DURHAM, North Carolina (CNN) — Sen. Edward Kennedy was at Duke University Medical Center on Monday for surgery to treat a malignant brain tumor.

Sen. Edward Kennedy, right, leaves a Boston hospital with his son Patrick on May 21.

In a statement, the 76-year-old Democratic icon said he and his wife, Vicki, “along with my outstanding team of doctors at Massachusetts General Hospital, have consulted with experts from around the country and have decided that the best course of action for my brain tumor is targeted surgery followed by chemotherapy and radiation.”

Aides said the senator would be going into surgery around 9 a.m. ET and the surgery would last four to six hours.

Afterward, Kennedy said in the statement, he expects to remain in the hospital “to recuperate for approximately one week.”

He added, “Shortly thereafter, I will start radiation treatments at Massachusetts General Hospital and begin chemotherapy.”

Enlarged Image for Glioma – Glioblastoma multiforme

Kennedy, a senator from Massachusetts since 1962, suffered a seizure May 17 while walking his dogs at his home in Hyannisport, Massachusetts.

Three days later, Kennedy’s doctors at Massachusetts General said that preliminary results from a brain biopsy showed a tumor in the left parietal lobe was responsible for the seizure.

Enlarged Image for Glioma

Astrocytoma is the most common type of primary brain tumor.

The surgeon is Dr. Allan Friedman, Kennedy’s statement said. Friedman is chief of the division of neurosurgery and co-director of Duke’s Neuro-Oncology Program, according to the hospital’s Web site.

Friedman is responsible for more than 90 percent of all tumor removals and biopsies conducted at Duke, the medical center’s Web site says.


It’s possible Kennedy will be awake for his surgery, according to Dr. Sanjay Gupta, CNN’s chief medical correspondent a neurosurgeon.

Friedman and the Duke hospital are known for surgery called “motor mapping” in which doctors locate the areas of the brain responsible for things such as movement and speech and map these areas to ensure they are avoided.

Often during such operations, surgeons ask a patient to repeat certain words or make a movement such as squeezing a hand so they can identify areas of the brain involving speech and movement.

They then attempt to remove as much of the tumor as they believe they can safely, Gupta said.

Gupta said earlier that a tumor in the left parietal lobe could affect the senator’s ability to speak and understand speech as well as the strength on the right side of his body.

Gupta said such tumors don’t usually metastasize or spread to other parts of the body.

“What they do do — and I think that’s a concern to people — is that they grow, and sometimes they invade other normal parts of the brain. That is the big concern here,” he said.

Enlarged Image for Glioma – PET Scan of glioblastoma multiforme

Malignant glioma is the most common primary brain tumor, accounting for more than half of the 18,000 primary malignant brain tumors diagnosed each year in the United States, according to the National Cancer Institute.

Kennedy used his statement Monday to focus on the presidential race as well his surgery. “After completing treatment, I look forward to returning to the United States Senate and to doing everything I can to help elect Barack Obama as our next president,” he said.

Obama, the front-runner for the Democratic presidential nomination, described Kennedy as a “giant” of the Senate.

“I think you can argue that I would not be sitting here as a presidential candidate had it not been for some of the battles that Ted Kennedy has fought,” Obama said.

“He is somebody who battled for voting rights and civil rights when I was a child. I stand on his shoulders.”

Obama’s rival, Sen. Hillary Clinton, said Kennedy’s courage and resolve made him one of the greatest legislators in Senate history.

“He’s a fighter. There isn’t anybody like him who gets up and goes out and does battle on behalf of all of us every single day,” Clinton said. “I know he’s a fighter when it comes to the challenges he’s facing right now.”

Sen. John McCain, the GOP presumptive presidential nominee, also offered his thoughts and prayers for Kennedy’s family.

“I have described Ted Kennedy as the last lion in the Senate. And I have held that view because he remains the single most effective member of the Senate,” McCain said.

President Bush said in a statement he was saddened by the news and would keep the senator in his prayers.

“Laura and I are concerned to learn of our friend Sen. Kennedy’s diagnosis. Ted Kennedy is a man of tremendous courage, remarkable strength and powerful spirit. Our thoughts are with Sen. Kennedy and his family during this difficult period,” he said.

Kennedy had surgery in October to clear his carotid artery in hopes of preventing a stroke. Until the seizure, the powerful Democrat appeared in fine health. He suffers chronic back pain from injuries suffered in a 1964 plane crash.

Kennedy is one of only six senators in U.S. history to serve more than 40 years. He is an iconic liberal champion of social issues such as health care, family leave and the minimum wage.

