Overview

Brain Tumour

• A brain tumour is an abnormal growth of cells present from the brain or its nerves or its coverings
• It can arise from cells inside the brain/nerves/brain coverings, and can be cancerous or noncancerous
• It can also be a cancerous growth that has spread to the brain from a cancer present in another part of the body

Tumour Biopsy

• In some brain cancer cases, removal of some tumour tissue (biopsy) to confirm its nature and its suitability for further treatment (radiation therapy, chemotherapy) may be all that can be done
• This biopsy is done with MRI-guidance using a special metal frame (frame-based) or a computerised neuronavigation system (frameless)
• It can be done under Local or General anaesthesia
• A small scalp incision is needed
• A small opening, the size of a 10 cent coin, is made in the skull bone
• A biopsy needle is inserted to take out samples of the brain tumour tissue

Causes

Brain Tumour

• Overall risk: 3-5%
• Bleeding: Craniotomy to evacuate the clot may be necessary
• Infection
• Negative or inconclusive biopsy
• Seizures
• Stroke
• Non-neurological risks:
• Risks of general anaesthesia: Heart attack, lung problems, allergy to anaesthetic drugs, etc
• Blockage of leg veins
• Chest infection
• Urinary tract infection
• Death (remote possibility)

Treatment Options
  
After the Biopsy

• Patients are expected to have same level of alertness as before procedure. They are not expected to be more awake or more drowsy
• The scalp incision is covered with a small dressing
• Histology results take a week or longer to be ready

What are the alternatives?

• Observation i.e. non intervention: Proper treatment cannot be given as type of tumour is unknown. Repeat MRI/CT then biopsy if tumour has grown bigger
• Radiation therapy/chemotherapy: Given usually when nature of tumour is known, because of risks

Craniotomy and Excision of Brain Tumour

• This is a brain operation wherein the surgeon makes an opening in the skull bone and removes the brain tumour
• It may be done under General or Local anaesthesia
• A scalp incision is made over the area of the brain tumour
• An opening will be made in the skull bone
• The outer covering of the brain is opened to expose the brain and the tumour
• Symptomatic relief from mass effect
• Improve neurological condition
• Decrease tumour size of the tumour to improve results of adjuvant therapy (radiation therapy, chemotherapy)
• Histological diagnosis: No sampling error
• Complete cure (benign) or improved survival (malignant)
• The tumour is separated from normal brain and other important structures such as blood vessels and nerves, then removed
• In cancerous tumours, tumour cells often spreads beyond tumour boundaries into adjacent “normal” brain, so it would not be possible to remove all of it
• The aim is to remove as much tumour as is safely possible, without injuring the normal brain and other important structures
• Tumour may be left
• If stuck to important brain structures, blood vessels, or nerves,
• If there is excessive bleeding or brain swelling during the operation
• Second operation or other measures e.g. Radiotherapy/chemotherapy may be required to treat the remnant tumour

Risk Factors

Risks of Craniotomy and Excision of Brain Tumour

• Overall risk: 5-10%
• Bleeding: May need second operation to evacuate the blood clot
• Infection
• Seizures
• Stroke
• Brain swelling
• Weakness on one side of the body
• Inability to speak/understand speech
• Inability to take care of oneself
• Visual impairment
• Hormonal and fluid and electrolyte problems (hypothalamic/pituitary tumours)
• Risks of craniotomy and excision of brain tumour
• Non-neurological risks:
• Risks of general anaesthesia: Heart attack
• Lung problems, allergy to anaesthetic drugs
• Inability to pass urine
• Blockage of leg veins
• Chest infection
• Urinary tract infection

Risks of Craniotomy amd Excision of Brain Tumour (Infratentorial)

• Injury to the brainstem
• Impaired consciousness
• Possible need for ventilator support
• Injury to cranial nerves
• Double vision
• Facial numbness, facial asymmetry
• Loss of hearing
• Difficulty swallowing
• Slurring of speech
• Hydrocephalus
• May need to undergo a ventriculo-peritoneal shunt operation
• Inability to speak (cerebellar mutism)
• Involuntary head movements (titubation)
• Difficulty with walking and balance