General classification
Brain tumors constitute an important group of diseases in neurosurgery. In general, we can classify brain tumors as malignant (malignant) and benign (benign).
I-Malignant Tumors
A-Glial Tumors: They are the most common tumors of the brain. These cause most brain cancers. It contains cells with uncontrolled proliferation. They grow rapidly and extend into the healthy tissue around them, although very rarely, they can spread to the spinal cord and even to other organs of the body. Staging is done in four groups. Stages I and II are called “low stage”, while Stage III (anaplastic astrocytoma) and Stage IV (glioblastoma multiforme) are considered “high stage.” Some other tumors in this group; ependymoma, medulloblastoma, oligodendroglioma. Survival times, pathological staging, radiotherapy, chemotherapy or not are related with age. Low-grade glial tumors have a long survival time. Low-grade tumors can transform into high-grade tumors. The average chance of survival for high-grade gliomas is much shorter.
B-Metastatic brain tumors: These are tumors that result from the spread of a tumor elsewhere in the body to the brain. They most commonly originate from the lung, breast, large intestine, stomach, skin or prostate. However, sometimes the organ of origin cannot be determined. Brain metastases are seen in 20-40% of patients diagnosed in oncology clinics and hospitalized for treatment. This rate constitutes 10% of all brain tumors. If possible, making a definitive diagnosis by biopsy with stereotaxic surgery, which can be performed under local anesthesia, facilitates the choice of treatment.
Treatment options in malignant brain tumors; surgical intervention, biopsy, radiation therapy, drug therapy and radiosurgery. Response to treatment is related to factors such as the focus of origin of the tumor, the number of organs to which it has spread, the number of metastatic lesions, the age of the patient, and the presence of additional disease. Therefore, the survival times are different.
II-Benine Tumors
These are tumors that usually develop inside the skull but outside the brain tissue. Meningiomas, pituitary adenomas, craniopharyngiomas, dermoid and epidermoid tumors, hemangioblastoma, colloid cyst, subependymal giant cell astrocytoma, neuromas are the most common lesions of this group. Meningiomas constitute an important part of this group. Unlike benign tumors in other organs, benign brain tumors can sometimes cause life-threatening conditions. Some (for example, meningiomas) can transform into malignant tumors, although they are rare. Since they generally do not spread to the surrounding brain tissue, they have a high chance of being completely removed by surgery. However, they may reappear, albeit to a lesser extent. It is known that even in the case of complete removal of meningiomas, 20% of them can recur in 10 years, and post-surgical complications may occur, especially in those that are adhered to important areas.
Symptoms
Patients with brain tumors have headache, vomiting, nausea, visual impairment, impaired consciousness, convulsions, weakness in arms and legs, irritability, loss of appetite, decreased hearing, forgetfulness, speech and understanding. They may apply with one or more of the complaints such as inability, inability to write, imbalance, and growth in the hands and feet. Headache (usually more severe in the morning) and seizure are the most common findings.
Diagnostic Methods
Diagnosis is usually made by clinical evaluation, computerized brain tomography (CT) or magnetic resonance imaging (MRI) examinations. These examinations can also be repeated with contrast material in order to better define tumor boundaries and features. Definitive diagnosis is made after pathological examinations. Some tests helpful in diagnosis include direct head x-rays, EEG, whole body bone scintigraphy, and hormone examinations.
Treatment Methods
Generally, surgical removal of the tumor is considered the first choice for almost all brain tumors. In a minority, partial removal or radiotherapy and follow-up are recommended due to the high complication rate. Especially in high-grade glial tumors, after the diagnosis is confirmed by biopsy, radio-surgery or chemotherapy (drug therapy) can be applied instead of tumor removal. Some of the benign lesions located in the brain stem can be surgically removed, while radio-surgery (Gamma knife, linear accelator=linac) can be applied in some of them. In short, the degree of malignancy and location of the tumor, the age, general condition of the patient, and the presence of additional systemic problems determine the surgical decision making and the limits of surgical tumor removal.
In summary; Today, in the treatment of brain tumors, surgery, radiotherapy (radiation therapy), radio-surgery and chemotherapy (drug therapy) methods are used separately or in combination, depending on the pathological diagnosis of the tumor.
Possible Complications After Surgery
Complications that may occur after surgery are not independent of the tumor type, location, age and general condition of the patient. Seizure, severe headache, nausea, vomiting, bleeding, worsening of the existing neurological condition, deterioration in vision, speech and perception, hydrocephalus, swelling in the extremities, redness, delayed healing of the wound site, infection, thromboembolism, some psychiatric problems are some of the possible complications of surgery. . While the majority of these complications can improve with post-operative medical care, some (for example, worsening of the neurological condition) may be permanent. One or more of these complications may develop in the same patient. However, the most important point to remember is; In the presence of a tumor in the brain, the systemic problems caused by this tumor are often life-threatening.
Follow-up and Suggestions
If the tumor is benign (benign) and has been completely removed, a check-up is usually done once a year after the first and six-month check-ups. In malignant tumors, it is appropriate to determine the control times by taking into account the follow-ups of the neurosurgeon, medical oncologist (expert in the treatment with cancer drugs), radiation oncologist (expert in the radiation therapy of cancer), physical therapy and rehabilitation departments. Writing the necessary examinations in the control at the time of discharge makes it easier for the patient to balance their appointments. If the patient has any problem (headache, seizure, impaired consciousness, weakness in the arms and legs, etc.) during the follow-up period, he or she should apply to the clinic where he was treated, to the emergency service or to the physician they were treated.
Some Definitions
Benin: Typically slow growing tumor without cancer features.
Biopsy: A small piece of tumor tissue taken to determine the tumor type in pathological examination. If possible, stereotaxic surgery rather than open surgery may lead to fewer complications.
Burr hole: A hole in the skull. It is performed for the purpose of removing the bone, bleeding, draining the abscess or biopsy.
‘Grade’: It is a special definition used in grading tumors and determining some of their characteristics. For example, a ‘grade’ I tumor grows slowly, while a ‘grade’ IV tumor grows the fastest.
Chemotherapy: The use of drugs in cancer treatment. They are given orally or intravenously = Medication
Craniotomy: Removing a piece of bone from the skull and putting it back at the end of the surgery.
Malignant: It is the definition made for tumors (cancers) whose cells multiply uncontrollably.
‘Survey’: Survival time =Survival
Radiotherapy: Treatment of tumor with radiation beams =Radiation therapy
