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Brain Tumour Treatment

The abnormal and uncontrolled cell growth in the brain is known as a brain tumor. It is a deadly disease. It can be treated by multiple treatment methods available depending on the stage and overall health of the patient.

What are the symptoms of brain tumors?

The symptoms of a brain tumor may vary according to the area it is affecting. Check with your doctor in case you experience any of the symptoms:

  • Headaches, especially in the morning
  • Nausea and vomiting
  • Changes in your ability to hear, talk or see
  • Problems with walking or balance
  • Problems with memory or thinking
  • Feeling sleepy or weak
  • Changes in your behavior or mood
  • Seizures

 

 

 

 

What causes brain tumors and who is at risk?

The exact cause of the brain tumor is unknown. However, certain risk factors will increase the chances of a tumor.

· Age: Brain tumor is more common in children and elderly, although it can develop at any age.

· Gender: Brain tumors are more commonly developed in men than women.

· Home and work exposures: Exposure to pesticides, solvents, oil products, rubber, or vinyl chloride may increase the risk of developing a brain tumor. However, scientific evidence that supports this is not available.

· Family history: Having anyone in closed blood relation with a history of a brain tumor increases the risk.

· Exposure to infections, viruses, and allergens: People infected with the Epstein-Barr virus (EBV) increases the risk of central nervous system (CNS) lymphoma.

· Electromagnetic fields: Many searches show exposure to electromagnetic fields is linked to a brain tumor. Most studies show no link to electromagnetic fields like energy from mobile phones in developing a brain tumor in adults. Due to this conflicting information regarding risk in children, the World Health Organization (WHO) recommends limiting the use of cell phones.

· Race and ethnicity: White people are more likely to develop gliomas (type of brain tumor) but less likely to develop meningioma (type of brain tumor) than black people.

· Ionizing radiation: Previous exposure to ionizing radiation to the brain or head, like x-rays, has been linked as a risk factor for a brain tumor.

· Head injury and seizures: Some studies and researches associate a link between meningioma (type of brain tumor) and head trauma, but not between head trauma and glioma (type of brain tumor).

 

How is a brain tumor diagnosed?

Brain tumors are usually not diagnosed until symptoms appear. When you visit the doctor with symptoms, he will examine you to identify the problem and recommend various tests like CT scan, MRI scan, etc., to confirm the diagnosis.

 

What are the different types of brain tumor surgery?

Biopsy: In this procedure, a sample tissue is taken from the suspicious site and sent to the laboratory to look for any cancer cells. In most cases, a hole is drilled into the skull to access the tumor; then, a hollow needle is inserted to extract a small amount of tissue. Craniotomy: A craniotomy is a surgical method that involves the removal of the part of the cranium or skull to access the brain. Generally, it is done to remove brain tumors. This is commonly used for removing a brain tumor. After removing the tumor, the surgeon may replace the pieces of the skull and stitch the scalp closed. Below are the types of craniotomy:

  • Stereotactic craniotomy: In this procedure, the surgeon uses imaging tests like MRI/CT scan to create three-dimensional images of your brain that allow them to distinguish between abnormal and healthy tissue. This technique also helps the surgeon to find the best spot for a scalp incision. This makes it simple for them to make more minor cuts and perform minimally invasive procedures.
  • Endoscopic craniotomy: During this procedure, the surgeon makes a small incision in your skull and inserts an endoscope (a small lighted device with a camera). An endoscopic craniotomy is often used with keyhole craniotomies.
  • Awake craniotomy: This procedure is done while you’re awake. During the surgery, the surgeons ask you questions while monitoring your brain activity. While you reply, they’ll indicate what parts of the brain are involved in speech, vision, and movement. This helps the surgeons avoid these areas while performing the surgery.
  • Keyhole craniotomy: This technique is used to remove tumors of the brain. It’s a minimally invasive surgery associated with a shorter recovery time and less scarring. A tiny cut is made behind the ear to remove the brain tumor through this incision.
  • Supra-orbital ‘eyebrow’ craniotomy: This type of surgery is performed to remove brain tumors in the front of your brain. It is a minimally invasive approach where the surgeon makes a small cut in your eyebrow, and it causes minimal scar.
  • Pterional (frontotemporal) craniotomy: The pterion is where the frontal, sphenoid, temporal, and parietal bones meet in the skull. During this procedure, a part of the pterion is removed. The surgeon makes an incision behind your hairline, which lets them access numerous parts of the brain.
  • Orbitozygomatic craniotomy: Aneurysms or complex tumors may be treated with an orbitozygomatic craniotomy. This procedure involves a tiny scalp incision behind your hairline. The surgeon temporarily removes part of the bone, which creates the curve of your orbit, or eye socket, and cheek. This technique allows the surgeon to reach deeper regions of the brain while decreasing the brain damage risk.
  • Posterior fossa craniotomy: The posterior fossa is a small space in the skull, near the cerebellum (controls balance and coordination) and brainstem. Tumors in the posterior fossa can place pressure on the cerebellum, spinal cord, and brainstem. A posterior fossa craniotomy removes the tumor and relieves the pressure. This procedure is done through an incision at the base of your skull.
  • Translabyrinthine craniotomy: During this procedure, the surgeon makes a cut behind your ear and removes part of the semicircular canals and the mastoid bone. This technique is used to remove an acoustic neuroma, also known as vestibular schwannoma.
  • Bifrontal craniotomy: It is done to remove complex tumors in front of the brain and is often used in treating tumors that are too complex for minimally invasive surgery. The surgeon makes a cut behind your front hairline and removes a piece of the bone that forms the curve of your forehead, allowing them access to the front of your brain.

Other key terms related to brain tumor surgery:

  • Gross total resection: In this procedure, the surgeon removes the entire tumor. However, it is possible that some tumor cells may remain, but they are not visible to the human eye and on magnetic resonance imaging (MRI) after resection. Your neurosurgeon will be able to discuss the potential risk of re-growth and if additional treatment is required.
  • Debulking surgery: In this procedure, the entire tumor was not removed. “Debulk” means reducing the size of the tumor surgically. You may hear your surgeon saying that they have “debulked'' the tumor, which means that a tumor was surgically made smaller.
  • Partial Removal: During this procedure, the surgeon removes a part of the tumor due to the risk of neurological damage associated with the surgery.
  • Ommaya Reservoir: In this technique, a surgical container is implanted under the scalp, has an attached tube used to deliver chemotherapy to the brain, and remove cerebrospinal fluid to look for abnormal cells, or remove the cystic fluid.
  • Shunt: In this procedure, a tube is surgically inserted into the brain. It is connected to a flexible tube placed under the skin to drain the excess fluid into either the abdomen or the chest cavity to be absorbed by the body.
  • Skull Base Surgery: The skull base is the delicate bony area that supports the bottom of your brain, which contains nerves and blood vessels responsible for vision, smell, speech, hearing, swallowing, and facial movements. This kind of surgery may be a lengthy procedure as the neurosurgeon may need to remove and rearrange the bone surrounding the brain without disrupting the blood vessels and crucial nerves located in this area.
  • Transsphenoidal Surgery: This kind of surgery is used most commonly in treating pituitary adenomas and craniopharyngiomas. The surgeon will usually try to access the tumor either through under the upper lip or the nostril to access the pituitary gland.
  • Laser Interstitial Thermal Therapy (LITT): This is a new treatment option available in only a few places, and an MRI and laser are used in this kind of treatment. The brain tumor is targeted with a laser that heats and destroys the tumor tissue, and all this is done under monitoring by MRI. LITT uses a stereotactic technique to target the tumor with one or multiple small holes in the skull.

 

 

What happens before brain tumor surgery?

