Brain tumor surgery: Difference between revisions

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*If the tumor is deep and the patient's health does not allow an open operation, a stereotactic biopsy can be performed.  
*If the tumor is deep and the patient's health does not allow an open operation, a stereotactic biopsy can be performed.  
**Using a small needle under CAT scan or MRI guidance, a small piece of the tumor can be taken out. In the open operation a piece of the skull is taken out, the brain is entered and the tumor is taken out. The piece of the skull is then replaced and the skin is closed. Sometimes it is possible to take the whole tumor out especially in the case of malignant gliomas. In some cases, if the whole tumor is taken out, the surrounding brain can be damaged or deficiencies in the brain can result. Depending on the location of the tumor, the neurosurgeon may have to decide during the operation exactly how much of the tumor can be removed. Surgery on metastatic brain tumors may be done to help diagnose the disease and may be needed to save the life of the patient. If the original tumor is under control, removal of the metastatic tumor may help to extend the patient's life.
**Using a small needle under CAT scan or MRI guidance, a small piece of the tumor can be taken out. In the open operation a piece of the skull is taken out, the brain is entered and the tumor is taken out. The piece of the skull is then replaced and the skin is closed. Sometimes it is possible to take the whole tumor out especially in the case of malignant gliomas. In some cases, if the whole tumor is taken out, the surrounding brain can be damaged or deficiencies in the brain can result. Depending on the location of the tumor, the neurosurgeon may have to decide during the operation exactly how much of the tumor can be removed. Surgery on metastatic brain tumors may be done to help diagnose the disease and may be needed to save the life of the patient. If the original tumor is under control, removal of the metastatic tumor may help to extend the patient's life.
===Radiation Therapy===
In case of a malignant brain tumor, radiation therapy is needed to control the tumor and possibly acheive long-term remission.
There are some possible side effects of radiation therapy; these include the possibility of strokes and [[dementia]]. The severity as well as the chance that they happen, worsen with higher doses of therapy. The radiation therapy is usually very well tolerated.
'''Stereotactic Radiosurgery:'''
Stereotactic radiosurgery is a special form of
radiation therapy - it is not surgery. Stereotactic
radiosurgery allows precisely focused, high dose
X-ray beams to be delivered to a small, localized
area of the brain. It is used to treat small brain and
spinal cord tumors (both benign and malignant);
blood vessel abnormalities in the brain; defined
areas of cancer; certain small tumors in the lungs
and liver; and neurologic problems such as
movement disorders.Stereotactic radiosurgery is given in
a single session. If given in multiple sessions, the
treatment may be called stereotactic radiotherapy
or fractionated stereotactic radiotherapy.
“Frameless radiosurgery” refers to radiosurgery
that does not use a metal frame to immobilize the
head during treatment. Rather, markers able to be
viewed on a scan are placed on the scalp, or a face
mask is used to help hold the head steady. The
treatment equipment is then aligned with the
markers or with the face mask.
Radiosurgery is different from Conventional Radiation therapy.
Conventional external beam radiation therapy –
the most common form of radiation therapy –
delivers full dose radiation to the tumor and some
of the surrounding brain tissue. For several
reasons, the target area for conventional radiation
deliberately includes a border (called a “margin”)
of normal brain around the tumor. These reasons
include uneven tumor borders, the risk of invisible
spread of the tumor into the surrounding tissue, a
larger tumor size, or the presence of multiple
tumors. This larger zone of full-dose radiation
includes the borders of the tumor where
microscopic tumor cells may be located.
Since normal brain tissue is included in the
full-dose region, conventional radiation is broken
down into small daily doses so the normal brain
tissue can tolerate it. As a result, reaching the
desired dose of radiation takes several weeks of
daily treatment.
Radiosurgery focuses radiation beams more
closely to the tumor than conventional external
beam radiation. This is possible through the use
of highly sophisticated computer-assisted
equipment. A head frame or facemask used for
this treatment allows very precise set up,
localization and treatment of the tumor. Using
advanced computer planning, radiosurgery
minimizes the amount of radiation received by
normal brain tissue and focuses radiation in the
area to be treated.
Since conventional radiation therapy covers more
normal tissue, it can often be given only once.
Radiosurgery, however, may be considered for
re-irradiation due to its precision and the
possibility of avoiding previously treated areas
'''Gamma knife, Linear Accelerators, Proton Beam radiosurgery units''' are the types of equipment used in Radiosurgery.  Radiosurgery requires a
team of specialists. That team may include a
neurosurgeon, radiation oncologist, radiologist,
radiation physicist, neurologist, anesthesiologist,
specially trained nurses, technologists and the unit
support staff.The actual treatment time for any of these
techniques generally ranges from 15 minutes to
about two hours.
Some people have few or no side
effects from this type of radiation therapy. Once
they have rested following the treatment and have
resumed their regular activities, tenderness at the
pin sites may be the only side effect
Early symptoms are often due to brain edema
(swelling) caused by the radiation. These
symptoms can include nausea, vomiting, dizziness,
or headaches which are usually temporary. Once the
swelling resolves, these symptoms usually resolve.
Two to three weeks after treatment, some may
experience hair loss in the area radiated, but this
does not occur in everyone. Hair loss depends on
the dose of radiation received by portions of the
scalp and the ability of the radiated hair follicles to
heal. Regrowth usually begins in 3-4 months, and
may be a slightly different color or texture than
before. The scalp may also become temporarily
irritated.
Some patients may experience delayed reactions
weeks or months after treatment. These reactions
can include necrosis or cell death in the high
radiation dose region due to swelling in reaction
to the radiation effect on the target region. These
symptoms are mainly due to swelling or death of
brain tissue in the treated area. They may mimic
the symptoms of tumor regrowth or stroke.
Treatment will be based on the type of side effect
that occurred. Other effects depend on the
location of the tumor.
====Shunt Operation====
A shunt operation is used not as a cure but to relieve the symptoms.[http://www.emedicinehealth.com/normal_pressure_hydrocephalus/page9_em.htm] The [[hydrocephalus]] caused by the blocking drainage of the [[cerebrospinal fluid]] can be removed with this operation.


