Brain tumour treatment

Examination and tests for brain tumours

Diagnosis begins with the initial consultation of a neurosurgeon. He examines your nervous system to check for problems related to the lump. It may include checking:

• Arm and leg strength;
• Reflexes such as your knee reflex;
• Hearing and sight;
• Skin sensitivity;
• Balance and coordination;
• Memory and mental agility using simple questions or arithmetic.

In addition, the physician prescribes standard diagnostic methods, such as blood and urine tests and ECG, to assess the general condition, and accompanied disease.

If a cerebral formation is suspected, the patient will be prescribed the following examinations:

• Computed tomography of the head (cranial computed tomography, CCT) is a 3D X-ray examination. The body is exposed to a small amount of radiation.
• The specialist can visualise the blood vessels and thus their abnormalities by administering a contrast agent (CT angiography).
• Magnetic resonance imaging (MRI) is a gentle method because it works with magnetic fields and radio waves. There is no exposure to radiation. It helps to determine the size and localisation of the brain tumour, as well as to understand how it is connected to the surrounding vessels and structures.
• Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) allow for studying many processes that underlie the vital activity of the brain, its blood supply and perfusion, the exchange of amino acids, proteins, water, and other features of cerebral metabolism. Currently, SPECT and PET are the main radionuclide methods for diagnosing brain disorders and cerebral tumours.
• To classify a brain tumour more precisely, the doctor takes a biopsy (tissue sample) and examines it under a microscope. It is done either through the operation or a stereotactic surgical technique. It helps a physician determine the tumour origin and its type.

Treatment overview for a brain tumour

Not all neoplasms need immediate treatment. For example, if it is tiny and does not cause any symptoms, the doctor uses the wait-and-scan tactic. Here, the development of the tumour is regularly checked using CT or MRI. However, surgery is required if it starts causing discomfort or grows.

The neoplasm is removed as completely as possible. A neurosurgeon will discuss the course of the operation and potential risks with the patient in advance. Surgery is a classic and proven method for brain tumour treatment. If the procedure is performed early, the patient has every chance of a full recovery. A neurosurgeon performs the following interventions:

• Trepanation of the skull (through access to the skull bone) followed by removal of the tumour. It sometimes is called craniotomy and is an open surgery;
• Endoscopic intervention through a minimal opening in the head. A neurosurgeon will use a thin probe with the camera to operate inside the skull;
• Transsphenoidal (through the nasal passages) operation to remove the pineal gland or pituitary gland tumour.

In neurosurgical practice, tumour removal is often performed using laser and ultrasound methods (in cases where the neoplasm is too large or located in an area of ​​the brain inaccessible to the surgeon). Such methods might be MRI-guided laser brain surgery or HIFU device.

Another possible treatment is radiosurgery with GammaKnife and CyberKnife. It is a form of radiotherapy that uses precisely directed ionising radiation to destroy tumour compartments. A high dose affects the formation with high-precision powerful beams with an accuracy of one millimetre at various angles. This way, an effect comparable to surgery is achieved without pain and blood loss.

There is also a special method for brain angiomas, arteriovenous malformations, aneurysms and cavernomas - endovascular embolisation. It is considered a modern, minimally invasive neurosurgical technique. The operation is performed through a single puncture of the artery on the thigh in the groin region. First, the surgeon inserts a thin tubular catheter into the femoral artery, which, under constant X-ray control, is installed in the vessels of the brain directly near the pathological focus. Afterwards, an embolisation substance is introduced through the catheter, which "sticks" the pathological vessels.

However, preserving the brain functions has absolute priority over completely removing the tumour to enable the patient to continue to lead an everyday life. Therefore, neurosurgeons are more likely to accept a residual tumour than permanent damage to a vital brain function. In the case of benign neoplasms, this residual tumour is often observed for years or is treated and stopped by radiosurgery.

If neurological deficits (speech or movement disorders) occur postoperatively, inpatient neurological rehabilitation is helpful.

Suffering from minor limitations or if inpatient rehabilitation is not desired, there are numerous outpatient therapy options to make it easier to get back into everyday life. They include outpatient physiotherapy, occupational therapy, speech therapy, psychosocial care, etc.

In case some brain tumours do not require further treatment, regular follow-up checks and MRI examinations are carried out. The intervals for these checks depend on the type of tumour and the recommendations of your neurosurgeon.