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THE JOHNS HOPKINS
INTERNATIONAL
BRAIN TUMOR PROGRAM
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JOHNS HOPKINS International Brain Tumor Program


    The JOHNS HOPKINS International Brain Tumor Program offers the International Physician the most advanced evaluation and treatment for the international patient. The JOHNS HOPKINS International Brain Tumor Program offers the International Patient the effective multi-disciplinary treatment of brain tumors. The JOHNS HOPKINS International Brain Tumor Program offers neurosurgical consultation for brain tumors including:

  • Benign Tumors: meningiomas, pituitary adenomas, acoustic neuromas. For many cases, fractionated stereotactic radiosurgery offers non-invasive radiosurgery for treatment.

  • Malignant Tumors: glioblastomas, malignant astrocytomas, anaplastic astrocytomas, gliosarcomas. Evaluation is multi-disciplinary within the weekly brain tumor board presentations of the cases that are submitted by the international physician or patient.

  • Brain Metastases: Comprehensive evaluation and treatment. For multiple metastases radiosurgery offers non-invasive control. For solitary or few metastases surgical resection is an important option for treatment.

Expedited Review

Jeffery A. Williams, M.D.
Director, Stereotactic Radiosurgery
Harvey 811
Department of Neurosurgery
JOHNS HOPKINS Hospital
600 North Wolfe Street
Baltimore, MD 21205-8811


Curriculum Vitae

Dr. Jeffery A. Williams
Director, Brain Tumor Stereotactic Radiosurgery
Dr. Williams is the only Radiosurgeon / Neurosurgeon in the world who is:
Board Certified: Neurological Surgery and
Board Certified: Radiation Oncology



Make an Appointment for Brain Tumor Evaluation

  • Office: 410-614-2886 or (Fax) 410-614-2982
  • Toll Free: 1-800-507-9952 (JOHNS HOPKINS USA: Patient Assistance for Appointment, Travel, Lodging)
  • Toll Free: 1-800-225-2201 (Travel Guide (JOHNS HOPKINS RADIOSURGERY Travel Agency: Info regarding Discounted Travel and Hotel)
  • Toll Free: 1-800-765-5447 (Hopkins Access Line: Immediate Physician to Physician referral)
  • Services for the International Patient: Visit the JOHNS HOPKINS International Services site.


On-Line Discussions


Email Dr. Jeffery Williams (jw@jhu.edu) for on-line brain tumor radiosurgery discussions. In the text please
  • Outline the problem.
  • Describe any treatments given so far.
  • Provide the report of the important MRI findings.
A response will be made within 24 hours.


Explore these Features of the JOHNS HOPKINS Brain Tumor Radiosurgery Program

JOHNS HOPKINS International Radiosurgery Topics

Johns Hopkins Stereotactic Radiosurgery employs the non-invasive (no pins in scalp) relocatable system for precise localization of the brain tumor during radiosurgery. This system is easily tolerated and leaves no scars.

Stereotactic Radiosurgery (SRS) allows precise delivery of high doses of radiation to specific targets within the brain. SRS successfully treats both benign and malignant brain tumors. This site describes the conditions for which SRS is beneficial, the processes for patient evaluation and treatment, the participating medical staff and their qualifications, and the subsequent processes for communication with the referring physician and follow-up for the patient.

TUMORS

Johns Hopkins Stereotactic Radiosurgery employs the non-invasive (no pins in scalp) relocatable system for precise localization of the tumor during radiosurgery. This system is easily tolerated because it requires no "pin" placement as with conventional frames. The Hopkins system results in no incision or resultant scar.

For treatment of tumors, fractionation of SRS uses multiple smaller treatments (fractions) instead of one large treatment. This allows administration of a higher total dose of radiation without increasing the risk of toxicity to normal brain.

Such treatment is not currently possible with radiosurgical devices that utilize multiple cobalt sources.



Eligible Patients

Both benign and malignant intracranial tumors are successfully treated with fractionated SRS. Malignant tumors include metastases and malignant intrinsic brain neoplasms. Benign tumors include meningioma, acoustic neuroma and pituitary adenomas.

The desirable imaging characteristics of tumors are:

  • Radiographically distinct from normal brain.
  • Small in number (fewer than 6).
  • Small in size (less than four centimeters in diameter).
Treatment

Fractionated SRS for tumors is a non-invasive, outpatient procedure that involves a limited number of separate visits. During the first visit, the patient is fitted with a relocatable plastic mask that precisely contours the face and head. The stereotactic frame is then fitted to the mask. After the contrast-enhanced CT scan with mask and frame in place, computerized dosimetry calculates the most effect targeting. This outpatient radiation treatment is fractionated, i.e., it takes place over a number of separate visits. Usually, the treatment can be completed in one to two weeks. Hopkins offers assistance to patients who travel to Baltimore in locating accommodations for the duration of their treatment. A wide range of facilities and prices are available. Additionally, the Marburg Pavilion offers the highest quality inpatient accommodations.

Acoustic Neuroma

The acoustic neuromas may be treated surgically or by stereotactic radiosurgery. Radiosurgery offers less risk to the seventh (facial motor) and fifth (trigeminal: facial sensory) nerves. Further, the rates of the preservation of hearing appear to be higher following radiosurgery when compared to surgical resection. When compared to conventional surgical resection, radiosurgery does not result in complications such as spinal fluid leak or infection, nor does radiosurgery require a stay in the hospital. To learn the questions related to radiosurgical treatment of acoustic neuroma, please visit JOHNS HOPKINS Acoustic Neuroma Radiosurgery Trial

Meningioma

The meningiomas most suitable for radiosurgery are those of the skull base (rendering resection difficult) or those recurrent after conventional surgery and conventional external beam radiotherapy. Those meningiomas involving the cavernous sinus (middle of skull base) are particularly suited for radiosurgery.

