Brain Tumours - New Horizons, New Thoughts

A century has elapsed since the first successful brain tumour surgery was performed by the "" FATHER OF NEUROSURGERY "" DR HARVEY CUSHING.

In the following 70 years progress was made in all basic aspects of diagnosis and management of brain tumours.

The introduction of CT SCAN in 1971 the brain tumours diagnosis became fast,accurate,specific and easier. The lengthy , laborious,risky and invasive investigative procedures became the things of past.

In INDIA about 40-50,000 people are diagnosed with brain tumours and successfully managed with very good results.

Even then the fear of brain tumour diagnosis and pessimism regarding the surgery outcome are prevalent even today.

The popular impression in general public is that brain tumours are VERY COMMON & all are UNIFORMLY CANCEROUS is without scientific basis.

In fact brain cancers incidence is 2-3% per one lakh population,amounting to LESS than 2% of all cancers in human body.

It is very important to note that only ONE THIRD (1/3)of are all brain tumours are cancerous while there about 125 varieties of such .

Equally important to state that chances of any person to develop a MALIGNANT TUMOUR in their life span is LESS Than 1% .

Presenting symptoms are::

Morning headaches mainly in forehead

Vomitings

Double vision

Epilepsy

Memory disturbances

Loss of vision , smell , hearing particularly ONE SIDE

weakness of one half of body

Swallowing difficulty

Walking disturbance

Unclear speech

Menstrual cycle irregularity

Drowsy or unconscious

INVESTIGATIONS ::

Ct scan brain: PLAIN & CONTRAST MRI BRAIN WITH CONTRAT PET SCAN BRAIN —rarely

Causative factors of brain tumours::

For a long time it was said to be UNKNOWN

Now with improved research and surveillance few causes are mentioned like:

1 Stress

2. Exposure to radiation

3. Exposure to chemicals like PESTICIDES, OIL PRODUCTS, RUBBER , CHLORINATED INDUSTRIAL SOLVENTS

4. Genetic factors and family history

5. Life style choices like Wrong diet disrupted sleep Sedentary life style Alcohol SmokingObesity

6. Vitamin deficiency like Vitamin c, beta carotene , folate

Brain tumours can develop in all AGE GROUPS mainly CHILDREN & ADULTS

Brain tumours are mainly two Varieties

PRIMARY & SECONDARY

PRIMARY: Tumours developing in brain, brain coverings & cranial nerves.

SECONDARY: Also known as METASTATIC TUMOURS from other parts of body like THYROID ,LUNG, BREAST , KIDNEY & INTESTINES secondary tumours amount to 40% of total brain tumours.

Once brain tumours are confirmed the line of treatment is SURGERY.

Nowadays tumours of less than 2 CENTIMETRES size are managed with radiotherapy if there is no significant brain compression.

Advances in surgical techniques and surgical equipment like NEURONAVIGATION, ULTRASOUND SURGICAL ASPIRATOR , OPERATING MICROSCOPE, intraoperative MRI and CT Scan, cortical mapping and AWAKE PRECEDURES have made possible access to & total removal of tumours with presentation of vital brain functions.

Of the primary brain tumours there are TWO IMPORTANT DIVISIONS.

1. CANCEROUS or MALIGNANT

2. NONMALIGNANT of BENIGN

BENIGN tumour are mostly removed completely with total CURE to patients. Some residual tumours in a critical brain area are managed with latest radiation methods.

Cancerous tumours are excised to the maximum possible without compromising important brain functions followed by adjuvant latest modalities of treatment.

The most malignant primary brain tumour called as GLIOBLASTOMA MULTI FORME was associated with poor outcome and testing the nerves of affected patients as well as treating neurosurgeons.

In fact almost half of these patients are alive at 2 YEARS an impressive result considering previous survival was thought to be LESS THAN A YEAR!!!!

It is no exaggeration to state that few lucky patients with GLIOBLASTOMA are living for 5,10,20 years

This is possible with advances in several areas like :

MOLECULAR ONCOGENESIS with identification of deletions in chromosome segments 1P &2Q

ADVANCES in imaging like functional localisations,spectroscopy,diffusion and perfusion measurements,diffusion tensor imaging to visualise white fibre tracts

Effectiveness of CHEMOTHERAPY and delivery of drugs placing catheters and TARGETED THERAPY

Most recently STEM CELLS have been used to target brain tumours

MULTIDISCIPLINARY approach in addressing the diversity and complexity of brain tumours is the key for successful results

The few important points to remember:

1. NOT ALL BRAIN TUMOURS ARE CANCEROUS

2. Whole skull is NOT OPENED during surgery

2. Brain tumour surgery is reasonably SAFE

3. Most of the time patient is CONSCIOUS after surgery

4. Within 12 hours patients are given feeds

5. Mobilisation at the earliest

6. Early diagnosis and treatment is mandatory for good results

7. Present day RADIOTHERAPY techniques are SAFE DELIVERS HIGHER DOSES IN PRECISE LOCATION & LEAST DAMAGE TO THE SURROUNDING NORMAL BRAIN STRUCTURES