Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Treatment Options - Surgery

Surgery to remove or reduce brain tumors is safer and more successful than ever before. It’s usually the first line of treatment for most brain tumors. Today’s advanced technology lets surgeons at the Peak Brain & Pituitary Tumor Center at Houston Methodist treat single or multiple tumors, even those that were previously considered high risk or inoperable.

Today’s neurosurgery to treat brain tumors takes less time, is less invasive, and results in minimal blood loss. Depending on your condition, we employ many surgical options, such as:


Make an appointment: Call 713-441-8500 to schedule a consultation with a Peak Center brain tumor or pituitary tumor expert.

Hear Dr. David Baskin, Director of the Kenneth R. Peak Brain & Pituitary Tumor Treatment Center describe the latest surgical advances utilized at Houston Methodist:

Virtual Image Guidance System

Neurosurgeons at Peak Center use a virtual image guidance system to achieve unprecedented surgical accuracy. This virtual reality system uses magnetic resonance imaging (MRI) to give surgeons an expanded, high-definition view of tiny, yet critical, areas of the brain. This helps surgeons stay within safe corridors of the brain, and avoid damaging surrounding areas that are essential to body and cognitive functioning. In fact, surgeons can be accurate within one millimeter. The system helps neurosurgeons treat multiple tumors, which would have been too dangerous with earlier techniques.

Our surgeons also use virtual image guidance before surgery to help them plan the safest, least invasive path to the tumor during surgery, including craniotomy. They can perform the surgery in virtual reality first, before the actual surgery is done, making the operation much more safe and precise.


A craniotomy is a type of surgery where part of the skull bone is removed so the surgeon can access the brain. This section of skull (called the bone flap) is replaced at the end of surgery. There are different types of craniotomy:

  • Stereotactic craniotomy uses the virtual imaging guidance system before surgery to plan the safest route to the tumor. This, along with three-dimensional scans, helps pinpoint the tumor’s exact location in the brain and distinguish the tumor from healthy tissue.
  • Craniectomy temporarily removes a section of the skull when swelling is likely. It is a life-saving procedure when brain swelling would otherwise be fatal. The bone is stored in a tissue bank and replaced at a later date.
  • Minimally invasive craniotomy options include endoscopy, "eyebrow”andkeyhole surgeries.

Make an appointment: Call 713-441-8500 to schedule a consultation with a Peak Center brain tumor or pituitary tumor expert.

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High-Frequency Ultrasound

High-frequency ultrasounds are different than diagnostic ultrasounds. High-frequency ultrasounds use powerful waves to shatter large tumors into tiny pieces without any incisions. These smaller tumor pieces can be more easily removed during surgery. The surgeon can core the tumor with this technique, much like one would core the pulp of an orange or a grapefruit. Then, the skin or the outside of the tumor can be more easily dissected away from surrounding structures. High-frequency ultrasound waves are precisely focused to break apart abnormal cells without damaging healthy brain tissue.

Minimally Invasive Surgery

Whenever possible, Houston Methodist neurosurgeons use the least invasive approach that promises the best treatment outcome. Many times a traditional craniotomy, where a large portion of skull is removed to access the brain, can be replaced with a minimally invasive technique that requires only small incisions and minimal bone removal. This results in less blood loss, less brain and structural manipulation and less scarring. Minimally invasive surgeries are often used to successfully reach most brain tumors.

Supra-orbital (Eyebrow) Approach

This less invasive type of craniotomy uses a small incision in the eyebrow to access tumors in the front of the brain or in in the pituitary gland. Sometimes this is a better option thanendoscopy through the nose when tumors are large, or are near the optic nerve or major arteries. The eyebrow is not shaved and once healed, the incision is virtually undetectable.

Retrosigmoid (Keyhole) Surgery

Retrosigmoid (“keyhole”) craniotomy uses a small incision behind the ear to reach tumors at the base of the skull, brainstem and back of the head.

Minimally Invasive Endoscopies

An endoscope is a narrow tube with a tiny, telescope-like video camera on the end that lets surgeons view internal structures on a high-resolution screen. Only small incisions—and sometimes no incisions—are needed to perform an endoscopy. Surgeons can also attach small surgical instruments to the endoscope to cut away and remove diseased tissue. Endoscopic craniotomy uses a tiny scope and camera inserted through a small incision in the skull, or introduced through the nose without any incision.

Endonasal Endoscopy for Pituitary Tumors

During endonasal endoscopy, the surgeon inserts an endoscope through the nose to reach the pituitary gland and brain without any incisions. This kind of endoscopy is often used to treat hard-to-reach tumors, pituitary tumors, and tumors that were previously considered inoperable. The endoscope allows the surgeon to “look around the corner” and visualize structures in ways not previously possible. The system uses a tiny scope about 1/10 of an inch in diameter, and has the definition of a Blue Ray DVD (1080P). With endonasal endoscopy, patients have:

  • Less pain
  • No visible scars
  • A shorter surgery and recovery time
  • Reduced hospital stays—often patients can be discharged on the morning after surgery
  • Much improved outcomes

Make an appointment: Call 713-441-8500 to schedule a consultation with a Peak Center brain tumor or pituitary tumor expert.

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BrainPath Technology and the Six Pillars

Peak Brain & Pituitary Treatment Center at Houston Methodist is one of only a dozen places in the country to offer a new brain surgery technology called BrainPath. It is used along with other minimally invasive techniques to help neurosurgeons safely maneuver to deep, hard-to-reach areas of the brain. Surgeons access the brain through a dime-sized port while neuro-navigation and three-dimensional imaging help guide them safely through the brain’s folds and corridors, along the safest route to the tumor. Tumors and blood clots are suctioned out with a non-heated device. With this technique, most patients are discharged on the morning after surgery.

Functional Magnetic Resonance Imaging (fMRI)

Conventional MRIs show brain anatomy, and are very helpful both before and during brain surgery. But new functional MRI technology goes even farther to show brain activity in response to stimuli. This type of functional brain mapping shows neurosurgeons where in the brain’s critical functions, such as speech and language, sensation vision, and motor functions, are located.

Functional MRI helps neurosurgeons plan their approach to tumors during complicated brain surgeries to avoid damaging surrounding tissues. This kind of fMRI brain mapping offers a quicker, more accurate, and less invasive alternative to direct electrocortical stimulation (ECS), where electrodes are placed on the surface of the brain to measure and map brain activity. It makes previously inoperable tumors accessible for surgical removal.

Make an appointment: Call 713-441-8500 to schedule a consultation with a Peak Center brain tumor or pituitary tumor expert.

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