MARCH-APRIL , 2023 | THE HEALTH

BY DR RAVINDRAN VASHU

While this may be true in certain cases , others can be treated and are curable .

SIGNS AND SYMPTOMS

• Headache .

• Weakness of limbs or speech .

• Fits .

• Changes in behavior .

• Visual disturbances . There is strong correlation between the size and location of a tumour and it ’ s clinical presentation ( left or right ; in different parts of the brain and whether the tumour is within the brain or pressing on it from outside the brain , etc .).

Occasionally , a tumour can be discovered during a routine health check-up or as a result of an incidental discovery when investigating other conditions .

THE DIFFERENT TYPES OF TUMOURS

A tumour can develop from the brain cell itself ( tumour of the brain ); from surrounding tissues , such as the covering of the brain ( meninges ) that compresses the brain to cause symptoms ( tumour around the brain ); or from other parts of the body that spread to the brain ( such as cancers of the lungs or breast - tumours to the brain ). This is referred to as metastasis , which means the cancer has spread to the brain .

There are also tumour mimics such as Abscesses , Tuberculosis , Cysts and other less common conditions which we will not discuss here . Depending on the type , brain tumours can be classified as benign or malignant / cancerous . Some have intermediate characteristics .

The types of tumours and the location of the tumours can also differ significantly between children and adults , thus requiring different treatment approaches ; whether surgical , medical ( chemotherapy ) or radiation . Medical and radiation therapy are collectively known as adjuvant treatment . When given before surgery , it is called neo adjuvant therapy .

A large proportion of patients will require surgery . Depending on the type of tumour , a biopsy ( sampling ), debulking ( major removal ), or resection ( total removal of the tumour ) procedure will be performed . Chemo / radiation treatment can be given either before or after surgery , depending on the type of tumour .

In certain situations , such as

in advanced disease , only chemo / radiation is given . This is usually decided after prior discussion between the neurosurgeon and oncologist , particularly in cancer cases .

The most common brain tumours seen among adults include the following : a . Astrocytoma / Glioma : High and low grade

High-grade Astrocytoma / Glioma has a poor overall prognosis . Most of these high-grade tumours can return and require more than one procedure . The aim in high-grade glioma is usually to prolong life . Low grade glioma treatment involves only surgery unless it has transformed to a high-grade tumour . b . Meningioma : High and low grade

Most meningioma with symptoms are treated with surgery and chemo / radiation is reserved for certain situations such as residual or recurrence of tumour . Smaller or incidental tumours can be observed or treated with radiotherapy . c . Metastasis

Metastasis refers to the cancer that has spread to the brain . It is one of the most common tumours in adults . With advancements in surgery and

oncology , patients with metastasis are living longer . d . Haemangioblastoma ( posterior fossa )

I . Pituitary tumours / Craniopharyngioma : These tumours can cause hormonal and / or eye disorders , most of which can be treated with keyhole surgery through the nose or skull , depending on their size and location .

II . Vestibular Schwannoma ( VS ): Symptoms include tinnitus , vertigo , and unilateral deafness . When large , this tumour can cause headaches , difficulty swallowing , speech difficulties , and tongue wasting . Neurosurgeons face many challenges with this group of tumours . During diagnosis and treatment , an otorhinolaryngologist is involved . The surgery , however , is performed by a neurosurgeon , sometimes with the aid of a otorhinolaryngologist . Imaging allows smaller tumours to be treated with radiation or closely monitored with serial imaging .

TUMOURS IN CHILDREN

The range of tumours among children is quite different from that of adults . Most of the brain tumours in children are located in the smaller brain ( cerebellum ), at the back of the skull .

Due to this location , tumours often cause obstructed flow of brain fluid ( hydrocephalus ) which requires surgery either before , during or after brain tumour surgery .

Listed below are some types of common paediatric brain tumours : I . Astrocytoma / Glioma II . Medulloblastoma III . Ependymoma

Ependymoma Surgery is the mainstay of treatment and oncological for recurrences .

Certain syndromes are related to specific brain tumours in children or young adults . For example , Von Hippel Lidau Syndrome ( haemangioblastoma ); Tuberous sclerosis ( subependymal giant cell astrocytes ); and Neurofibromatosis 1 and 2 ( astrocytoma , vestibular schwannoma , meningioma , and ependymoma ).

Fortunately , metastasis ( tumours to the brain ) is rare among children .

TREATMENT REGIME

Much research & development ( R & D ) has taken place in brain tumour management over the last decades . Imaging ( Radiology ) I .

Multi-slice Magnetic Resonance Imaging ( MRI ) and Computed Tomography ( CT ) II . Intraoperative Neuronavigation III . Diffusion Tensor Imaging ( DTI ); and IV . Functional MRI ( fMRI )

fMRI for low grade glicoma .

Awake craniotomy involves removing a tumour while the patient is conscious to reduce risk of injury to critical structures surrounding the tumour .

UNDERSTANDING TUMOURS BETTER

Newer approaches to brain tumours aim to better understand tumour behaviour and response to treatment . Efforts are being made to improve outcomes and quality of life for patients .

The diagnosis of each tumour is getting more specific , where each tumour is further classified based on molecular characteristics . In this way , the nature of the tumour and its response to chemotherapy / radiation is better understood .

In some cases , better outcomes are seen when brain tumours are detected early . Treatment goals must be tailored to the needs and expectations of patients , guided by a neurosurgeon and a team of various specialities . – The Health

Dr Ravindran Vashu @ Dr Ravind is Resident Consultant Neurosurgeon at Sri Kota Specialist Medical Centre