Glioma & Glioblastoma Surgery in New York City

Advanced Surgical Management • Connectomics-Guided Planning • Multidisciplinary Care in New York City

Overview

Gliomas are primary brain tumors that range from slower-growing IDH-mutant gliomas to aggressive high-grade tumors such as glioblastoma (GBM). Surgery often plays an important role in establishing the diagnosis, obtaining tissue for molecular testing, relieving symptoms, and removing as much tumor as safely possible.

Randy S. D’Amico, MD, is a neurosurgical oncologist at Lenox Hill Hospital in New York City who specializes in surgery for gliomas and glioblastoma, including newly diagnosed, recurrent, and complex tumors involving critical brain networks. His surgical approach combines advanced imaging, connectomics, awake or asleep brain mapping when appropriate, fluorescence-guided surgery, and minimally invasive techniques to maximize safe tumor removal while preserving neurological and cognitive function.

Treatment decisions are coordinated with neuro-oncology, radiation oncology, neuropathology, and other specialists and incorporate tumor location, molecular features, neurological function, prior treatment, and the individual patient's goals.

Types of Gliomas Treated

  • Glioblastoma (GBM), IDH-wildtype

  • IDH-mutant astrocytoma

  • Oligodendroglioma

  • Low-grade and high-grade diffuse gliomas

  • Newly diagnosed gliomas

  • Recurrent or previously treated gliomas

  • Tumors involving motor, language, or other critical functional networks

  • Gliomas associated with seizures, cognitive changes, or neurological deficits

Each tumor type requires a customized strategy informed by imaging, functional mapping, and multidisciplinary input.

Symptoms

Glioma symptoms vary depending on tumor location and growth pattern:

  • Headaches or nausea

  • Seizures

  • Speech or language changes

  • Weakness or coordination problems

  • Cognitive slowing or personality change

  • Vision problems

  • Difficulty with planning, multitasking, or executive function

Any new neurological symptom warrants prompt evaluation.

Diagnosis & Evaluation

Evaluation typically includes:

  • MRI with advanced tumor protocols

  • Functional MRI (fMRI) for language and motor network assessment

  • DTI / connectomics analysis to map white-matter networks

  • Neurocognitive assessment, especially for tumors near language or executive networks

  • Tumor molecular profiling (IDH status, MGMT methylation, other biomarkers)

These elements together help determine whether surgery, radiation, chemotherapy, or clinical trials are most appropriate.

When Is Surgery Recommended for Glioma or Glioblastoma?

Surgery may be recommended to establish a diagnosis, obtain tissue for molecular profiling, reduce tumor burden, relieve neurological symptoms, or achieve maximal safe resection before additional treatment. Whether surgery is appropriate—and how aggressive a resection should be—depends on the tumor's location, imaging characteristics, molecular diagnosis, previous treatment, and relationship to critical brain networks.

Glioma and Glioblastoma Surgery

Fluorescence-Guided Surgery (5-ALA)

For selected high-grade gliomas, 5-aminolevulinic acid (5-ALA) can cause tumor tissue to fluoresce under specialized operating-room visualization. This can help distinguish tumor from surrounding brain during surgery and assist with achieving maximal safe resection.

Connectomics-Guided Planning

Dr. D’Amico uses individualized brain network mapping to understand how each patient’s tumor interacts with functional circuits. This allows for:

  • Identification of critical structural and functional networks

  • Planning of surgical corridors around important brain pathways

  • Integration of network anatomy with intraoperative mapping

  • Individualization of the balance between tumor removal and functional preservation

Awake Brain Surgery

For tumors near language or motor areas, Dr. D’Amico performs awake craniotomy with intraoperative mapping, allowing real-time testing of:

  • Speech

  • Movement

  • Sensation

  • Cognition and executive tasks

Awake mapping can be particularly useful when a tumor is near language or other functions that cannot be reliably monitored under general anesthesia. Other tumors can be safely treated asleep using motor mapping, neuromonitoring, imaging, and connectomic guidance. The choice is individualized to the tumor and the patient.

Minimally Invasive Approaches

Select cases may be approached using:

  • Keyhole craniotomies

  • Tubular or endoscopic-assisted corridors

  • Exoscopic visualization

  • Laser Interstitial Thermal Therapy (LITT)

These techniques aim to reduce recovery time and minimize disruption to healthy tissue.

Surgery for Recurrent Glioma and Glioblastoma

Recurrence does not automatically mean that surgery is no longer an option. In selected patients, reoperation or minimally invasive treatment such as LITT may help obtain updated tumor tissue, relieve mass effect, reduce tumor burden, distinguish treatment effect from recurrent tumor, or facilitate additional therapies and clinical trials. Decisions about repeat surgery require careful consideration of tumor location, prior treatment, neurological function, and available systemic or radiation options.

Treatment Beyond Surgery

Dr. D’Amico works closely with neuro-oncology and radiation oncology to coordinate:

  • Radiation therapy (IMRT, proton therapy, brachytherapy, GammaTile in select cases)

  • Chemotherapy and targeted systemic treatments

  • Clinical trials for IDH-mutant gliomas, recurrent GBM, and innovative therapeutics

  • Rehabilitation and cognitive recovery strategies

This multidisciplinary approach ensures that patients receive comprehensive, personalized care.

Second Opinions

Many patients seek Dr. D’Amico for:

  • Gliomas considered high-risk or “inoperable” because of their location

  • Tumors in eloquent areas

  • Recurrent glioma or GBM after prior treatment

  • Evaluation for advanced mapping techniques

  • Guidance on surgery vs. radiation vs. clinical trials

Second opinions are often available quickly, especially for new or symptomatic diagnoses.

A second opinion does not necessarily mean another operation will be recommended. Its purpose is to independently review the imaging, pathology, molecular findings, and available surgical and nonsurgical options.

Serving Patients in New York City & the Tri-State Area

Care is provided at Lenox Hill Hospital, located on the Upper East Side of Manhattan (100 E 77th St, New York, NY 10075), with convenient access for patients from:

  • Manhattan

  • Brooklyn

  • Queens

  • The Bronx

  • Long Island

  • Westchester

  • Northern New Jersey

Request a Glioma or Glioblastoma Consultation

If you or a loved one has been newly diagnosed with a glioma or glioblastoma, has experienced tumor recurrence, or would like another opinion about whether surgery is appropriate, you can request an evaluation at Lenox Hill Hospital in New York City.

Request a Consultation | Request a Second Opinion | Refer a Patient

For a comprehensive overview of related conditions, return to the Conditions Treated page.