==References==
==References==

Revision as of 12:56, 21 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Brain tumor Microchapters

Patient Information

Overview

Classification

Adult brain tumors
Glioblastoma multiforme
Oligodendroglioma
Meningioma
Hemangioblastoma
Pituitary adenoma
Schwannoma
Primary CNS lymphoma
Childhood brain tumors
Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Craniopharyngioma
Pinealoma
Metastasis
Lung cancer
Breast cancer
Melanoma
Gastrointestinal tract cancer
Renal cell carcinoma
Osteoblastoma
Head and neck cancer
Neuroblastoma
Lymphoma
Prostate cancer

Causes

Differentiating Brain Tumor from other Diseases

Overview

Meningiomas, with the exception of some tumors located at the skull base, can be successfully removed surgically, but the chances are less than 50%. In more difficult cases, stereotactic radiosurgery, such as Gamma Knife radiosurgery, remains a viable option. Most pituitary adenomas can be removed surgically, often using a minimally invasive approach through the nasal cavity and skull base (trans-nasal, trans-sphenoidal approach). Large pituitary adenomas require a craniotomy (opening of the skull) for their removal. Radiotherapy, including stereotactic approaches, is reserved for the inoperable cases.

Surgery

Surgery is usually done on primary brain tumors to help pinpoint the diagnosis and to take as much as the tumor as possible. There are two main types of surgery commonly used on brain tumors: Open and stereotactic.

  • If the tumor is accessible and the patient is in good health, an open operation is done to take the tumor as much as possible.
  • If the tumor is deep and the patient's health does not allow an open operation, a stereotactic biopsy can be performed.
    • Using a small needle under CAT scan or MRI guidance, a small piece of the tumor can be taken out. In the open operation a piece of the skull is taken out, the brain is entered and the tumor is taken out. The piece of the skull is then replaced and the skin is closed. Sometimes it is possible to take the whole tumor out especially in the case of malignant gliomas. In some cases, if the whole tumor is taken out, the surrounding brain can be damaged or deficiencies in the brain can result. Depending on the location of the tumor, the neurosurgeon may have to decide during the operation exactly how much of the tumor can be removed. Surgery on metastatic brain tumors may be done to help diagnose the disease and may be needed to save the life of the patient. If the original tumor is under control, removal of the metastatic tumor may help to extend the patient's life.

References

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