During your office visit, the neurosurgeon will explain the procedure along with the risk and benefits associated with the surgery. He will take your medical history like allergies, medicine, bleeding history, prior surgeries, etc. He may suggest some tests (blood test, CT scan, MRI scan, etc.) that need to be done a few days before surgery. It is advised to quit smoking and stop alcohol consumption before surgery. It is recommended to stop taking anti-inflammatory drugs like Advil 2 weeks before the surgery. Practice deep breathing exercises and coughing before your surgery. You will be provided with an incentive spirometer to help expand your lungs. Follow a healthy diet plan. If you have some concerns regarding your surgery, discuss them with your doctor, and they will help you deal with them and prepare you for surgery.

 

What happens during brain tumor surgery?

When you arrive for the surgery, you’ll be asked to remove all jewelry and clothes, and you will wear a hospital gown. The surgical procedure varies depending on whether it is microscopic or open surgery. However, in the case of craniotomy, you’ll lie down on the operating table in a position depending upon the brain area that needs to be operated on. After this, an intravenous line, a urinary catheter will be inserted, a head device will hold your head in place, and general anesthesia will be given. Hair at the site of the operation will be shaved and cleaned to decrease the risk of infection.

The neurosurgeon makes an incision on the scalp and uses a medical drill and saw to remove a piece of bone known as a bone flap. Then, the surgeon will cut the dura mater to have access to the brain. The tumor will be removed and a sample tissue may be taken during the procedure. Once the procedure is done, they’ll stitch the tissue back together and replace the bone flap with wires, stitches, or plates. Finally, your surgeon will staple or stitch the skin incision, then apply a sterile bandage. The whole procedure may take approximately 2 1/2 hours.

 

What happens after a brain tumor surgery?

· Immediately post-surgery: Once the procedure is over, you’ll be taken to the intensive care unit (ICU) or recovery unit. You will be kept under observation. You’ll be shifted to the hospital room once your vitals are stable and may have to stay at the hospital for about one week. During your stay, the doctors and nurse will monitor you closely and help you deal with post-operative pain and swelling. The physiotherapist will visit you to teach deep breathing exercises to prevent pneumonia and various other exercises to keep you active. The urinary catheter will stay for some days. Doctors will frequently do neurological check-ups to ensure your body and brain are functioning properly. Once the doctor is sure that you are stable, they will discharge you with specific guidelines that you have to follow.

· At home: Once you are home, do follow your doctor’s instructions religiously. Take your medicine on time. You might face problems in walking, talking, balance, strength, etc. You can get in touch with a physiotherapist, occupational therapist, speech therapist, etc., who will help you get back to normal. Avoid missing the follow-up visit with your doctor, and in case you face any problem with your health, get in touch with your doctor immediately.

 

What precautions should you take after a brain tumor surgery?

Even after a full recovery, it’s still important to take care of yourself. This will avoid future complications and improve your long-term outlook. Be regular with your follow up with your doctor and bring some lifestyle modifications like:

  • Exercise regularly
  • Have a healthy diet
  • limit or avoid alcohol
  • Quit smoking
  • Get enough rest and sleep

 

 

 

 

Types of Brain Tumour

  • Acoustic neuroma
  • Astrocytoma
  • Brain metastases
  • Choroid plexus carcinoma
  • Craniopharyngioma
  • Embryonal tumours
  • Ependymoma
  • Glioblastoma
  • Glioma
  • Medulloblastoma
  • Meningioma
  • Oligodendroglioma
  • Pediatric brain tumours
  • Pineoblastoma
  • Pituitary tumours

Symptoms of a Brain Tumour

Depending on the location and size of the tumour, there are various symptoms attributed to it. Some tumours can cause direct damage to the brain tissue and some tumours generate pressure on the surrounding brain.

