A brain tumor is a mass or growth of abnormal cells in brain. It occurs when abnormal cells form within the brain. Brain tumors can be of 2 types: malignant or cancerous tumors and benign tumors. Further brain tumors can be divided into Primary Tumors (which start within the brain), and Secondary or Metastatic Tumors (which begin in other parts of your body and spread to brain).
How quickly a brain tumor grows varies greatly and depends on many factors. The growth rate and the location of brain tumor determines how it will affect the function of nervous system. All types of brain tumors produce symptoms that vary depending on the part of the brain involved.
Brain tumors may grow from pituitary gland (craniopharyngioma or pituitary adenoma), nerves (neuroma), dura (meningioma). They may also grow from the brain tissue itself (glioma). As they grow, they may compress normal tissue and cause various symptoms.
Brain tumor treatment options depend on the type of brain tumor, as well as its size and location. Treatment goals may focus on relieving symptoms or be curative.
Symptoms experienced due to pituitary tumors depend on their size and the hormones they release. Some common symptoms include :
Medical science neither knows the causes of brain tumors nor how to prevent primary tumors that start in the brain. But there are certain factors that increase the risk of brain tumors, which include: –
Signs and Symptoms
The signs and symptoms of a brain tumor vary greatly and depend on the size, location and rate of growth of tumor. Some tumors cause direct damage by invading brain tissue and some tumors may cause pressure on the surrounding brain. General symptoms include:
If one has symptoms that suggest a brain tumor, doctor will do a physical exam and ask about personal and family health history. One may also have to undergo one or more of the following tests :
- Neurological examination : Checking eye, vision, hearing, alertness, muscle strength, coordination, and reflexes.
- MRI : MRI can show abnormal areas in brain, such as a tumor
- CT scan
- Spinal tap
- Biopsy : Biopsy is the removal of tissue to look for tumor cells. A biopsy can show cancer, tissue changes that may lead to cancer, and other conditions. Biopsy is the only sure way to diagnose a type of brain tumor, learn what grade it is, and plan treatment.
There are several treatment options for Brain Tumors. The options include surgery, radiation therapy, and chemotherapy. Many people might require a combination of treatments. The choice of treatment depends mainly on the following:
- Type and grade of brain tumor
- Location of brain tumor
- Size of brain tumor
- Patient’s age and general health
Craniotomy is an operation in which a surgeon removes a piece of the skull over the tumor. They carefully remove part or all of the tumor and replace the piece of skull. Some of this operation may be done while you are awake so the surgeon can check your speech and movement.
MRI-guided laser ablation is a minimally invasive neurosurgical technique for a number of diseases, including brain tumors. This treatment involves using lasers to target and destroy the tumor. This procedure can help surgeons address the most serious brain tumors, including glioblastoma multiforme (GBM) and brain tumors that are located close to sensitive structures in the brain, making them hard to access through traditional open surgery (craniotomy). This technique can reduce pain after surgery and shorten recovery time compared to that associated with craniotomy.
This surgery allows surgeon to remove tumors or lesions through nose and sinuses. It allows them to access parts of the brain without making an incision. The procedure involves the use of an endoscope. Surgeon can use this technique for tumors on the pituitary gland, tumors on the base of the skull, and tumors growing at the bottom part of the brain.
Neuroendoscopy uses endoscopes to remove brain tumors. Surgeon may make small, dime-sized holes in the skull to access parts of the brain during this surgery.
This procedure is used to remove a small amount of brain tissue or a tumor so it can be examined under a microscope. This involves a small incision and hole in the skull.
In few of the surgeries, patient may be awake when the surgeon removes part or all of the brain tumor or patient may be given general anesthesia. Patient may be asked to move a leg, count, say the alphabet, or tell a story. His ability to follow these commands helps the surgeon protect important parts of the brain.
In some cases, surgery isn’t possible. If the tumor is in the areas like brain stem or certain other areas, the surgeon may not be able to remove the tumor without harming normal brain tissue. In such cases other treatment options are considered like radiation therapy and chemotherapy.
