Brain Tumor Surgery

Tumours can either be benign or malignant, depending on their growth type:

Benign Brain Tumours: Benign tumours grow locally and remain separate from the surrounding brain. They are harmless cells that can be removed safely, and are unlikely to recur but can cause severe pain, permanent brain damage, seizures (fits) and death. Benign brain tumours sometimes become malignant.

A malignant brain tumour is a fast-growing cancer and should be treated immediately in order to limit the spread of cancer to other parts of the brain and spine.

The actual risk factors which cause brain tumours are not known. The possible risk factors for primary brain tumours could be:

• Long term exposure to radiation 
• Family history 
• HIV infection 
• Cigarette Smoking  
• Environmental toxins (for example, chemicals used in oil refineries, embalming chemicals, rubber industry chemicals)

Symptoms of brain tumour are not specific to the disease. Neither do they generally show-up until the tumour has grown large enough to displace, damage, or destroy delicate brain tissue, and the patient may then experience:  

• Headaches that become increasingly painful and annoying when lying down 
• Nausea and vomiting or sudden attacks of vomiting not accompanied by nausea 
• Seizures (fits)  
• Personality changes 
• Sudden vision loss 
• Speech problems 
• Weakness or paralysis on one side of the body

A complete physical examination and a detailed medical history are taken by the doctor, who then conducts the primary neurologic examination. If the results suggest a patient may have a brain tumour, additional diagnostic tests are recommended which include: 

• Computed Tomography Scan (CT scan) to reveal brain abnormalities  
• Magnetic Resonance Imaging (MRI) to detect tumours in the brain 
• Complex imaging techniques such as Positron Emission Tomography (PET scan), Single-photon emission tomography (SPECT scan)  
• Angiography to outline a tumour and the blood vessels that lead to it  
• A lumbar puncture (spinal tap) to obtain spinal fluid, which may contain tumour cells. 
• Microscopic examination of tumour tissue (biopsy) is the only way to identify the kind of cells it contains and to make the correct diagnosis. Nowadays, Immunohistochemistry (IHC makers) can be done to make the exact diagnosis and for grading of the tumour for HPE (histopathological examination).

Treatment regimens are individualized and based upon the patient's age and general health status as well as the size, location, type, and grade of the tumour.

The most widely used treatment options are surgery, radiation therapy, and chemotherapy.

1. Surgery is the treatment of choice for accessible brain tumours, which can be removed without causing grave neurological damage. The procedure performed is known as a craniotomy. Depending on the type of brain tumour, its location, and its size, several techniques may be used, which include a craniotomy, laser microsurgery (using hightemperatures to vaporize tumour cells), ultrasonic aspiration (using ultrasound waves to break up the tumour into smaller bits, which can be vacuumed out)

Radiation and chemotherapy are done to eradicate cells that may have escaped the scalpel, depending on the grade of the tumour and the diagnosis.

Side-Eects: In modern times, the risk of death after elective brain surgery is < 1% while the risk of side effects is < 10%. However, certain side effects like seizures, weakness, coordination problems, personality changes, difficulty in speaking or thinking may vary depending on the site of the tumour. Most side effects of surgery lessen or disappear with time.

Radiation Therapy: External radiotherapy delivered on an outpatient basis, directs radiation to the tumour and the area around it. Implant radiation therapy (also called brachytherapy) involves placing tiny pieces of radioactive material in the brain. Left in place permanently or for a short time, these radioactive pellets release measured doses of radiation each day.

Chemotherapy: Chemotherapy may be used with radiation and surgery as part of a patient's initial treatment or used alone to treat tumours that recur in the same place or another part of the body.

Other treatments: If a brain tumour can't be cured, then other treatment options/plans are designed to make the patient as comfortable as possible and preserve as much of his neurologic functioning as possible. The patient's doctor may prescribe: 

• Analgesics to relieve pain  
• Anti-cancer drugs to limit tumour growth  
• Anticonvulsants to control seizures 
• Steroids to reduce swelling of brain tissue