Dr. George Jallo--Neurosurgeon at John Hopkins
Me: I know what a neurosurgeon does. But let’s say that I am a patient, and I just found out that I have a brain tumor and I have no idea what your role is in my treatments. Could you explain to me what your job is as neurosurgeon?
Dr. Jallo: Sure. My role is, as a neurosurgeon, is to cut. That means I operate in the brain and provide tissue to, one, determine the diagnosis to know exactly what the tumor type is. And two, for a lot of tumors if you can take them out, it makes other treatments all that much easier. And in some cases, if you are able to remove the entire tumor you don’t need any other treatments such as radiation or chemotherapy. So, the neurosurgeons have a major part in the care of the child who has a brain tumor. You can almost say that they become the first line approach. Once they can safely remove the tumor, we send it to the pathologist. The pathologist reviews it and makes the diagnosis. And once we have a diagnosis we discuss it with the neuro-oncologist to come up with a plan for the patient. If they need chemotherapy, the oncologist will take over. If they need radiation, the radiation-oncologist will take over. The neurosurgeon will take a “backseat” knowledge in case there are problems that develop or, in the case of a malignant tumor, if it grows back and it needs another operation, then we step up to the plate again.
Me: How heavily does the type of treatment depend on what kind of tumor it is?
Dr. Jallo: Absolutely. If it is a benign low-grade tumor and you take it out, it may not need any other treatment, just imaging—MRIs now and then to make sure it doesn’t grow back. If it’s malignant, it may need chemotherapy, radiation, or a combination of the two. If it’s a benign or slow growing tumor sometimes we do nothing but surgery. And even if it comes back again, we’ll go in and re-operate to get it all out or as much of it as possible, trying to avoid all the other modalities from chemotherapy and radiation. They also have some side effects associated with them.
Me: Are there any other treatment options besides surgery, chemotherapy, or radiation, such as a vaccine, for example?
Dr. Jallo: There are some vaccines under trial now that are being opened for children. There are vaccine trials for malignant tumors in adults but currently there are one or two vaccine trials for children for low-grade tumors and high grade tumors. And sometimes vaccine trials need some catheters inserted in that location so they can deliver the drugs.
Me: Do you have any current research that you are conducting at the moment that you could tell me about?
Dr. Jallo: Yes, I am doing research on brain stem and spinal cord tumors; these are really difficult tumors. What we do is creating the tumors in animals and then I am trying to treat them by putting in catheters and delivering drugs. So we’re trying to treat them with that surgery, just with the delivery of chemotherapy agents.
Me: So you’re testing them out on animals first and then on people?
Dr. Jallo: Well, yes. You can’t just test it in a human trial. So you have to do these safety studies on animals. And we use small animals: mice and rats.
Me: That’s really interesting. So, I am curious about one thing. My sister had hydrocephalus. I was never told much about it, so there isn’t much I know about it other than that it is water in the brain. If you come across a patient who has hyrdocephalus, do you remove it? Or do you work around it? Can you explain that to me?
Dr. Jallo: Hydrocephalus, it’s actually very common in children. One, there are some children who are born with it. Two, the children develop it once they have a tumor. What hydrocephalus is, in a simple definition: hydro is water and cephalus is brain; so water on the brain. But really what it is is a cerebral spinal fluid (CSF). We all have it in our brain. One, it provides nutrients. Two, it cushions the brain which is confined in the skull. It is a clear fluid so everyone thinks it is water, but it’s not. It’s full of chemicals and electrolytes inside it, but it provides nutrients to all the brain cells as well as providing the cushions. So what happens is we make about [in comparison] one can of soda a day, but we reabsorb that whole can each day. What happens is, some tumors can cause you to make more cerebral fluid that you can’t reabsorb, and an accumulation occurs. And you have hydrocephalus. Some tumors can block the fluid pathways or you make it and it can’t get out and get reabsorbed. To treat it we have a couple of options. We can bypass the instruction. Other times we have to put a shunt into the fluid cavity, the ventricles, and run the tube under the skin and put it into some other orient such as around the abdomen or in the lungs, and sometimes in the heart, to treat the fluid.
Me: Regarding the quality of life, how do you balance that and trying to save your patient?
Dr. Jallo: Lots of practice. When I first finished my training, it was extremely difficult. I just wanted to be here all the time for my patients and try to be the best physician for them. I think that surgery is actually easier that balancing that.
Me: After all the treatments over, and the patient is tumor-free, what is your role with the patient thereon out?
Dr. Jallo: So after that, I’m going to have to follow patients. In some cases it could be the oncologist, other times it may be the surgeon. I have followed some of my children with brain tumors for 20 years. I see them once or twice a year just to make sure they are doing okay. So I continue to follow them even though I don’t need to do surgery. I am still interested in their lives and how they are developing.
Me: I have asked every doctor this question. I just enjoy hearing their answers. What is the most rewarding aspect about what you do?
