Diseases and Treatments
Brain Tumor Program
The team has seen excellent outcomes in its brain tumor program, which focuses on multiple types of tumors, including primary tumors, which begin in the brain; secondary tumors, which are cancers that began elsewhere and have metastasized to the brain (the most common tumors); and brain stem tumors, which are located in the most dense, complex areas of the brain. "Brain stem tumors have historically been very difficult to treat surgically because of the risks involved in cutting into that part of the brain," Dr. Limonadi explains. "In the past, the best we could do for a patient was to treat the tumor with radiation and hope to slow its growth. Now, thanks to new technology, we have had a number of successes at Eisenhower surgically removing the tumor and returning the patient to their life very quickly."
Eisenhower neurosurgeons are among a very small group in the country who use a technique called stereotactic neuroendoscopy to minimize the invasiveness of brain stem tumor removal and other brain surgeries. The procedure uses an endoscope, a small probe with a light and a camera to guide the operation through the pathways of the brain, much like an automobile's GPS (global positioning system) guides a car through city streets. Impressively, the neurosurgery team at Eisenhower is the only medical facility in the Coachella Valley utilizing this technology.
The Eisenhower Neuroscience Institute's team approach has been critical to the successful treatment of brain tumors. Dr. Limonadi chairs the Brain Tumor Board that reviews all Eisenhower Neuroscience Institute cases. The elite board includes neurosurgeons, neurointerventional radiologists (who lay out the anatomy of the tumor), radiation oncologists and medical oncologists. "Together we can come up with the most comprehensive, evidence-based approach, the option that provides the best treatment with the least amount of risk to the patient," shares Limonadi. "By working together, we can optimize surgical outcomes and obtain the best quality of life for the patient."
Another focus is the treatment of complex pain syndromes, particularly in the area of trigeminal neuralgia, a disorder of the trigeminal nerve - located in the brain - that causes episodes of intense pain in the face and jaw. Most common in women over 50, trigeminal neuralgia can sometimes be treated with medication. But, for patients who do not respond well to medication, or who for a variety of reasons cannot handle the medication, surgery is their best option. Through surgery, physicians can relieve pressure on the nerve that is causing the pain, as opposed to a variety of techniques to "damage" the nerve, thus disrupting the pain signals. The surgical success rate for trigeminal neuralgia at Eisenhower is quite high, with most patients suffering no recurrence of their pain.
Although all neurosurgeons at the Eisenhower Neuroscience Institute perform myriad of complex spine and brain surgeries, each is specialized and has fellowship training in a specific branch of neurosurgery. While performing minimally invasive spine (neck and back) surgeries, neurosurgeon Farhad Limonadi, MD leads the brain surgery team at Eisenhower Medical Center, focusing on innovative surgical approaches to treat brain tumors, trigeminal neuralgia and facial pain, aneurysms and chronic pain associated with the brain, and cranial cavity.
"Everyone in our neurosurgery group is a specialist, and fellowship-trained in his or her field," Dr. Limonadi shares. "We are not general neurosurgeons - we have specific areas of expertise that we can apply to the particular needs of the patient. That level of training throughout a surgical team is rare - we are very fortunate to have it here at Eisenhower." According to Dr. Limonadi, the combination of the team's specialized expertise and the availability of new technologies has made it possible for surgeons to precisely target problem areas in the brain with minimal impact on surrounding tissues. As a result, many patients who previously were not considered candidates for surgery - for example, individuals with what were thought to be inoperable brain tumors - can now be treated surgically with minimal risk.
Advanced Intraoperative EP Monitoring and Brain Mapping
Dr. Limonadi is an instructor and an expert in Advanced Intraoperative EP (Evoked Potentials) Monitoring and Brain Mapping, a technology used in the operating room to guide anesthetic and surgical procedures in real time. Advanced intraoperative neurological monitoring allows surgeons to closely monitor brain, spine, and nerve functions as they operate. Brain mapping makes it possible for surgical teams to precisely isolate the affected area of the brain, whether it be for removal of a brain tumor or the treatment of an aneurysm.
"Our ability to monitor more and more of the brain's functions as we operate is critical to successful patient outcomes," Dr. Limonadi says. "Our surgeons can see exactly what is going on in the brain and tell immediately if there is any risk of damage. For example, if we are operating close to the brain's speech center, we can monitor that function, and if we see any impact from our procedures, we can adjust them immediately so that nothing we do will affect the patient's speech."