March 03, 2013

Brain tumor removal surgery: a well planned procedure is needed

Brain tumors are either benign or malignant. Brain tumor removal surgery requires in depth planning and evaluation. While benign tumors found in other areas of the body are not always removed, they must be removed from the brain, as they can be life threatening. Just their presence in the brain can create pressure on critical areas and create serious health problems. Malignant brain tumors usually grow rapidly and also invade surrounding tissue. They may spread to other areas of the brain, but rarely to other areas of the body.

The first step when a brain tumor is diagnosed is to get a biopsy if possible. Determining the type of tumor will help determine the most effective treatment for that specific tumor. One form of biopsy is the stereotactic procedure, where the surgeon uses a thin biopsy probe to remove enough tissue to guarantee a pathological evaluation. It must be done under computer guidance as it is possible to miss the tumor completely. The other is a partial tumor removal. The patient’s overall health is the best indicator as to which method is used.

Tumors are graded. Grade I is a benign tumor whose cells may look health, and it grows slowly. Grade II is the first level of a malignant tumor where the cells begin to change in appearance from normal cells. Grade III tumor cells are quite different from normal cells and have an active development (anaplastic). Grade IV tumor cells look the most abnormal and often develop extremely rapidly.

The specific type of tumor also determines the how and time sequence of surgery. Then its location within the brain must be considered. Finally, the size along with the age and health of the patient are reviewed. It is necessary to learn, when it comes to certain types of tumors, if any cancer cells are in the cerebrospinal fluid.

If it is decided that the tumor is one that can be removed, most often before surgery, a patient is given steroids to remove any swelling. If there is hydrocephalus present, a shunt is needed to drain cerebrospinal fluid. Then an opening in the skull is made (craniotomy). Hopefully the entire tumor is in easy reach and can be removed.

There are times that the location and growth make it impossible for full removal because critical areas of the brain may be damaged. One important part of the tumor to be removed is the hypoxic tissue as it is this that feeds the tumor oxygen and nutrients. This tissue is most resistant to radiation and somewhat to chemotherapy. Its removal means if any tumor remains, it will hopefully starve over time.

Brain mapping is used to help the surgeon avoid any critical areas of the normal brain to lessen harmful damage regarding normal brain functioning. Using cat-scan (CAT) and magnetic resonance imagery (MRI) during surgery makes this task easier.

One procedure now in place is Gliadel®, where a cavity is created during the tumor removal and then the cavity left after surgery is lined with a biodegradable wafer of BCNU, a chemotherapy drug. It is used in patients with malignant gliomas. Medium-sized tumors can be treated with a Gamma Knife or CyberKnife radiosurgery, a noninvasive method of radiation treatment.

If you wish to learn more about brain tumors and what resources are available, contact us.


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