What is a Brain Tumor?
A brain tumor is a mass of abnormal (cancerous) cells in the brain. There are many types of brain tumors. They are divided into two different groups:
- Primary: starting in the brain (Primary brain tumors can be divided into the following subgroups)
a. Benign: slow growing cells that rarely spread
b. Malignant: fast growing cells that invade surrounding tissue - Metastatic: a tumor that traveled to the brain from another part of the body
Brain Tumor Symptoms:
- Headaches
- Nausea and vomiting
- Confusion
- Seizures
- Paralysis or weakness
- Vision problems
- Speech difficulty
Treatment Plan
As neurosurgeons, we operate on brain tumors and other problems of the nervous system. We are part of a healthcare team and work closely with the following members to determine the best treatment for you. We work with the oncologist to determine if surgery is indicated for your type of tumor and what is the safest and best surgical approach to either biopsy or resect your brain tumor. The rest of the healthcare team members that help direct your care during this time include:
- Neuro-oncologist: specializes in treating tumors of the nervous system
- Neurologist: diagnoses and treats disease of the nervous system (i.e. seizures caused by tumors)
- Radiation Oncologist: specializes in using radiation to treat tumors
- Medical Oncologist: specializes in treating tumors with chemotherapy
- Pathologist: diagnoses the type of tumor based on tissue samples taken during surgery.
Treatment plans are determined by the size, type, and location of the tumor. Your health history and age also play a role in the treatment plan. Treatment plans include: observation, surgery, radiation, and
chemotherapy.
Types of Surgical Treatment
Stereotactic Biopsy: Surgery to remove a tumor (resection) is the preferred treatment for brain tumors. However, if the tumor is in a hard place to reach or appears to be inoperable (removing it would leave the patient with severe symptoms i.e. inability to speak, paralysis), you may need a stereotactic biopsy. During the procedure a small sample of tumor tissue is removed so your healthcare team can make the best treatment plan for the tumor. Treatment with radiation and chemotherapy is usually started after two weeks from surgery to allow the incision to heal. During this time, the pathology report from the biopsy is obtained. This usually takes several days to over a week to obtain. Sometimes longer if a second opinion is needed and you tissue samples are sent to another pathologist to review.
Craniotomy: Is the most common surgery to remove a tumor. During surgery, we make an incision in your scalp and remove part of the skull bone. Then as much of the brain tumor is removed as possible and the tissue from the tumor is sent to the pathologist to review. Surgery is performed using a number of techniques and this will depend on the tumor and location. When the surgery is complete, the bone is replaced with titanium plate and screws. In a few incidences, the bone is left off. The incision is closed with stitches or staples that are removed 10-14 days later. With pituitary tumors we approach the majority of times with the assistance of our ENT colleagues under the lip or through the nose to remove these tumors. After the surgery is completed there is packing in the nose. There is no visible incision and packing is usually removed 3-5 days later.
Skull base brain tumors: There are some brain tumors due to location that are treated with surgery but require a neurosurgeon who specializes in skull base neurosurgery to resect these lesions. An example is an acoustic schwannoma that grows on the nerve for hearing. We can evaluate you for these lesions and if these tumors cannot be treated by us surgically in West Texas we can help facilitate and expedite your referral to our colleagues who specialize in removing these types of tumors. We are also able to help follow up after initial surgical removal visits with your operative neurosurgeon.
Types of Radiation Treatment
Radiation: The goal of radiation therapy is to slow or help control tumor growth. It can be used alone or with other types of treatment. There are two main types of radiation treatment traditional and stereotactic radiosurgery.
Traditional:
- Focused radiation is aimed at the tumor and the area adjacent to it.
- Whole brain radiation is aimed at the entire brain, often treating multiple tumors.
Stereotactic Radiosurgery:
- Can be used with traditional radiation. The procedure involves 1 to 3 high doses of radiation per lesion. Since each dose is very focused, the normal tissue around the tumor receives little or
no radiation.
Common words associated with brain tumors:
Grade: The degree of aggressiveness of a tumor. It can range from 1 (lowest) to 4 (highest).
Intracranial Pressure (ICP): Pressure within the brain
Common brain tumor types in adults:
Astrocytoma: A tumor that arises from the cells that make up the supportive tissue of the brain.
Glioblastoma multiforme (GBM): The most malignant astrocytoma. It grows quickly and aggressively.
Meningioma: A tumor that grows slowly from the meninges (covering) of the brain and spinal cord.
Oligodendroglioma: A tumor that arises from oligodendrocytes, a type of supportive brain tissue that provides insulation for the brain that nerve signals stay intact.
Pituitary adenoma: A glow growing benign tumor of the pituitary gland
Metastatic brain tumor: A tumor that traveled to brain for another part of the body (i.e. lung and breast cancer)