Understanding tumours in the brain

This World Brain Tumour Day on June 8, let’s understand different types of brain tumours, symptoms, procedures, and treatment  
For representational purpose
For representational purpose

KOCHI: A tumour in any other organ won’t seem as horrifying as the one in the brain. Many people associate it with cancer. However, not all brain tumours are cancerous. 

A brain tumour is an abnormal growth of cells in the brain or near it. There are different types of tumours based on the tissues they arise from. They originate from various parts such as within the brain tissue, its coverings, the nerves at the base of the brain, the skull and the skull base. There are also tumours which spread to the brain from cancers in other parts of the body. 

Symptoms of brain tumours can vary but often include headaches (‘early morning headache’) accompanied by vomiting, seizures, limb weakness, speech difficulties, changes in behaviour, memory issues, and sensory problems with vision, hearing, or smell — depending on the location of the lesion.

Clinical suspicion and physical examination play vital role in diagnosing tumours. The gold standard diagnostic tool is an MRI of the brain, which provides detailed soft tissue visualisation. Tests like CT scans and angiograms may be used for additional information. Neurocognitive and psychological evaluations help determine the extent of brain function affected.

Treatment options
Most brain tumours are addressed by surgery. Non-cancerous tumours may require surgery alone, while cancerous ones often require follow-up therapy like radiation and/or chemotherapy. Here, the goal is to achieve a ‘safe maximal resection’ considering the brain’s functionality. The type of tumour and the location will determine how to approach it and how much can be removed.

Surgical procedures
The surgery for brain tumour removal can be performed through open or keyhole approaches based on location. There are risks involved since the brain around the tumour or even within can be functional. Intra-operative monitoring ensures that no damage happens in any functional tissue while removing the tumour.

Brain tumour awareness is crucial for early detection and prompt treatment. Not all headaches should be ignored, especially if there is a change in their characteristics. Though most tumours do not have an identifiable cause, individuals at high risk (those getting exposed to radiation, family history of certain lesions, and previous history of cancers like leukaemia) need to be vigilant. 

Awake surgery
It is done for tumours which grow from within the brain substance, at or near a functional area like the speech area or the area which controls movement. Patients are kept awake during surgery and made to move limbs and speak. The brain surface is also stimulated with a low-intensity current to look for any movement or speech arrest. This way the maximum amount of tumour is removed without creating a deficit for the patient. 

Keyhole surgery 
It is performed using endoscopes and is suitable for tumours like skull base lesions and ventricular tumours. Navigation technology helps pinpoint the location. This results in faster recovery for patients. 

Non-surgical treatments 
Radiation therapy or chemotherapy is given only in a very limited subset of tumours- either small but growing non-cancer ones or as palliative care.

The writer is a senior consultant and programme director of neurosurgery at Aster Medcity in Kochi

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