Brain Tumor Surgery / Treatment
What is a brain tumor?
A brain tumor is the abnormal growth of cells within the brain tissue. It can arise directly from the brain tissue, which is known as a primary brain tumor, or it can be due to cancer cells depositing in the brain from elsewhere in the body, which is known as secondary brain tumors/deposits.
Post operative Brain Tumour patient In middle and his son on left, Total removal of grade 2 oligodendroglioma. Radiotherapy completed.
What are the warning signs I may be having a brain tumor?
- Headache – if it becomes persistent, increases in severity or is present on waking up, you need to make sure you see a doctor.
- Paralysis or weakness of the muscles.
- Difficulty in walking and maintaining balance.
- Nausea, vomiting and dizziness.
- Impaired speech with changes in voice.
- Impaired vision.
- Impaired sense of smell and taste.
- Presence of seizures, which can be full blown convulsions or mild events such as twitching of muscles or transient loss of awareness.
- Altered level of consciousness with periods of increased drowsiness or loss of consciousness.
- Change in personality of an individual with increased irritability.
Are there different types of brain tumors?
All brain tumors can be divided into two types, benign or malignant. Benign tumors are those which contain cells that are very similar to the brain tissue, they don not grow very rapidly and do not invade the surrounding brain matter, instead they increase in size by pushing on the adjacent brain tissue, which can lead to health problems. Malignant tumors are made of very abnormal looking cells, which multiply very rapidly and grow by invading the surrounding tissue. They can also break away from the primary tumor and spread to other parts of the brain and spinal cord.The 2016 World Health Organization Classification of Tumors of the Central Nervous System is most widely accepted.
Amongst the primary benign brain tumors the common types we see in the adult population are Astrocytoma, Meningioma, Oligodendroglioma, Glioblastoma, Acoustic Neuroma, Pituitary adenoma, Craniopharyngioma. In children the common types of benign brain tumors we come across are Medulloblastoma, Low grade astrocytoma, Ependymoma and Brain stem glioma.
Is surgery the treatment option for brain tumors?
The types of treatment available for brain tumors are surgery, radiotherapy and chemotherapy. But which combination of treatment options is used on a patient depends on various factors such as the type of tumor, its size and location as well as patient factors such as age and general health condition.
The first step in deciding the treatment option is to stage and grade the brain tumor. Staging of a cancer gives you an idea of the extent of the cancer, the size of it and how far into the brain tissue it has spread. Brain cancers are also graded according to the type of cell present in the growth. They are graded into 4 groups according to how rapidly the cells can grow and their ability to invade adjacent tissue. Grade 1 has cells which look almost normal and grow very slowly. Grade 2, the cells are less normal than in grade 1 but they also grow slowly and therefore Grade 1 and Grade 2 tumors are called low grade tumors. Grade 3, the cells look distinctly abnormal and are actively growing. Grade 4, the cells look very much abnormal and are growing at a rapid rate.
In the case of benign tumors surgery remains the mainstay, because surgical removal of the tumor is curative. But for malignant tumors along with surgery, the patient may have to undergo radiotherapy or chemotherapy depending on how extensive the spread of the tumor is.
What are the goals of surgical treatment for brain tumors?
The goals of surgical treatment is to remove as much of the tumor as possible, and relieve the buildup of intracranial pressure. Because most of the disability arises as a result of the increased intracranial pressure which occurs because there is extra tissue growing inside the enclosed cavity of the skull. Therefore by relieving the pressure, we are able to reduce the symptoms the patient is experiencing and improve quality of life. Opening up the cranial cavity during surgery also helps with the implantation of internal chemotherapy and radiation therapy agents as well as the option of performing hypertherapy laser surgery.
What are the types of surgeries which can be done for removal of brain tumors?
There are several different types of surgical interventions available for the treatment of brain tumors currently, with the advancement of technology. Which type of surgery is used on a patient depends on the exact location of the tumor, the size of it, as well as the stage and grade of the tumor.