Headaches are a frequent occurrence due to brain tumours. You may experience headaches that:

  • while waking up
  • occur while you’re sleeping.
  • occur due to coughing, sneezing, or exercise

 

You may also experience:

  • Vomiting
  • Blurred vision or double vision
  • Confusion
  • Seizures (especially in adults)
  • The weakness of a limb or part of the face
  • A change in mental functioning

Other common symptoms include:

  • Clumsiness
  • Memory loss
  • Confusion
  • Difficulty writing or reading
  • Changes in the ability to taste, hear, or smell
  • Decreased alertness, which may include drowsiness and loss of consciousness
  • Difficulty swallowing
  • Dizziness or vertigo
  • Eye problems, such as drooping eyelids and unequal pupils
  • Uncontrollable movements
  • Hand tremors
  • Loss of balance
  • Loss of bladder or bowel control
  • Numbness or tingling sensation on one side of the body
  • Trouble in speaking or understanding other people conversations
  • Changes in personality, mood, emotions, and behavior
  • Difficulty walking
  • Weakness in Muscles in the face, arm, or leg

Symptoms of pituitary tumours

  • Nipple discharge, or galactorrhea
  • Lack of menstruation in women
  • Development of breast tissue in men, or gynecomastia
  • Enlargement of the hands and feet
  • Sensitivity to heat or cold
  • Increased amounts of body hair
  • Low blood pressure
  • Obesity
  • Changes in vision, such as blurry vision or tunnel vision

Diagnosing Brain Tumour

The Doctor will diagnose the brain tumour by conducting a physical exam and will take look at your medical history. The physical exam will include a very detailed neurological examination. The doctor will examine cranial nerves to observe if they are intact or not. These are the nerves that originate inside your brain.

  • A neurological exam: The Doctor will conduct a neurological exam that may include, checking your vision, balance, hearing, coordination, strength, and reflexes. Any difficulty in one or more areas may provide clues to the part of the brain which may be affected by Brain Tumour.
  • Imaging tests: To help diagnose brain tumours, magnetic resonance imaging (MRI) is commonly used. The dye is injected through a vein in your arm during your MRI study to provide detailed pictures of the structures of the brain itself.
  • Collecting and analyzing a sample of abnormal tissue (biopsy): Biopsy is performed to identify if the tumour cells are benign or malignant. A small piece of the tumour is extracted from the brain during a biopsy.
  • CT scan of the head: With the help of a CT scan, the doctor will get a more detailed scan of your body than they could with an X-ray machine.

Treatment of Brain Tumours

The Doctor suggestion of the treatment of a brain tumour depends on:

  • The type of tumour
  • The size of the tumour
  • The location of the tumour
  • Your general health

Following are the treatments:

Surgery: Your surgeon will perform surgery if the brain tumour is located in a place that makes it accessible for operation. If tumours can't be separated from surrounding tissue or they're located near sensitive areas in your brain, the surgery will be deemed risky for you. In this case, the surgeon removes as much of the tumour as is safe.

Radiation therapy: To kill tumour cells, this therapy uses high-energy beams, such as X-rays or protons. When cancer has spread to the brain from some other part of the body and developed multiple tumours in the brain, then whole brain radiation is performed.

Radiosurgery: To kill the tumour cells in a very limited area, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment.

Chemotherapy: To kill tumour cells, drugs are used in Chemotherapy. These drugs can be taken orally in pill form or injected into a vein (intravenously).

Targeted drug therapy: For certain types of brain tumours, targeted therapy drugs are available. By focussing on specific abnormalities present within cancer cells, targeted drug treatments block these abnormalities causing the cancer cells to die.

Rehabilitation after Treatment

After the surgery, consult health care provider continually. Keep up your appointments with your doctor for regular health updates.

 Brain tumours can develop in certain parts of the brain that control motor skills, vision speech, and thinking. Hence, rehabilitation becomes a necessary part of recovery. The doctor may advise you different therapies such as physical therapy, occupational therapy, andspeech therapy.

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