Dr. Jallo: For me, as a surgeon, it’s seeing the children tumor-free and trying to live their lives to their fullest potential.
Dr. Jallo: Sure. My role is, as a neurosurgeon, is to cut. That means I operate in the brain and provide tissue to, one, determine the diagnosis to know exactly what the tumor type is. And two, for a lot of tumors if you can take them out, it makes other treatments all that much easier. And in some cases, if you are able to remove the entire tumor you don’t need any other treatments such as radiation or chemotherapy. So, the neurosurgeons have a major part in the care of the child who has a brain tumor. You can almost say that they become the first line approach. Once they can safely remove the tumor, we send it to the pathologist. The pathologist reviews it and makes the diagnosis. And once we have a diagnosis we discuss it with the neuro-oncologist to come up with a plan for the patient. If they need chemotherapy, the oncologist will take over. If they need radiation, the radiation-oncologist will take over. The neurosurgeon will take a “backseat” knowledge in case there are problems that develop or, in the case of a malignant tumor, if it grows back and it needs another operation, then we step up to the plate again.
Me: How heavily does the type of treatment depend on what kind of tumor it is?
Dr. Jallo: Absolutely. If it is a benign low-grade tumor and you take it out, it may not need any other treatment, just imaging—MRIs now and then to make sure it doesn’t grow back. If it’s malignant, it may need chemotherapy, radiation, or a combination of the two. If it’s a benign or slow growing tumor sometimes we do nothing but surgery. And even if it comes back again, we’ll go in and re-operate to get it all out or as much of it as possible, trying to avoid all the other modalities from chemotherapy and radiation. They also have some side effects associated with them.
Me: Are there any other treatment options besides surgery, chemotherapy, or radiation, such as a vaccine, for example?
Dr. Jallo: There are some vaccines under trial now that are being opened for children. There are vaccine trials for malignant tumors in adults but currently there are one or two vaccine trials for children for low-grade tumors and high grade tumors. And sometimes vaccine trials need some catheters inserted in that location so they can deliver the drugs.
Me: Do you have any current research that you are conducting at the moment that you could tell me about?
Dr. Jallo: Yes, I am doing research on brain stem and spinal cord tumors; these are really difficult tumors. What we do is creating the tumors in animals and then I am trying to treat them by putting in catheters and delivering drugs. So we’re trying to treat them with that surgery, just with the delivery of chemotherapy agents.
Me: So you’re testing them out on animals first and then on people?
Dr. Jallo: Well, yes. You can’t just test it in a human trial. So you have to do these safety studies on animals. And we use small animals: mice and rats.
Me: That’s really interesting. So, I am curious about one thing. My sister had hydrocephalus. I was never told much about it, so there isn’t much I know about it other than that it is water in the brain. If you come across a patient who has hyrdocephalus, do you remove it? Or do you work around it? Can you explain that to me?
Dr. Jallo: Hydrocephalus, it’s actually very common in children. One, there are some children who are born with it. Two, the children develop it once they have a tumor. What hydrocephalus is, in a simple definition: hydro is water and cephalus is brain; so water on the brain. But really what it is is a cerebral spinal fluid (CSF). We all have it in our brain. One, it provides nutrients. Two, it cushions the brain which is confined in the skull. It is a clear fluid so everyone thinks it is water, but it’s not. It’s full of chemicals and electrolytes inside it, but it provides nutrients to all the brain cells as well as providing the cushions. So what happens is we make about [in comparison] one can of soda a day, but we reabsorb that whole can each day. What happens is, some tumors can cause you to make more cerebral fluid that you can’t reabsorb, and an accumulation occurs. And you have hydrocephalus. Some tumors can block the fluid pathways or you make it and it can’t get out and get reabsorbed. To treat it we have a couple of options. We can bypass the instruction. Other times we have to put a shunt into the fluid cavity, the ventricles, and run the tube under the skin and put it into some other orient such as around the abdomen or in the lungs, and sometimes in the heart, to treat the fluid.
Me: Regarding the quality of life, how do you balance that and trying to save your patient?
Dr. Jallo: Lots of practice. When I first finished my training, it was extremely difficult. I just wanted to be here all the time for my patients and try to be the best physician for them. I think that surgery is actually easier that balancing that.
Me: After all the treatments over, and the patient is tumor-free, what is your role with the patient thereon out?
Dr. Jallo: So after that, I’m going to have to follow patients. In some cases it could be the oncologist, other times it may be the surgeon. I have followed some of my children with brain tumors for 20 years. I see them once or twice a year just to make sure they are doing okay. So I continue to follow them even though I don’t need to do surgery. I am still interested in their lives and how they are developing.
Me: I have asked every doctor this question. I just enjoy hearing their answers. What is the most rewarding aspect about what you do?
Dr. Jallo: For me, as a surgeon, it’s seeing the children tumor-free and trying to live their lives to their fullest potential.