He is the youngest of four brothers in a powerful and legendary family. His oldest brother, Joe Kennedy, was killed in World War II; John F. Kennedy was the 35th president of the United States and slain in 1963; and Sen. Robert F. Kennedy, a former U.S. attorney general, was running for president when he was assassinated in 1968.

About Gliomas (Primary Brain Tumors)

A tumor is a mass or growth of abnormal cells. Tumors found in the brain typically are categorized as primary or secondary. Gliomas (primary brain tumors) start in the brain or spinal cord tissue. They can spread within the nervous system but do not spread outside the nervous system. Gliomas can be either benign (slow growing) or malignant (fast growing). Annually, about 17,000 Americans are diagnosed with a primary brain tumor.

Brain tumors can be challenging to treat, but many are treated successfully. Also, new technology helps physicians target tumors more precisely. Innovative treatments under investigation offer hope for the future.

Sophisticated 3-D computer models help Mayo neurosurgeons plan the safest way to a brain tumor.

Brain tumor treatment at Mayo Clinic is a team process. A patient may see several Mayo Clinic specialists from the brain tumor treatment team, who work together to provide the high-quality, integrated care for which Mayo Clinic is known. Generally, a neurologist who has expertise and additional training in neuro-oncology, will coordinate the care team. In addition, the neuro-oncologist will counsel the patient about neurologic issues.

Because new treatments develop continually, several options may be available for patients at different points in their treatment. The pros and cons of each option are discussed in detail during treatment planning. Mayo Clinic’s goal is to improve the duration and quality of survival. Every effort is made to tailor the treatment program to the needs of the patient and family.

When appropriate, the patient’s case history may be presented and discussed with a multidisciplinary tumor team, comprised of specialists in neurosurgery, medical oncology, neurology, radiation oncology, neuroradiology and neuropathology. This collaborative team helps identify the best treatment plan.

Most brain tumor care, aside from surgery, is delivered on an outpatient basis.

During chemotherapy and radiation therapy, blood counts and blood chemistry are closely monitored. During phases of active therapy (which can last up to a year or more) MRI scans of the brain are obtained at regular intervals to monitor tumor growth or shrinkage. These scans are also conducted for several years after active therapy has been completed to watch for signs of tumor recurrence and allow for immediate intervention, if necessary.

Quality of Life

Quality of life is as important as quantity of life in Mayo’s treatment plans. As cancer treatments become more successful, enabling patients to live longer, patients face greater risks of long-term adverse effects of treatment. The most significant adverse effects are cognitive problems. Mayo specialists, including world-renowned neuropsychologists and experts in brain rehabilitation, help patients with these issues. Almost all clinical trials at Mayo and the North Central Cancer Treatment Group incorporate quality of life measures.

Whenever possible, the brain tumor treatment team tries to integrate care from the patient’s local physician and oncologists to offer the most comprehensive management. Mayo specialists work with local physicians to administer some therapy closer to home for patients who live a significant distance from Mayo Clinic.
Treatment Options

Surgery is the initial therapy for nearly all patients with brain tumors and can cure most benign tumors, including meningiomas. The goal of surgery is to remove as much of the tumor as possible while minimizing damage to healthy tissue.

Some tumors can be removed completely; others can be removed only partially or not at all. Partial removal helps relieve symptoms by reducing pressure on the brain and reducing the size of the tumor to be treated by radiation or chemotherapy.

After the tumor has been removed, Mayo Clinic pathologists immediately evaluate the tissue and report results directly to the surgeon in the operating room. Direct, face-to-face contact with the pathologist during the surgery allows the surgeon to verify that the tumor has been fully removed and may reduce the need for an additional operation.

If a tumor cannot be surgically removed, the physician may do only a biopsy. A small piece of the tumor is removed so a pathologist can examine it under a microscope to determine its cell makeup. The finding helps determine the proper treatment.

Patients diagnosed with brain tumors often can be scheduled for surgery the next day, if desired. Surgeons provide patients with information to help them decide which treatment is best for them.

Surgical removal demands great skill. Mayo’s neurosurgeons operate on hundreds of patients each year, using the latest technological advances. Mayo surgeons were pioneers in developing computer-assisted neurosurgery, which allows surgeons to precisely map the brain and more accurately and aggressively treat brain tumors.

Another technology available at Mayo is intraoperative MRI, which provides the neurosurgeon with real-time data on tumor volume and location.

Mayo Clinic neurosurgeons also use awake brain surgery on tumors that infiltrate brain regions which control functions like speech and movement. The surgery is performed with the patient awake during segments of the operation. The patient’s responses to questions allow the surgeon and attending team to more precisely identify critical brain regions and minimize injury during tumor removal.

