Cranial Surgery for Brain Tumor



For some brain surgeons, surgical technique hasn’t changed for the past 30 years. Open surgical craniotomies are still being performed when simpler, safer methods can be used. Of course, not all brain pathology may be managed without opening the skull, but it is advantageous to know of a neurosurgeon practiced in both the open and “closed skull” techniques.
This phenomenon of “minimizing” the surgical procedure or making it “less invasive” is not new or unique to brain surgery. Arthroscopic surgery in the field of orthopedics can repair a torn meniscus through the use of scopes and television screens, a gall bladder can now be removed through three tiny incisions in the abdomen, etc. Neurosurgery is a leader in the field of minimally invasive surgery because of techniques involving stereotactic localization, stereotactic surgery and radiosurgery (all explained in other sections of this website).

Even when a craniotomy (or opening of the skull) IS necessary, it should be performed with stereotactic guidance. The stereotactic navigational computer helps the surgeon operate in the brain with “radar-like” accuracy.



The surgeon is able to register points from the patient’s head into the computer so that the computer can guide him or her to a tumor through an MRI map of the brain.


Using stereotactic technique, the navigational computer, and good general neurosurgical principles, tumors and vascular malformations may now be removed much more safely, and more completely. Smaller cranial openings to achieve the same goals may be made, and the patient usually has a shorter hospital stay.

With Gamma Knife radiosurgery, Dr. Duma is able to treat primary brain tumors, metastases, acoustic neuromas, meningiomas, arteriovenous malformations (AVMs), trigeminal neuralgia and the tremor of Parkinson’s disease, without opening the skull. Click the button at the left for information on treatments using the Gamma Knife radiosurgery.

Of course, the epitome of minimally invasive surgery, which is not experimental, and which has been used by Dr. Duma since 1990, is Gamma Knife stereotactic radiosurgery. In fact, Dr. Duma is a course instructor at national meetings for this technique, and a pioneer in its technology here in America.

In addition, new techniques involving brain tumor immunotherapy (gene therapy, etc.) toward a cure for malignant tumors of the brain are currently being used by Dr. Duma in certain patients.

Modern techniques are now available to all patients for the management of intracranial disease in Los Angeles County.

Welcome to a tour through the field of minimally invasive neurosurgery.



Computers, computer navigation and special intraoperative equipment and monitors have allowed us to bring the 21st century into the OR. No longer should neurosurgery be performed using only the surgeons judgment as to determining routes through the brain, skull openings etc.

Dr. Duma has written book chapters on the use of “navigation” through the brain intraoperatively and has been an instructor of this topic at major national neurosurgical conferences for years.


The surgeon is able to register points from the patient’s head into the computer so that the computer can guide him or her to a tumor through an MRI map of the brain.


The concept is as follows: if a patient undergoes an MRI prior to surgery, that MRI may be used in the operating room literally to guide the surgeon through the brain DURING the operation. Small markers, or fiducials, are attached to the patients scalp prior to the MRI with adhesive and these are picked up by the MRI. Once the patient is positioned in the OR, these fiducials are registered into the computer and the patient’s brain is now part of the three-dimensional space within the OR. Using a hand-held probe, or the actual operating microscope itself, the surgeon can navigate through the brain to reach the desired target with precision, efficiency and the utmost of safety. At the conclusion of the cranial surgery procedures the adhesive markers are removed and the patient is returned to the recovery room for a faster recovery. The modern neurosurgical patient should insist on this technology as being a part of his or her OR experience.



Neurosurgical navigation has revolutionized the field of neurosurgery. The modern neurosurgical patient should insist on this technology as being a part of his or her OR experience. After the cranial surgery procedure, the patients usually have smaller craniotomy openings, smaller incisions, lower complication rates, quicker recovery, and spend less time in the hospital post-operatively. This allows the patient to get home faster.


Tumor elegantly removed avoiding critical structures.


In Dr. Duma’s experience, the average length of stay after craniotomy for brain tumor is 2-3 days. Incisions are usually linear and small. Ninety-five percent of patients spend only one evening (the immediate post-op evening) in the intensive care unit. Patients have all arterial lines, Foley catheters etc, removed the day after surgery and they immediately begin physical therapy, occupational therapy and/or speech therapy as needed. This all hastens their recovery from their cranial surgery. This is modern neurosurgical management in Los Angeles County, and makes brain tumor surgery far less traumatic than open heart surgery or even gall bladder surgery.


Christopher Duma, MD, FACS
3900 West Coast Highway, Suite 300
Newport Beach, CA 92663
Phone: 949-989-5894
Fax: 949.642.4833

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