Treatment for Nervous System Tumors
Treatment for brain tumors usually involves a combination of surgery, radiation and chemotherapy. The first goal of treatment is to remove as much of the tumor as possible, without damaging the surrounding normal brain tissue. Factors such as the patient's age, general health, occupation, and personal choice, all play a role in determining a course of treatment.
Some nervous system tumors can be treated surgically and others cannot. Sometimes there are several different surgical procedures for a particular type of tumor. Sometimes a tumor can be treated with radiation alone, and does not need to be surgically removed.
In most cases, a multidisciplinary team of medical specialists work together to contribute to a patient's treatment.
Nervous System Tumor Surgery
For patients undergoing brain tumor surgery, it is important to perform certain medical tests beforehand to provide the safest possible surgery. All patients should be in generally stable medical condition.
Patients over the age of 40 should have an EKG and chest x-ray, as well as several other tests to evaluate factors such as blood pressure and diabetes. If the patient has uncontrolled hypertension or diabetes, their blood exhibits anticoagulation, or they have active coronary ischemia, surgery usually is not done.
Surgery is used to diagnose and treat brain tumors. Complications occur in less than 5 percent of cases, and depend on the type of tumor.
Most types of surgery involve temporarily removing a section of the skull, opening the dura (outer membrane that covers the brain), and then removing the tumor and replacing the bone.
New surgical techniques include stereotactic biopsy or surgery that use computer guidance to exactly locate and either biopsy or remove the tumor, endoscopic surgery, laser surgery, and surgery under local anesthesia.
Stereotactic Surgery to Treat Nervous System Tumors
The word stereotactic comes from Greek and Latin words meaning "three dimensions" and "to touch." This technique utilizes CT scan and MRI scan of the brain to find the exact location of the tumor. A special frame is placed on the patient's head and only a very small hole is drilled through the skull. Stereotactic surgery reduces the rates of complications normally associated with performing an open resection (cutting or removing a tumor) in the brain, which involves cutting a wide opening in the skull. With computer guidance, the neurosurgeon is able to operate very precisely.
Endoscopic Surgery to Treat Nervous System Tumors
Endoscopic surgery is a type of surgery used to remove pituitary adenomas. In the past, pituitary adenomas were removed by making an incision in the mouth, beneath the upper lip, and then using a microscope to look up through the tissue to the base of the skull where the pituitary gland is located. With an endoscope, the tumor can be removed without any incision at all. Instead, the surgeon goes through the nose and is able to reach and remove a tumor in the pituitary gland through existing nasal channels. This procedure is less painful and has a quicker recovery time. Other tumors that are at the base of the skull can also be removed using endoscopic surgery.
Laser Surgery to Treat Nervous System Tumors
The use of lasers (light amplification by stimulated emission of radiation) allows a surgeon to remove diseased tissue by aiming a beam of concentrated light on it rather than using a scalpel to cut it away. Laser surgery is often used following traditional surgery to remove any residual tumor tissue.
Nervous System Tumor Surgery under Local Anesthesia
Surgery under local anesthesia involves the use of brain mapping techniques. A brain mapping technique that allow a surgeon to operate in sensitive areas of the brain, such as those that control motor function or speech. Small electrodes can be used to stimulate specific pathways so that the nerve response can be measured and a surgeon can determine the function of the nerve. The patient is awake during surgery.
Nervous System Tumor SurgeryPostoperative Care
Postoperative care includes drug therapy with corticosteroids, histamine inhibitors (blocking stomach acid), and antiepileptics. Sometimes patients may need to visit a postoperative rehabilitation facility. Corticosteroids (dexamethasone and Decadron) help reduce swelling and can relieve various postoperative neurological effects.