In the world of neurosurgery, where precision and expertise are of the utmost importance, one name stands out above all others: University Professor Dr. med. Dr. med. habil. Thomas M. Freiman. With a reputation that precedes him, Prof. Dr. Freiman serves as the head of the Department of Neurosurgery at the renowned University Medical Center Rostock. Specializing in spinal, head, and brain neurosurgery, he has established himself as a trusted figure who attracts patients seeking first-class care for their neurological conditions.
In the vibrant and growing Rostock region, the Clinic and Polyclinic for Neurosurgery serves as a comprehensive care provider for the surrounding community. The clinic places great emphasis on a comprehensive approach to patient care, relying on modern technology and innovative treatment methods, including robot-assisted surgery. Prof. Dr. Freiman and his team offer a wide range of therapies, from conservative treatments to surgical procedures. Particularly in cases where tumors must be removed from functionally critical areas, continuous neurophysiological monitoring is used to ensure optimal outcomes.
Several disciplines within the University Medical Center Rostock work seamlessly together—including neuroradiology, neuroanesthesia, intensive care medicine, pathology, oncology, radiation therapy, neuropsychology, and specialized nursing staff—to achieve the best possible outcomes. This approach is particularly effective in the treatment of neuro-oncological diseases and demonstrates the clinic’s commitment to holistic and patient-centered care.
Prof. Dr. Freiman’s expertise extends beyond spinal surgery to include head and brain neurosurgery. Here, the clinic has a proven track record of precise procedures, ranging from the removal of brain tumors and anomalies to the treatment of vascular anomalies and pediatric brain tumors. His expertise even extends to the field of neuromodulation, where techniques such as brain and spinal cord stimulation are used to treat various neurological conditions.
Beyond his clinical achievements, Prof. Dr. Freiman is a role model for leadership and dedication. With numerous awards, including European diplomas in neurosurgery and pediatric neurosurgery as well as a certificate in epilepsy surgery, Prof. Dr. Freiman’s credentials are impressive. It was therefore extremely valuable to speak with Professor Dr. Freiman specifically on the topic of “brain tumors” in order to better educate the public about this often-feared diagnosis.
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A brain tumor is a complex and often frightening medical diagnosis that can significantly impact the life of a person and their family. The brain is one of the most fascinating and complex organs in the human body, and tumors that occur in this vital organ are extremely diverse in terms of type, symptoms, and treatment options. Brain tumors can occur in both children and adults and range from benign tumors, which can usually be surgically removed, to malignant and aggressive forms that require intensive treatment. Brain tumors present a complex medical challenge, but with advances in medicine and research, there is hope and treatment options that can improve the lives of those affected.
The exact causes of brain tumors are often not fully understood, and many brain tumors occur in people without any apparent risk factors.
“Most brain tumors originate in the brain itself, and there is no risk factor for this. It is not known why the incidence of the disease is increasing. One reason could actually be that more MRI scans are being performed, which is how tumors are detected in the first place. One-third of tumors are metastases—cancer cells that have spread from other tumors in organs, such as the breast or lung, via the bloodstream. Smoking is clearly the cause of lung cancer; for other types of cancer, the causes cannot be clearly defined. Primary brain tumors primarily affect people aged 50 and older. “In children with leukemia, a brain tumor is often a complication of radiation therapy,” notes Prof. Dr. Freiman at the beginning of our conversation.
A family history of brain tumors can increase the risk of developing them. Some rare genetic syndromes, such as neurofibromatosis types 1 and 2, Hippel-Lindau disease, Li-Fraumeni syndrome, and Turcot syndrome, are associated with an increased risk of brain tumors.
Diagnosing brain tumors typically requires a combination of various diagnostic procedures to accurately determine the tumor type, size, and location.
“Most of my patients are referred by colleagues in neurology or orthopedics or by primary care physicians—that’s about 90%. There are a few who come directly, partly because they’ve researched their symptoms online on their own initiative due to possible symptoms such as persistent headaches. Other symptoms include epileptic seizures and, less commonly, hemiplegia or speech disorders. Anyone suffering from chronic headaches should definitely see their primary care physician first and then be referred to a neurologist. “So if headaches keep getting worse over the course of weeks, everyone should be vigilant,” advises Prof. Dr. Freiman. The location and size of the tumor play a major role in causing headaches. “Some patients have a relatively small tumor, but it is located in a difficult position within the head and therefore causes more symptoms. A small tumor can also trigger an epileptic seizure, which is actually a positive thing in itself, as it means the tumor will almost certainly be detected early,” adds Prof. Dr. Freiman.
If a patient exhibits symptoms such as persistent and worsening headaches and/or an epileptic seizure, the patient will be admitted to the hospital’s neurology department so that the necessary tests can be performed. “Ideally, an MRI is performed—anything else is really a waste of time when it comes to making a quick diagnosis. The question then is where the brain tumor originated—from the brain itself or elsewhere—and whether it contains highly malignant components. This is where we turn to nuclear medicine, which allows us to visualize the tumor’s metabolism using radioactive substances. This way, we can clearly determine whether immediate surgery is necessary or whether a biopsy is sufficient, followed by chemotherapy,” explains Prof. Dr. Freiman.
