brain, spinal cord, and nerve disorders
Overview of Brain Tumors
Treatment of Brain Tumors
Surgery, radiation therapy, medications (such as chemotherapy or immunotherapy) or, most often, a combination Sometimes medications, usually corticosteroids, to reduce pressure within the skull Antiseizure medications to treat seizures Treatment of a brain tumor depends on its location and type. Treatments for brain tumors include the following: Craniotomy (brain surgery) Radiation therapy Implants Shunts Stereotactic techniques Craniotomy(surgical removal of the tumor) is done when possible. This procedure involves opening the skull. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make removal by traditional surgery difficult or impossible without destroying essential structures. For craniotomy, part of the scalp is shaved. Then, an incision is made through the skin. A high-speed drill and a special saw are used to remove a small piece of bone above the tumor. The tumor is located and removed using one of the following: A scalpel may be used to cut out the tumor. A laser may be used to vaporize the tumor. A device that emits ultrasound waves may be used to break the tumor apart, so that the pieces can be suctioned out (aspirated). Lasers and ultrasound devices are used to remove tumors that would be difficult to cut out. Usually, the bone is then replaced, and the incision stitched closed. Traditional surgery sometimes causes brain damage that can lead to symptoms such as partial paralysis, changes in sensation, weakness, and impaired mental function. Nevertheless, removing a tumor—whether cancerous or noncancerous—is essential if its growth threatens important brain structures. Even when a cure is impossible, surgery may be useful to reduce the tumor’s size, relieve symptoms, and help doctors determine whether other treatments, such as radiation therapy or chemotherapy, are warranted. Radiation therapyincludes the following: Whole brain radiation Stereotactic radiation that targets the tumor (SRS) External radiation therapy None External radiation therapy None When agamma knifeis used, an imaging frame is attached to the person’s skull. The person lies on a sliding bed, and a large helmet with holes in it is placed over the frame. The head of the bed is then slid into a globe that contains radioactive cobalt. Radiation passes through the holes in the helmet and is aimed precisely at the tumor. When alinear acceleratoris used the head is immobilized in a fixed frame or molded mask. CT is used to make a 3-dimensional map of the tumor so that radiation delivered from different angles can be aimed to precisely match the shape of the tumor (called conformal radiation). Traditionally, radiosurgery is done when a person has four or fewer tumors, and radiation of the whole brain is done when a person has 5 or more tumors. However, some recent evidence suggests that radiosurgery can be done when a person has as many as 10 tumors. Radiosurgery is also useful for brain metastases. Damage to the Nervous System Due to Radiation Therapy sometimes occurs, despite doctor's efforts to prevent it. Stereotactic techniquescan also be used to do the following: Locate a site for biopsy Determine where to insert radioactive implants or to direct a laser to destroy tumor cells Computers are used to produce a three-dimensional image. The three-dimensional image can be obtained by attaching a light-weight metal imaging frame with a series of rods to the person’s skull. A local anesthetic is given to numb the area, and the pins are attached to the skull, piercing the skin. A computed tomography (CT) scan shows the rods as dots, providing reference points, which help locate the tumor. In a similar procedure, a plastic frame is used, and magnetic resonance imaging (MRI) is used to show where the tumor is. Techniques that do not involve attaching a frame may be used instead. For examples, special markers can be taped to the skull to provide reference points. The location of these markers is entered into a computer that contains images of the brain tumor. Implantsare occasionally inserted into the brain. The implants consist of wafers soaked with a chemotherapy drug, After a tumor is removed and before the skull and incision are closed, these wafers may be placed in the space where the tumor was. As the wafers gradually dissolve, they release the drug to destroy any remaining cancer cells. Shuntsmay be surgically placed if a tumor causes pressure within the skull to increase. A shunt is a thin piece of tubing that is inserted into one of the spaces of the brain (ventricles) or sometimes into the space around the spinal cord that contains cerebrospinal fluid (subarachnoid space). The other end of the tubing is threaded under the skin from the head usually into the abdomen. Excess cerebrospinal fluid is drained from the brain into the abdomen, where it is absorbed. The shunt contains a one-way valve that opens when there is too much fluid in the brain. Shunts may be temporary (until the tumor is removed) or permanent. Surgical removal is often safe and cures the person. However, very small tumors and tumors in older people may be left in place as long as they are not causing symptoms. Sometimes radiation therapy is given after surgery to destroy any remaining tumor cells. Radiosurgery using Treatment of pineal tumors is effective for treating noncancerous tumors such as meningiomas and Usually, a combination of surgery, radiation therapy, and chemotherapy is used. As much of the tumor as can be removed safely is removed, and then radiation therapy is begun. Radiation therapy is given over a course of several weeks. Radiosurgery is used when traditional surgery cannot be, especially for the treatment of metastases. For very aggressive tumors, chemotherapy is given with radiation therapy. Radiation therapy plus chemotherapy rarely cures but may shrink a tumor enough to keep it under control for many months or even years. After radiation therapy, ongoing chemotherapy is used to treat some types of cancerous brain tumors. Chemotherapy appears to be particularly effective in treating Gliomas . This extremely serious condition requires immediate medical attention. If people are in a coma or have difficulty breathing, Brain Herniation may be developing. To help such people breathe, doctors insert a plastic tube through the nose or mouth into the windpipe (trachea) and attach it to a If the tumor is blocking the flow of cerebrospinal fluid through the spaces within the brain, a device may be used to drain the cerebrospinal fluid and thus reduce the risk of herniation. The device consists of a small tube (catheter) connected to a gauge that measures the pressure within the skull. The tube is inserted through a tiny opening drilled in the skull. A local anesthetic (usually plus a sedative) or a general anesthetic may be used. The tube is removed or converted to a permanent drain ( Specific treatments for brain tumors ) after a few days. During this time, doctors surgically remove all or part of the tumor or use radiosurgery or whole-brain radiation therapy to reduce the size of the tumor and thus relieve the blockage. Treatment depends largely on where the cancer originated. Radiation therapy directed at the metastases in the brain is often used. Surgical removal before radiation therapy may benefit people who have only a single metastasis. Sometimes radiosurgery is used. Chemotherapy and Immunotherapy for Cancer may help treat metastases from certain types of cancer. People with cancerous brain tumors have a limited life expectancy and are likely to become unable to make decisions about medical care. Consequently, establishing Advance Directives is advisable. Advance directives can help a doctor determine what kind of care people want if they become unable to make decisions about medical care. Treatment that focuses on relieving symptoms as fully as possible ( Many cancer centers, especially those with palliative care and hospice facilities, provide counseling and home health services. 