A CALIFORNIA BRAIN SURGEON WIELDS FORMIDABLE NEW WEAPONS AS HE BATTLES

The Tumor War

f her brain tumor had shown up 10 years ago, Melinda Schuler would not have had much of a chance. Few doctors would even have tried to remove the malignant growth, located in her right frontal lobe, that had already taken over one-sixth of her cranium, pushing her brain down and to the left. Leave it alone, and the cancer would keep compressing useful tissue inexorably, robbing the patient of speech, movement, consciousness, life itself--all within months. Try to cut it out, and there would be the risk of taking too little, leaving cancerous tissue to grow again, or taking too much, causing profound and irreparable brain damage.

It was fortunate for Schuler that the tumor was discovered in 1997 rather than in 1987. In the intervening decade, brain surgery advanced dramatically, enabling doctors to refine their operating techniques enormously with the aid of more sophisticated medical technology. Today they can chart a far safer passage to tumors hidden deep in the brain. But, more to the point for Schuler, Dr. Keith Black, the man who stands over her exposed brain with scalpel in hand, is one of the world's most talented brain surgeons, known for working with the most difficult of brain tumors.

Of the 5,000 or so neurosurgeons working in the U.S. today, 4,900 concentrate mostly on the spine and deal on average with only five or six brain tumors a year. Of the 100 who routinely work inside the skull, perhaps 50 specialize in blood-vessel repairs rather than tumors. Only the remaining 50 can be considered brain-tumor specialists, averaging 100 surgeries annually. Along with a handful of others, Black averages more like 250 such operations a year. His referrals come not only from the U.S. but from Europe, the Middle East, South America, Japan and Australia as well. A tumor that is inoperable for the average neurosurgeon is not necessarily inoperable for Black.

That's how Melinda Schuler ended up on Black's operating table at the UCLA Medical Center. (This past summer Black became director of a new neurosurgery institute at Cedars-Sinai Medical Center, also in Los Angeles.) The neurosurgeon in Reno, Nev., who performed the original biopsy would not touch the tumor, which was sitting right in the middle of her motor area. He could have taken it out but feared that Schuler would be left paralyzed. "Most of the tumors I see are like this," Black says in his soft Southern voice.