Meningioma Support Group: Subscribe to the Meningioma Email Listserve.

Your messages will be sent to all members of the list. To subscribe to the meningioma mailing list, send an e-mail to:
requests@hydra.welch.jhu.edu
with the following in the message BODY:
subscribe meningioma

(to unsubscribe, use the message: unsubscribe meningioma).
To learn the questions related to radiosurgical treatment of meningioma, please visit JOHNS HOPKINS Meningioma Radiosurgery Trial

Pituitary Adenoma

Most pituitary adenomas are suitable for radiosurgery. This technique offers sparing of the optic chiasm, sparing of the hypothalamus (thus sparing the "releasing hormones" that drive the pituitary's normal function) and sparing of the scalp (and hair) when compared to conventional external beam irradiation. For recurrent pituitary adenomas following surgery and regular radiation, radiosurgery is particularly well suited. To learn the questions related to radiosurgical treatment of pituitary adenoma please visit JOHNS HOPKINS Pituitary Adenoma Radiosurgery Trial

Malignant Brain Tumors

Malignant brain tumors include brain metastases, primary malignant tumors (glioblastoma, anaplastic astrocytoma), hemangiopericytomas, malignant meningioma and others. In most cases surgery is the treatment of first choice. However, many times the tumor is in a location that renders resection difficult or impossible. For these cases, conventional radiation is often prescribed, and radiosurgery can provide the safe "boost" of radiation to improve the local control. If, some time after conventional therapy alone, the tumor recurs and if the "performance status" is high, then stereotactic radiosurgery may be indicated. Radiosurgery may again provide the "boost" to increase the response and local control. To learn the questions related to radiosurgical treatment of the malignant tumors, please visit JOHNS HOPKINS RADIOSURGERY Trial


AVM

Eligible Patients

The AVM most appropriate for SRS have the following characteristics:

  • Difficult to surgically excise without high morbidity and mortality:
  • Located in eloquent brain.
  • Deep venous drainage.
  • Appropriate geometry:
  • Less than four centimeters in diameter.
  • Compact shape.


Treatment

On a single day, the patient has sequential placement of the BRW head frame, angiography and SRS. Using sophisticated treatment planning software, computerized dosimetry allows contouring of the dose distribution to the AVM to maximize efficacy and minimize toxicity to the normal brain. For treatment, the specially modified linear accelerator administers highly collimated, narrow beams of radiation to the target with sub-millimeter accuracy. After treatment, patients generally stay that night in the hospital for observation. Outpatient follow-up includes clinical and radiographic (MRI) evaluations that are scheduled for one month, three months, and then every 6 months after SRS. Ablation of the lesion usually occurs over 24 to 36 months. For the international patient, MRI films may be mailed to Dr. Williams for review.


Patient Evaluation: AVM and Tumor

The patient is first referred to the Radiation Oncology Department for the initial evaluation. The patient should bring any outside medical records and radiographic studies. This evaluation involves.

  • History and physical examination.
  • Review of radiographs (CT, MRI, angiogram).
  • Analysis and complete discussion of the risks and benefits of radiosurgery.
Peer Review of Radiosurgical Cases Enhances Success

For AVM or tumors, the patient's case is presented before the JOHNS HOPKINS Multidisciplinary Vascular or Tumor Board. The following experts evaluate and discuss the patient's case before the treatment plan is finalized:

  • Neurosurgeons
  • Radiation Oncologists
  • Neuroradiologists
  • Medical Oncologists
  • Ophthalmologists
  • Pathologists

These conferences ensure that top experts in the ancillary fields provide consultation regarding the patient's treatment plan.

  1. Neurovascular Conference: Thursdays 8:00 a.m.
  2. Neuro-Oncology Conference: Fridays 1:00 p.m.
Communication with the International Referring Physician

Once a treatment plan is determined, the referring physician receives a phone call, email or fax (depending on the preference of the physician) communicating the proposed approach. At the end of treatment, a summary is similarly communicated to the physician. Hopkins physicians keep the referring physician apprised of the patient's progress after every follow-up visit. We are available to discuss the patient at any time with the referring physician, either directly or through the Hopkins Access Line (HAL).

For more information or a patient appointment, please call Dr. Williams at 410-614-2886 or through the HAL service 1-800-765-5447 HOPKINS RADIOSURGERY: COLLABORATORS

  • Jeffery Williams, M.D.: Director, Stereotactic Radiosurgery
    Department of Neurosurgery JOHNS HOPKINS Hospital

For an on-line evaluation, please email Dr. Williams (jw@jhu.edu). In the body of the text, please outline the problem and any treatments given so far. If possible, please report the important findings on the MRI to:

Jeffery A. Williams, M.D.
Director, Stereotactic Radiosurgery
The JOHNS HOPKINS Hospital
Harvey 811
600 North Wolfe Street
Baltimore, MD 21287-8811

Welcome to JOHNS HOPKINS USA (1-800-507-9952), the Gateway to the Nation's Premier Medical Center. A group of friendly, service-oriented professionals are solely dedicated to assisting patients with the full spectrum of arrangements for a visit to Hopkins Radiosurgery including travel, lodging and the appointment. A number of hotels offer sharply reduced rates for Hopkins Radiosurgery patients. Hopkins USA is a single point of contact for out-of-town patients and their referring physicians to ensure smooth access to JOHNS HOPKINS RADIOSURGERY. A single toll-free phone call is all it takes!



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JOHNS HOPKINS RADIOSURGERY
Harvey 811, 600 North Wolfe Street, Baltimore, MD 21205-8811
410-614-2886 (phone) | 410-614-2982 (fax) | jw@jhu.edu


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