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In This Video

  • Here, Lawrence Borges, MD, discusses his interest in intradural spinal tumors, which occur inside the spinal cord
  • Diagnosing the tumors sometimes require surgery, but some of these tumors, infiltrative tumors, are inoperable
  • He and his radiological colleagues hope to find ways to diagnose infiltrative tumors without surgery

Lawrence Borges, MD, is the director of the Neurosurgical Spine Center at Massachusetts General Hospital. He is interested in intradural spinal tumors, which occur inside the spinal cord. Diagnosing these tumors may require surgery, but some of these tumors, infiltrative tumors, are inoperable. He and his radiological colleagues are working to find ways to diagnose infiltrative tumors without surgery.

Transcript

My particular interest has always been angled more towards the intradural spinal tumors. Tumors that occur intradurally are particularly challenging because they compress the spinal cord directly. They arise from the nerves inside the dura. The most challenging of the tumors arise inside the spinal cord itself, and those are the tumors that I've chosen to focus on, primarily.

In some instances, surgery ends up having to be done simply for diagnosis. As a surgeon, I have a role in biopsying these tumors to determine the exact cell type, so we know further what kind of treatment, adjuvant-wise, is required. 

One of the challenges we face is that tumors that occur inside the spinal cord can be divided into two main categories: those that we can remove surgically, because they're not infiltrative into spinal cord tissue, despite being, or sitting, in the middle of the spinal cord. And the other kind of tumors that occur inside the spinal cord, which are the infiltrative tumors, categorized in a broad category as astrocytomas.

One of the thoughts as a surgeon I've always had is that wouldn't it be ideal if I could do away with surgery. One of the goals, in many respects, of a surgeon should be to make themselves irrelevant for the future of the patient's care. So, along those lines, we continue to work with our radiological colleagues and think about ways that we might diagnose infiltrative tumors in the absence of surgery. Are there particular characteristics of MRI scanning, or special MRI sequences, that we could develop that might allow us to come up with an accurate diagnosis of infiltrative tumors, such that we could move directly to treatment with adjuvant therapy or radiation therapy and avoid the surgery altogether? And that's one of our clear goals here.

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