Positron emission tomography can provide information about the tumor’s metabolism and help distinguish between malignant and benign tumors. A tissue sample (biopsy) is taken from the tumor and examined in the laboratory to determine the exact type of tumor. This is often necessary to plan the appropriate treatment.
The location of the tumor is of considerable importance.
“The exact location of the tumor is of fundamental importance for the entire treatment plan. There are some areas of the brain that are not easily accessible for surgery. If the tumor is located in a difficult position, surgery can result in deficits ranging from paralysis and severe speech disorders to personality changes. However, we are a specialized clinic for precisely these types of difficult tumors. For example, if a tumor poses a risk of causing paralysis, we perform surgery under electrophysiological monitoring—that is, the anesthetized patient is fitted with electrodes, and they move their arms and legs during the surgery, allowing us to determine whether we might damage these critical pathways or not. When it comes to speech, it’s more difficult to monitor speech function during surgery. The patient would need to be awake during the procedure. For such an operation, the patient is first anesthetized; we open the skull, and the patient wakes up (the brain is insensitive to pain). The patient must then speak with a neurologist and solve math problems during the procedure so that we can monitor the speech region. “However, this is often not necessary at all,” explains Prof. Dr. Freiman.
Personalized therapy for brain tumors has made significant progress in recent years, and these advances have made it possible to create individually tailored treatment plans.
“Every person is different, and every tumor is different. For example, we would operate on a young person differently than on an older person, even if the tumor is similarly malignant. In the case of a young person, we perform radical surgery. For an older person, we prioritize quality of life. If the potential risk of harm is too great, we may leave a residual tumor in the brain. This must be discussed on a case-by-case basis during a thorough consultation with the patient. We must also always explain the alternatives so that the patient can help decide how the treatment should proceed. This individualized approach is very important to me personally, because we doctors are entrusted with an incredible amount of trust. To earn that trust, we must prove ourselves every day and maintain close contact with the patient. In this context, the surgery itself is not necessarily the primary focus; rather, it is the ongoing care of the patient. Interdisciplinary collaboration is also incredibly important, and we are frequently recommended by many colleagues,” explains Prof. Dr. Freiman.
Personalized therapy for brain tumors holds great promise for the future, as it offers the prospect of more targeted, effective, and less burdensome treatments for patients. However, it is important to note that not every patient is a candidate for all personalized treatment approaches, and selecting the right treatment requires careful evaluation by a multidisciplinary team of physicians. Close collaboration between oncologists, neurosurgeons, pathologists, and other specialists is crucial to developing the best possible treatment for each patient.
Acoustic neuromas, also known as vestibular schwannomas or vestibular neuromas, are slow-growing tumors that develop near the hearing and balance nerve (vestibulocochlear nerve or eighth cranial nerve) in the inner ear. This type of tumor is relatively rare and accounts for about 6–10% of all intracranial tumors.
The exact cause of acoustic neuromas is unknown, and most of these tumors are benign. The diagnosis and treatment of acoustic neuromas present specific challenges. Because these tumors grow slowly, symptoms may develop gradually and are often nonspecific at first. The most common symptoms are unilateral hearing loss and tinnitus (ringing in the ears). However, advanced tumors can lead to balance disorders, dizziness, facial paralysis, and headaches. Acoustic neuromas are typically diagnosed using a combination of imaging techniques, such as MRI or CT scans, and an audiological examination. Imaging allows for the precise determination of the tumor’s size and location.
“These tumors are tricky. An acoustic neuroma is potentially benign, but it grows in an unfavorable location. They originate in the vestibular portion of the auditory nerve, and right next to it—through the same tiny opening in the skull—the facial nerve exits the skull. And that’s actually the crux of the matter. The facial nerve is so close that as the tumor grows, it splits the nerve—which is as thin as paper—into individual tiny fibers, making it difficult to remove the tumor completely in the end. Ultimately, there is a risk of hemifacial paralysis if the tumor has fused too tightly with the nerve, although most cases of paralysis often resolve on their own after 1–2 months. “In any case, the surgeon needs a high degree of finesse and must have extensive experience with this type of surgery,” says Prof. Dr. Freiman regarding this particular characteristic of this brain tumor.
Radiation therapy, including stereotactic radiosurgery, can be used to treat acoustic neuromas, particularly in older patients or when surgery carries a higher risk.
