The decision of treatment for brain tumors is made according to the type, location, and size of the tumor, the patient’s general health condition, and the mutual choices of the patient and the physician.
The first treatment option for brain tumors is surgical treatment. Particularly the small tumors located in non-highly sensitive areas of the brain may be removed completely (totally) by surgery. However, it may also be preferable to leave a portion of the tumor if the tumor is large and close/attached to the sensitive areas of the brain. Even removing a portion of the brain tumor can help reduce some of the complaints and symptoms. Surgery to remove the brain tumor carries many risks such as infection and bleeding. Other risks may stem from the brain functions and important structures near the tumor site.
Technological Innovations Used in Tumor Surgery
By using ultrasonography during surgery, it is possible to determine the location and the boundaries of the tumors, reach the tumor with minimal damage to the brain tissue and remove as much tumor tissue as possible.
It is used to record and instantly evaluate the stimuli coming from the brain to preserve different functions depending on the location of the tumors during surgery (such as protection against facial paralysis in vestibular schwannoma cases).
It is an advanced computer technology that provides 3D imaging for the removal of tumors that are located in the brain, for doing a biopsy and for the removal of deeply located abscesses. In this technique, the patient’s previously taken MRI or tomography images are exported to the neuronavigation device. This enables an approach to the lesion in the brain with great accuracy during surgery. In this way, the potential damage that could be inflicted on the healthy tissue during surgery may also be minimized.
Use of Intraoperative Fluorescence
This technique is used to better determine the tumor tissue and its boundaries during surgery. During surgery, the tumor tissue is stained intravenously and with the specific imaging method of the most modern microscope, the tumor tissue is displayed in a different color from the brain. In this way, the tumor tissue, which is difficult to distinguish from the normal brain tissue under normal light, becomes apparent under fluorescent light. Thus, it becomes possible to remove the entire tumor.
Radiotherapy and Radiosurgery
Radiation therapy uses high-energy rays, such as X-rays, to kill tumor cells. Radiation therapy can be applied from a machine outside the body, or in very rare cases, a radiation source can be placed inside the body near the brain tumor. With advanced devices in recent years, it is now possible to focus and apply radiotherapy on only to the region where the tumor is located, with precise boundaries, without affecting the surrounding normal tissue. In radiosurgery, a large number of radiation beams are used to apply focused radiation on the tumor to kill tumor cells in a very small area. A single one of the radiation rays is not strong enough to damage the brain, but at the point where all the rays are focused on the brain tumor, a large dose of radiation is created to kill the tumor cells. Radiation therapy that is applied to the whole brain can usually be used to treat cancer that has spread to the brain from other parts of the body and created a large number of tumors in the brain. The side effects of radiation therapy depend on the type of radiation received and its dose. Fatigue, weakness, headache, memory loss, and scalp irritation are among the common side effects seen during or immediately after radiation.
It is a treatment that kills tumor cells with specific drugs. It can be applied orally in the form of a pill or intravenously. Many chemotherapy drugs are available and can be used depending on the type of cancer. The side effects of chemotherapy depend on the type and dose of the medication. Chemotherapy may cause nausea, vomiting and hair loss. The tumor response to chemotherapy may vary depending on the type of the tumor.
Prof. Dr. Erkan KAPTANOĞLU
Brain and Nerve Surgery