, however, without any damage to the nerve controlling facial movement.

Malignant Glioma (Anaplastic Astrocytoma)

The dark circular area on the left side of this MRI scan represents the tumor. This tumor was extremely difficult to resect given its proximity to the sensory and motor cortex of the brain.

It is extremely difficult during surgery to differentiate between the swollen brain surrounding such a tumor and the tumor itself. In this area, however, accidental removal of any of the edematous brain around the tumor would leave the patient unable to use their hand or arm.

To ensure safety during this operation, Dr. Sampson performed the surgery with the patient awake and constantly stimulated the brain surrounding the tumor in order to very specifically remove the tumor cells without removing any of the normal brain cells.

This tumor was resected and the patient's neurologic symptoms actually improved after surgery.

Malignant Glioma (Glioblastoma Multiforme)

The large white ring on the left side of this patient's MRI scan represents a malignant tumor that arose within the brain. These highly malignant tumors never metastasize outside of the brain but are devastating because of their invasive growth within the brain.

This patient was treated with an experimental protocol developed by Dr. Sampson and his colleagues at the Brain Tumor Center that infuses anti-tumor agents directly into the brain tumor, using specialized techniques.

These techniques allow delivery of very high concentrations of anti-tumor agents to the brain, often in excess of 100,000 times the amount that could be delivered by intravenous infusion or other technologies.

Dr. Sampson is a pioneer in the field of intratumoral infusion and has several protocols for delivering novel therapeutic agents using this technique currently open at Duke University.

Acoustic Neuroma (Vestibular Schwannoma)

The large mass on the right side of this patient's MRI scan represents a large vestibular schwannoma.

This patient had an operation at another university hospital using a retromastoid approach which resulted in partial facial weakness and complete hearing loss.

Because the tumor extends upward and this portion was not removed, the patient suffered from terrible facial pain as a result of pressure on the trigeminal nerve.

Because the patient's hearing had already been scarified by the previous surgery, Dr. Sampson elected to perform a resection using the translabyrinthine approach in order to visualize the facial nerve well and minimize the risks of further damaging this already injured facial nerve.

Using this approach this tumor was completely removed and postoperatively the patient's facial nerve was no weaker than it had been previously. However, three months after the surgery, probably because of the complete tumor removal, the patient's facial nerve functioned even better than before surgery.

Pituitary Adenoma

The large multicolored mass in the lower center portion of this patient's brain represents a pituitary adenoma. These are benign tumors of the pituitary gland which cause symptoms because of abnormal secretion of hormones, but can also cause blindness by pushing upwards on the nerves traveling to the eyes, as in this case.

This patient presented with rapidly decreasing eyesight and this MRI scan demonstrated this massive tumor. This patient was taken to the operating room by Dr. Sampson where he used a special approach to these tumors called the endonasal approach.

This approach leaves no scars at all on the face as the entire surgery is performed through one nostril.

Despite this limited approach this entire tumor was entirely resected at the time of surgery and the patient's visual symptoms returned to normal.

Chondrosarcoma of the Cavernous Sinus

The massive white area on the right side of this MRI scan represents a chondrosarcoma of the cavernous sinus.

The cavernous sinus is the bloodiest and most difficult area in the brain to operate. Most neurosurgeons do not have the training and experience to successfully operate on tumors or other abnormalities in this area.

However, tumors or vascular malformations in the cavernous sinus can grow to large sizes and cause damage to the cranial nerves resulting in blindness, double vision, or facial numbness. Many tumors in this area are benign, however, and can be completely resected by a well-trained and technically skilled neurosurgeon.

This patient's chondrosarcoma was completely removed without permanent neurologic deficits.