“As recently as the 1970s, an acoustic neuroma was fatal. Thanks to advances in surgical techniques—specifically the use of the surgical microscope and the capabilities of intraoperative electrophysiology, which allow the facial nerve to be stimulated and spared—this has changed drastically. Hearing loss almost always occurs. However, patients often do not even notice it; they compensate with their other ear. Today, small tumors can be removed very effectively without causing any damage. We discuss every tumor in our tumor board and decide whether or not to proceed with surgery. This is because some tumors eventually stop growing. In such cases, high-dose radiation therapy is an option. However, this also carries the risk of permanent facial paralysis, for which there is no further treatment available. “An acoustic neuroma always requires a personalized treatment plan and comprehensive counseling and education for the patient,” explains Prof. Dr. Freiman. The choice of the best treatment option therefore depends on many factors, including the size of the tumor, the degree of hearing loss, the patient’s overall health, and individual preferences. Close collaboration between neurosurgeons, audiologists, and radiation oncologists is crucial for determining the best approach for each patient.
The treatment of brain tumors remains a challenging and complex task, but there are several promising novel treatment methods and immunotherapeutic approaches currently being tested in the fight against brain tumors.
Immunotherapies aim to activate the patient’s immune system to attack the tumor. Although results have been mixed so far and not all patients benefit from this therapy, some studies show promising results, and research in this field is advancing. “There is still no statistically significant benefit in neurology. CAR-T cell therapy (Chimeric Antigen Receptor T-Cell Therapy) is a promising new form of immunotherapy in which the patient’s T cells are genetically modified to recognize and attack cancer cells. However, the brain receives little blood flow, which means antibodies and immune cells have difficulty reaching it. Nevertheless, there is still the option of attacking the tumor with viruses. We are working closely with Harvard University on this. This promising method uses viruses to specifically target and destroy tumor cells. But here, too, we are still in the experimental stage. For smaller metastases (up to 2 cm), a so-called Gamma Knife can also be used; in fact, it is the treatment of choice in such cases. “It involves focused, high-dose radiation that causes minimal damage to the surrounding tissue, which is why this therapy can be used frequently,” says Prof. Dr. Freiman.
The Gamma Knife is a highly precise medical device used to treat brain tumors, brain metastases, and other neurological conditions. It is a non-invasive procedure that directs highly concentrated beams from various angles at a precise point in the brain. These beams converge at the target point to treat the tumor specifically, while sparing the surrounding healthy tissue as much as possible. The Gamma Knife is often considered a form of radiosurgery and is the preferred option for patients for whom conventional surgery is too risky or not possible. It enables precise and effective treatment with minimal damage to surrounding tissue.
Coping with a brain tumor diagnosis and the entire treatment process is an extremely demanding task that poses significant challenges for both the patient and their family. Comprehensive and empathetic support is crucial to helping them through this difficult time.
It is important to provide those affected with clear and understandable information about the diagnosis, the planned course of treatment, and the challenges they can expect. This helps reduce fears and uncertainties and enables patients and their families to make more informed decisions. Psychosocial support plays a central role in this process. The mental health of those affected is of great importance, and therefore access to psychologists, psychiatrists, or social workers should be ensured. These professionals can help manage emotional distress, reduce stress, and provide those affected with tools to cope with the situation. Self-help groups and online communities are also valuable resources that allow those affected to connect with others in similar situations and share experiences. Connecting with like-minded people can be comforting and help reduce feelings of isolation.
“It’s also very important to provide patients with financial assistance and guidance. We explain what rights the patient has and what options are available for asset protection and guardianship. To this end, we have a social worker here who also handles insurance and administrative matters and supports the patient from the very beginning. In addition, we have a psychological-oncology service with experts in helping patients cope with anxiety. Many patients don’t have strong family support, are alone, and can thus learn coping mechanisms to manage their anxiety,” explains Prof. Dr. Freiman.
In advanced cases where a cure is no longer possible, hospice and palliative care can offer comfort and support to patients and their families to ensure the best possible quality of life during this final phase of life.
A top-notch team and a high level of dedication at the University Hospital of Rostock!
“Fifty percent of my work focuses on the treatment of brain tumors. Another major focus is on children with these conditions, whom I successfully treat as a recognized specialist in pediatric neurosurgery. This ranges from brain tumors resulting from leukemia to the treatment of hydrocephalus, spina bifida, or other congenital malformations. I have excellent senior physicians with whom I enjoy working very much; as a university instructor, I also train them and hope that they, too, will one day become department heads. It’s a truly great team! Looking ahead, I hope the hospital will acquire an intraoperative MRI scanner—a specialized magnetic resonance imaging device capable of providing real-time imaging of the brain or spinal cord during surgery—which is expected to be installed here at the hospital in about two years. Research, especially cancer research, is also a major focus at Rostock University Hospital. Fundamentally, I feel a deep sense of gratitude, including for having been awarded one of the 20 professorships in neurosurgery in Germany. “I worked very hard for it—but a little bit of luck is always part of it!” explains Prof. Dr. Freiman at the conclusion of our conversation.
Dear Professor Dr. Freiman, thank you very much for this in-depth look into the world of neurosurgery!