After brain tumor surgery, it will take time for the patient to return to his/her usual level of energy. One may have a headache or feel uncomfortable for the first few days. However, medicines can usually control pain. Regular checkups may be required post-surgery. Extra rest would be required for healing. The amount of time required to recover after brain tumor surgery is different for each person and depends on:
- The procedure used to remove the brain tumor
- The location of the tumor within the brain
- Areas of the brain affected by the surgery
- The patient’s age and overall health
Brain tumor surgery can cause problems with thoughts, feelings and behaviors. After surgery, the patient may need help in recovering with physical therapists, occupational therapists and speech therapists. The recovery period may vary ranging from 4-6 weeks to approximately 6 months.
Brain tumor treatment cost in India
|Sr.No.||Name of Procedure||Cost in India (USD)|
|1||Investigations||800 – 1000|
|2||Craniotomy or Open Brain Surgery||6000 – 8000|
|3||Minimally Invasive Endonasal Endoscopy||4500 – 5500|
|4||Minimally Invasive Neuroendoscopy||7500 – 9000|
Frequently Asked Questions and patient concerns:
1. How is a brain tumor recognized?
No signs that are peculiar to brain tumors are present. They are due to damage to the area of the brain where the tumor happens to be located when symptoms do occur. Thus, tumors in the front region of the brain can alter personality, tumors in the middle of the brain can impact capability, feeling, vision, etc. With brain tumors, seizures can also occur, as can headaches. However, any of these signs may be caused by a number of other neurologic disorders. It takes many measures to understand that the neurological symptoms are due to a brain tumor.
2. What options are there to treat a metastatic tumor in the brain?
The two primary choices are to surgically remove or eliminate the metastatic tumor by concentrated radiation (gamma knife, stereotactic radiosurgery, or proton beam therapy). Conventional radiation therapy, an external beam, is often used to enhance prognosis and reduce recurrences.
3. What tests are needed to determine if a patient would be appropriate for Gamma knife?
The gamma knife is an effective treatment for metastatic brain tumors (as opposed to primary brain tumors) if the tumor is not too large, if there are not too many tumors, and if the tumor is located in a brain area that is able to cope with the transient swelling that often occurs after treatment. The treating neurosurgeon and radiation oncologist need to examine both of these problems to determine if a gamma knife is necessary.
4. What can the patient expect after Gamma Knife treatment?
During the treatment, the Gamma Knife usually causes some brain swelling. Typically, this is mild and reversible, recovers after several weeks, and can be treated with medications.
5. What does it mean when a brain tumor is in remission?
This means that all symptoms (as assessed by MRI) of the tumor are gone. This does not mean that it cures the tumor. Instead, it means that our latest imaging methods, including MRI, are not sufficiently sensitive to pick up any remaining few tumor cells that are malignant. This is why, after all symptoms of the tumor are gone, we also begin treating brain tumors with chemotherapy.
6. What's the average length of hospitalization and recovery time after brain tumor surgery?
The hospitalization is usually one day when the surgeon performs a biopsy, and recovery is very quick. More comprehensive operations including removal of all or part of the tumor that is readily apparent require longer hospital stays (4-6 days) and a longer recovery period (3-6 weeks). While these may be problems for you to address with your neurosurgeon, you should note that when as much cancer is removed as possible, patients appear to do better.
7. Does awake brain surgery hurt?
The idea of being awake during brain tumor surgery may sound daunting, but it is actually painless and the best treatment choice in some cases. Awake brain surgery is painless since there are no sensory nerve fibers (nociceptors) that process pain in the gray and white matter of the brain. During a craniotomy, our anesthesiologist can numb the skin above the part of the skull that is to be cut so you do not feel pain. During the start and end of the operation, the neurosurgeon can also decide that you are unconscious, but awake during the resection so that you can provide motor and cognitive input.
8. What possible problems should I look for after brain surgery?
If you experience seizure, extreme headache, worsening neurological symptoms, fever or chills, ankle swelling, severe nausea or vomiting, or skin rash, you could consult your neurosurgeon.
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