The surgical options available are:
- Biopsy – this is done in order to obtain a sample of the tumor, so that the tissue can be viewed under a microscope by a pathologist, in order to determine the cell type within the tumor. This is what is called grading of the tumor. The biopsy can be performed in two ways, an open biopsy or a needle biopsy. An open biopsy involves exposing the tumor completely and then removing a small part of it. A needle biopsy involves drilling a small hole in the skull in order to insert a thin needle and drawing out a sample of the tumor. Needle biopsy are usually done under the guidance of imaging procedures such as CT or MRI.
- Craniotomy–This is the most commonly used surgical procedure for brain tumors. It can be done under general anesthesia or is sometimes done by keeping awake the patient (Awake Craniotomy) throughout the surgery if the surgeon wants to test the functions of different parts of the brain by asking the patient to perform certain skilled activities like reading, in order to make sure that the functions in these areas remain intact. Before the surgery you may be given a solution to drink which will be taken up by the tumor cells and help your surgeon differentiate the tumor cells from the normal brain tissue. The surgery itself involves making an incision through the scalp and then removing a part of the bone in the skull in the area where the tumor is located. Once the tumor is removed, in a conventional craniotomy the bone is immediately replaced and the scalp is sutured. But if swelling of the brain tissue is expected following surgery then the bone is replaced later on, after the swelling has died down, and this procedure is known as craniectomy.
- Neuroendoscopy – involves making a small incision on the skull, through which an endoscope is passed, which helps the surgeon visualize the insides of the cranial cavity. With the use of special instruments which are attached to the endoscope, the surgeon can then remove all of part of the tumor like colloid cyst.
- Endonasal endoscopy –For Pituitary Tumours, Craniopharyngioma, and skull base tumours--where an endoscope is passed through the nose and sinuses, without making an incision in the skull. Using various imaging procedures the endoscope is navigated in order to remove the tumor or take a biopsy.
What are the possible risks to undergoing a brain surgery?
As with undergoing any invasive procedure, there are risks associated with brain surgery as well. These include:
- Developing an allergic reaction to anesthesia.
- Damage to brain tissue which can lead to impaired memory, speech, vision, coordination and partial paralysis, depending on which area is damaged.
- Swelling/edema of the brain or build of fluid in the skull.
- Formation of blood clots or bleeding into the brain.
- Development of seizures.
- Infection of the brain or surgical site.
- Rarely Lapsing into a coma.
How much would surgery for a brain tumor cost?
The exact cost of surgery for a brain tumor cannot be standardized, because it depends on the location of the tumor, what type of procedure you have to undergo, and various other factors. The cost can approximately vary from $5,000 to $12,000. Benign tumors which are easily accessible and small will cost less.
What is the post procedure care for brain tumor surgery?
Immediately following the surgery you will be admitted to the ICU, in order to be monitored closely, because any type of brain surgery is considered high risk. One or two days following the surgery you will undergo an MRI scan in order to evaluate the condition of the brain tissue. Depending on your recovery you will have a hospital stay of 1 to 2 weeks, after which you will be requested to come for regular follow-ups.
You might require rehabilitation therapy, including physical therapy, speech therapy and even occupational therapy. And you should make sure the surgical site kept clean and dry while at home, and to avoid strenuous activities for a period of 2 to 3 months following surgery.
How does radiotherapy help with brain tumors?
Radiotherapy is the use of high energy radiation, given to destroy the cancer cells. It can be given in two forms, external radiation or internal implantation of radioactive material. Radiotherapy is used in order to shrink tumors before surgery, following surgery to destroy any tumor cells which may have been left behind, or when surgical resection of a brain tumor is not possible.
An abscess is what you can commonly call a collection of pus, which follows an infection by bacteria, viruses or fungi. A brain abscess usually occurs when these organisms reach your brain tissue, through a wound in your head, or through the blood stream when they are carried to the brain from other parts of the body. This infection ill result in the swelling of your brain, as the pus get collected within it, and you may experience symptoms such as high fever with chills, abnormalities of vision, speech or movement, altered levels of consciousness, and sometimes stiffness of the neck and sensitivity to light.