Modern Techniques for treating Brain Tumors

Brain tumors have always challenged the (hand) procedures. CT scan delineates the bone very well when compared neurosurgeon in many ways. They arise in many locations within and outside the brain substance; can get interlocked with the arteries and nerves; destroy bone and affect the functioning of the brain quite subtly at times.

The first decision-making process is to classify the tumors into benign and malignant .Generally, an experienced neurosurgeon can come to a preliminary conclusion based on the CT scan and MRI scan.

IMAGING TECHNOLOGY AND TECHNIQUES

Advances in imaging technology have given the neurosurgeon the ability to see within the skull and its confines in great detail, in the form of CT scan, MRI scan, PET Scan and Digital Subtraction Angiography.

While CT Scan and MRI Scan is commonplace,In PET Scan or Positron Emission Tomography Using isotope-labelled glucose as an intravenous injectable, the scans from this machine show areas of metabolic hyperactivity, which are a direct function of malignancy. PET scans have revolutionised detection of very early stages of cancer.

DIGITAL SUBTRACTION ANGIOGRAPHY: (DSA) This is commonly used to study the anatomical pattern of cerebral vasculature. It is the preferred standard for detecting Aneurysms
and Arterio-venous malformations(AVMs).

Microsurgery for Brain Tumor Treatement:The most commonly usedtechnique is Microsurgery. Microsurgery is the gold standard around which other technical innovations are based and it is the most common form of brain tumor surgery. The skill of the surgeon is paramount and effectively decides the final outcome for the patient. The other major techniques are Sterotaxy and Endoscopic Brain Tumour Surgery. The different types of technology and techniques can be
used alone or in conjunction with other methods, for example, Endoscope Assisted MicroSurgery (EAMS).

Microsurgery involves the use of the operating microscope, microinstruments,ultrasonic surgicalaspirator and other adjuncts.

Endoscopic Brain Tumour Surgery: This is the technology and technique that uses specially designed endoscopes and endoscopic instruments for treating brain tumors. Manyapproaches are already in vogue and new approaches are being developed. For certain brain tumors, endoscopic approaches offer a novel, minimally invasive method to excise these lesions effectively. The minimal operative scar, lesser dissection and minimal hospital stay offer an attractive alternative.

The tumors suitable for endoscopic surgery depend on the location and the tumor type

1.)Intraventricular tumours: colloid cyst excision, posterior third ventricular tumor biopsy,observation of ventricular wall for seedlings.

2.)Intracystic/Intracisternal tumours: Useful for Around the Corner observation, location of mural nodule, etc

3.Trans-nasal/Trans-oral approaches: Pituitary tumour, meningioma, craniopharyngioma,sellar cysts, skull base chordoma, etc.

The technology and the techniques described have improved the outlook for treating brain tumour patients. Patients can look forward to less operative trauma, less postoperative pain, and less hospital stay at no increased cost. These options should be discussed by the family physician with the patient and the neurosurgeon can guide effectively in improving patient care.

Courtesy:
Dr. DV Rajakumar M.Ch.
Senior Consultant Neurosurgeon
Wockhardt Hospitals,Bangalore