Lasers are sometimes used to remove tumors. In some cases, tumors can be removed using minimally invasive techniques. Innovative techniques such as gene therapy also are available under research protocols.

Radiation Therapy

Radiotherapy is an essential component of treatment for many patients with brain tumors. It can cure some patients and prolongs survival for most. Radiation is often the primary treatment for patients with metastatic brain tumors.
External-Beam Radiation

This traditional form of radiation therapy delivers radiation from outside the body. The radiation usually involves treatments five days a week; the length of time depends on the type of tumor. External beam radiation is less precise, but allows a wider area of tissue around the tumor to be treated.

Fractionated Stereotactic Radiotherapy (FSR)

This technique minimizes damage to normal tissue by carefully targeting radiation. The treatment involves many smaller treatments rather than one big “shot” of radiation. Normal brain tissues and cranial nerves can tolerate many smaller treatments but cannot tolerate single large treatments. FSR also offers the biological benefit of fractionation, which is to exploit the different sensitivities of normal versus cancer tissue. These advantages are helpful when treating lesions near structures such as the optic nerves, which cannot tolerate high levels of radiation.

For this procedure, the patient is fitted with a plastic mask that aids in targeting the radiation and locating the tumor during treatment. The patient lies on a table and X-rays are taken to determine correct positioning. The treatment is given in several smaller units called arcs. The number of treatments depends on the size and location of the tumor.

Stereotactic Radiosurgery

New Gamma Knife™ machine at Mayo Clinic shortens treatment time and expands capabilities.

Stereotactic radiosurgery is effective for well-circumscribed lesions such as meningioma or limited brain metastases. Radiosurgery precisely targets the tumor with high doses of radiation, while sparing nearby normal tissue because there is a rapid fall-off of radiation at the edges of the area being treated.


Although chemotherapy provides only modest benefit for many patients with brain tumors, it plays an increasingly important role in pain relief. Chemotherapy benefits only a small number of patients with glioma over the long term.

Other Drugs

Corticosteroids are indispensable for controlling increased intracranial pressure and reducing tumor sizes. Unfortunately, the long-term use of these agents can result in substantial toxic effects. Anti-convulsant drugs are sometimes administered after surgery in patients who have had seizures.

Deep vein thrombosis or pulmonary emboli can occur in 20 percent to 30 percent of patients with primary brain tumors. Conventional therapy with heparin and warfarin is usually effective and well tolerated.

Clinical Trials

Mayo Clinic participates in numerous clinical trials for brain and nervous system tumors, including trials originating at Mayo Clinic and those sponsored by the National Cancer Institute through the North Central Cancer Treatment Group (NCCTG).

Brain Tumor Drug – Click on the link to hear, in this video, about a new medication, not yet approved by the FDA

Brain Rehabilitation

Brain injury can lead to problems with thoughts, feelings and behaviors. Many people with brain injury find that returning to independent living, work or school presents challenges that they cannot cope with alone. Mayo Clinic rehabilitation specialists help people with brain injury live as independently as possible within their family and community.


More than 20,000 people in the United States will be diagnosed with cancers arising in brain or spinal cord this year, reports the American Cancer Society. Cancer is the second leading cause of death in children in the United States, with brain tumors’ lethality second to only leukemia. Brain cancer poses a unique challenge to cancer research and neuroscience, and its study demands a unique research environment, one that recognizes the special nature of the central nervous system and the tumors that develop there.

Brain tumor research is a relatively modern science that parallels the explosion of molecular biology and modern neuroimaging. While the science is new, Mayo Clinic Cancer Center’s Neuro-Oncology Program has its roots in Mayo’s long history of brain cancer treatment and research stretching back over 100 years.

Robert B Jenkins, MD, PhD – Program Co-Leader
Brian P O’Neill, M.D.


Ependyma is the thin epithelial membrane lining the ventricular system of the brain and the spinal cord. Ependyma is one of the four types of neuroglia in the central nervous system. It is involved in the production of cerebrospinal fluid (CSF).Section of central canal of medulla spinalis, showing ependymal and neuroglial cells.

The ependyma is made up of ependymal cells. These are the epithelial cells that line the CSF-filled ventricles in the brain and the central canal of the spinal cord. The cells are cuboidal/columnar. Their apical surfaces are covered in a layer of cilia, which circulate CSF around the central nervous system. Their apical surfaces are also covered with microvilli, which absorb CSF. Within the brain’s ventricles, a population of modified ependymal cells and capillaries together form a system called the choroid plexus, which produces the CSF.