Early Diagnosis is the Key to Improved Results
Treatment Advancing Rapidly, in Technique, Efficacy and Availability
Misconceptions, fear and misinformation abound among the public when it comes to brain tumours. The situation is compounded by half-cooked facts floated in social media, movies, and the “IDIOT” Syndrome – Internet Derived Information Obstructing Treatment.
And in a lighter vein, every Indian is born with a medical degree!
“Brain Tumour” is a very loose and generic term, encompassing a wide variety of conditions, from the completely benign to some very malignant and menacing ones.
Any uncontrolled or abnormal growth of the various types of cells in the brain can lead to a tumour – technically it just implies a lump. Symptoms and signs of a tumour in the brain arise due to
1. Raised intracranial pressure –
- Confusion in the early stages can progress to unconsciousness, if untreated
- Headache, especially early morning and associated with nausea and vomiting
- Blurred vision
2. Impairment of a bodily function due to the specific location of the tumour –
- For instance, Paralysis, speech, imbalance abnormalities from tumours in motor areas of the brain
- Impaired vision or hearing from compression of optic or auditory nerve respectively.
3. Secretion of certain substances from the tumour
- A common example of hormone secretion or suppression from the pituitary tumours
4. Electrical dysfunction leading to seizures
- From minor tingling or momentary blank episodes to full-blown grand mal seizures
5. Any combination of the above.
Yet, brain tumours can be diagnosed more easily and rapidly now thanks to widely available scans. Early symptoms like confusion, headache, vomiting, visual or hearing problems, seizures etc… are common to other conditions. High suspicion of the index in the medical fraternity is required to rule out or rule in the condition.
Further refinement is achieved in some cases by angiography (DSA), spectrography (MRS), tractography (DTA), electrophysiological tests, and hormonal assessments in the blood.
Treatment is like fighting a war, a team effort of various specialists. From multipronged attacks to masterly inactivity and monitoring, tumour treatment in the brain requires judgement and continued efforts from the diagnosis to long periods post-treatment.
The basic methods of treatment include
1. Surgery, which in most cases remains the cornerstone.
- Classical open surgery
- Minimally invasive techniques including endoscopic procedures
- After surgery as an adjunct
- After a stereotactic biopsy of deep-seated malignant tumours
- As a primary modality in certain inoperable, very small benign tumours
- Usually for malignant tumours as an adjunct after surgery
- Drugs to control/resolve certain hormone-secreting tumours like pituitary adenomas
- Monoclonal antibodies
- Targeted molecular therapy
5. Gene therapy
At present, mostly experimental but with promise in the future
Endoscopy is making rapid advances in accessing hitherto difficult to approach areas of the brain, esp. skull base. But the expertise in this is limited to certain dedicated centres and surgeons. The learning curve of these advanced endoscopic procedures is steep, but the advantages will make them the preferred technique in future.
Safe neuro anaesthesia, care in the ICU in the immediate post-operative period, good physiotherapy and rehabilitation in patients with neurological deficits have improved with expertise acquired by dedicated professionals.
Overall, the risks associated with neurosurgery and treatment of brain tumours has become very low in the last few years with improved results. The intangible barriers of ignorance and misconceptions, if overcome, the benefits of treatment far outweigh the morbidity and mortality of not treating brain tumours.
This article is authored by Dr. Ashish Shrivastav, HOD & Senior Consultant – Neurosurgery, Dharamshila Narayana Superspeciality Hospital, Delhi