The exact cause of brain tumors is not clear and scientists are regularly trying to find the causative factor of brain tumor. 

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Although the symptoms of brain tumor vary according to its location but most of the patients complain of some or all of the following symptoms:

•    Headaches that may get severe in the morning.

•    Convulsions and seizures

•    Dizziness or loss of balance

•    Vomiting or nausea

•    Difficulty in speaking and thinking

•    Vision changes

•    Hearing changes

•    Disorientation and confusion

•    Personality changes

•    Paralysis or weakness in one part or one side of the body

In addition to physical and neurological examination of the patient, following diagnostic tests can find out brain tumors:

•    CT Scan

•    MRI

•    Magnetic Resonance Spectroscopy

•    Positron Emission Tomography (PET Scan)

•    Intraoperative MRI

•    Histopathological examination

Even though the treatments may vary according to whether it is primary, metastatic, benign and cancerous and the most common treatment options are surgery, radiation or chemotherapy. They can be suggested alone/various combinations. For malignant, residual & recurrent tumors, chemotherapy and radiation are used. The best method is chosen according to various factors. Every type of surgery and therapy has it's own risks and complications.

Surgery :

As recommended medically, complete or nearly complete surgical removal of the tumor will give the best results. This is challenge to the neurosurgeon to remove as much tumor as possible. It should be done very carefully without doing any injury to the brain tissue. The brain tissue is very important for a patient’s neurological function. Craniotomy is the traditional method to remove the tumor. It is done by accessing the tumor by opening the skull. Other common procedure is the Stereotactic biopsy. A small operation is done as a diagnostic procedure. During this procedure, the doctor accesses the sample tissue through a hole made in the skull. The tissue obtained is taken for diagnosis. This procedure may sometimes be performed before craniotomy surgery.

Computerised devices such as surgical navigation systems have been introduced later during 1990s. Such systems help the surgeon to locate and precisely operate the tumors. As a result, the complications were reduced and more of the tumor could be removed. Surgical navigation systems also allowed previously inoperable tumors to be removed with minimal risks and complications. Another important technique that may be more beneficial to the patients with tumors that are large, dominant-hemisphere gliomas and affecting the language function.

Other surgical procedure may include:

•           Ventriculoperatoneal shunt as adjuvant or as aid in main surgical procedure

•           Radiation Therapy- The radiation therapy can kill abnormal brain cells and cancer cells to shrink the tumors. X-rays of high energy are used for the procedure. Radiation therapy is used when the surgery becomes ineffective to treat certain kinds of tumors. Some of the common therapies include are:

o          Chemotherapy

o          Proton Beam Treatment

o          Gamma knife radiosurgery

o          Standard external beam radiotherapy

o          Stereotactic radiosurgery

Although surgery is considered to be the first step of treatment in any form of tumor but its feasibility depends upon the type, size and location of the tumor. It is not necessary that every kind of brain tumor might require surgery.

Brain Tumor Surgery

o Diagnosis of the type of tumor by taking a sample of the tumor for laboratory examination

o Complete resection of tumor

o Removal of the tumor as much as possible to slow down its growth and improve the symptoms.

o Remove the tumor in order to help other treatments

o Provide direct access for other forms of treatment like chemotherapy, radiotherapy etc.

o To relieve pressure caused by tumor on surrounding structures.

Types of Brain Tumor Surgery :

The different types of surgery that are performed in cases of brain tumor include the following: 

Craniotomy: Craniotomy is the most commonly performed procedure by the surgeon to remove the brain tumor along with a piece of bone. The removed bone is replaced and the tumor is sent for histopathology (biopsy). The surgery is performed using a high-end microscope by any of the following techniques:

• Extended bifrontal craniotomy

• “Eyebrow” craniotomy (supra-orbital craniotomy)

• “Keyhole” craniotomy (retro-sigmoid craniotomy)

• Orbitozygomatic craniotomy

• Translabyrinthine craniotomy

Shunt: A narrow piece of flexible tube with a pressure regulated valve in between is called a shunt. This is used to relieve the intracranial pressure caused by obstruction of the natural brain fluid (CSF) pathway by tumor mass. The procedure involves insertion of a drainage system into the brain to remove or drain excess of blocked fluid into the peritoneal cavity.     

Stereotactic surgery: This surgery is done by creating a three-dimensional image called stereotaxy using computers. It aims to find out the location and position of the tumor. In fact it can also be done to aid tumor removal, implant radiation pellets or for other treatments. 

Embolization: It is a procedure used by the surgeon to reduce the amount of blood supply to a tumor by blocking the blood flow in the selected arteries. It is generally performed before the main surgery.

Endoscopy and endoscope assisted surgery : Endoscope is the tool which helps the surgeon to closely visualize the tissue through small openings in difficult to reach areas. This tool can be used in various brain surgeries to precisely reach the target location without damaging the adjacent structures.

Other surgeries: In addition to above mentioned surgeries, following surgeries may also be performed in relation to brain tumor treatment:

• Laser surgery

• Photodynamic laser surgery

• Ultrasonic aspiration

• Fluorescent-guided surgery

• Electrophysiological monitoring

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