Νευροχειρουργός Νίκος Μαραθεύτης


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All Posts Tagged: Surgical Treatment

Other brain tumors

 

  • Ependymomas
  • Germinomas
  • Neurocytoma
  • Gangliogliomas
  • Gliosarcomas
  • Mixed malignant gliomas
  • Oligodendrogliomas
  • Lymphomas of the central nervous system
  • Neuroectodermal tumors (myeloblastomas, neuroblastomas, esthesioneuroblastomas or olfactory neuroblastomas)
  • Ependymomas
  • Tumors of the epiphysis
  • Colloid cysts
  • Hemangioblastomas
  • Chordomas
  • Dermoid and epidermoid cysts
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Malignant brain tumors

 

Astrocytomas (or gliomas)

Astrocytomas are tumors that come from cells in the brain called astrocytes (due to their star shape). They are the most numerous cells in the brain, and their role is to support the nerve cells, to serve the nerve serves in terms of their energy, to facilitate their communication and they probably also play a role in higher functions, such as learning and memory. When they multiply out of control they form a tumor, called astrocytoma. These tumors do not metastasize to other areas of the body. They develop only in the brain and spinal cord.
There are different degrees of malignancy involved in these tumors. Unfortunately, the most malignant are the most common. They are called glioblastomas (Grade 4). Grade 3 anaplastic gliomas are also malignant. The other astrocytomas (Grade 1 and 2) may remain relatively non-aggressive for several years, but at some point they also become more malignant. There are other categories with a better prognosis, such as pilocytic astrocytomas, which are more common in children, and have a better prognosis since they can be completely cured if completely removed.
Although astrocytomas (or gliomas) do not metastasize, they are malignant because they have no clear anatomical boundaries, but they spread through the nerve pathways into the brain; this makes it impossible to completely remove them. In fact, they are often found in areas of the brain with very important functions, so they cannot be removed because the surgery would cause very severe neurological disabilities. Therefore, they cannot be treated surgically. They are the most common primary tumors of the brain.
The cause of astrocytomas is unknown. They are not considered hereditary; there is no environmental factor or pollutant clearly proven to cause them.

 

Symptoms

The most common symptom is headache, due to increased intracranial pressure. This headache is usually stronger in the morning and may be accompanied by vomiting, no nausea. Seizures, and mild symptoms such as personality change, difficulty concentrating, weakness on one side of the body, or unexplained malaise, may also occur. There may be symptoms of vision disturbance (blurring, diplopia)
If a patient develops these or similar symptoms that cannot be explained otherwise, a CT scan or MRI scan is required. Although malignant astrocytomas have some imaging characteristics, a definitive diagnosis can only be made by biopsy. The treatment depends on the stage of the tumor.

 

Treatment

There is no definitive cure for astrocytomas. Treatment may be conservative or surgical. Radiation therapy or chemotherapy may be used in some cases. If it is possible to combine these three treatments, the best possible result is ensured. However, the average survival in type 4 astrocytomas is one year, in type 3 it is 2-3 years, in type 2 it is 7-8 years and in type 1 it is 8-10 years.
Gene therapy has provided some new hope for cure. Due to the invasive nature of astrocytomas, no matter how evolved is a surgical technique, it could never provide the solution. Gene therapies will provide individualized therapies (such as vaccines specific to each patient), which, in combination with existing methods, could some day successfully treat astrocytomas. There is a very intensive laboratory and clinical research in this field, and we can expect spectacular results within the next 5-10 years.

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Benign brain tumors

 

Acoustic Neuromas

These are benign and slow-growing tumors that originate in the vestibular nerve, i.e. a part of the 8th cerebral nerve. They do not create metastases. They account for 6-8% of brain tumors. Tumor cells expand along the nerve, pressing on the rest of the brain nerves. They can even exert pressure on the brain stem.

Signs and Symptoms

Hearing loss on the side where the tumor is located. This can be slow and covert, and the patient may not notice it immediately. There may be dizziness, ringing in the ears and balance disorders. As these grow, they cause more symptoms, such as headache, facial asymmetry (paralysis of the facial nerve), numbness in half the face, and others.

 

What happens if they are not treated?

Permanent hearing loss or paralysis of half of the face may be caused. There may also be some pressure on the brain stem, where important centers are located, such as the control of respiration, of heart function and other centers. This can cause instability, difficulty in coordinating movements, and limb weakness.

 

Diagnosis

Diagnosis is made with laboratory and imaging tests, such as an audiogram to assess hearing damage, CT and MRI to determine the size and location of the tumor and its relationship to the anatomical structures of the brain, and electrophysiological examination.

 

Treatment

Simple monitoring in the case of small tumors, without symptoms, in elderly patients, in patients who do cannot accept treatment. In this case, MRI scans should be performed at regular intervals to monitor the size of the tumor.
Surgical treatment, in case where the complete removal achieves healing of the lesion and avoids future consequences and permanent damage to the brain and nerves.
Stereotactic Radiosurgery (γ-knife), for tumors up to 3 cm, or after the surgery, to treat any tumor remnants that was dangerous to remove. The tumor may not disappear with radiation, but it stops growing.

Meningiomas

A meningioma is a usually a benign tumor that grows slowly, located either in the brain or in the spinal cord. They account for 20% of brain tumors. They occur more frequently in women. They cause symptoms due to the pressure they exert.
Meningiomas do not come from the brain itself, but from the meninges, and specifically the arachnoid. The exact cause is unknown.

 

Symptoms

They depend on the location of where the tumor grows. Sometimes they are discovered by chance. Sometimes they cause increased intracranial pressure, i.e. headaches, vomiting, or they manifest with epileptic seizures or neurological symptoms such as vision disorders, limb weakness, balance disorders, aesthetics, loss of sense of smell, other such symptoms. When located in the spinal cord, they cause limb weakness (especially lower limbs, because they are more frequently located in the thoracic spine where the nerves that control the lower extremities originate), difficulty walking, muscle weakness, numbness, incontinence, and more.

 

Diagnosis

Diagnosis is almost always made via MRI with a contrast agent. The meningioma image is usually typical and it is possible to diagnose. Of course, a definitive diagnosis is made only after the biopsy.

 

Treatments

Conservative treatment

Simple follow-up when the findings are random, very small, in very elderly people, or people who do not refuse surgery. In this case, repeat MRI scans are required at regular intervals. The appearance of symptoms is not excluded.

 

Radiation therapy

There are various techniques, including conventional radiation therapy, stereotactic radiation therapy (γ-knife, cyber-knife). Stereotactic radiation therapy treats tumors up to 3 cm and aims to prevent the growth of the tumor, and sometimes even shrink it. It is sometimes used to treat a part of the tumor that could not be surgically removed due to its location or due to high surgical risk causing neurological side effects.

 

Surgical removal

This is the most effective treatment. The surgical risk depends on the location; however, it is usually possible to completely and relatively safely remove the tumor. After the operation, regular follow-up is required (initially every year, then less frequently), to exclude the possibility of recurrence.

 

Prognosis of meningiomas

Most are benign and can be cured with proper treatment. Very rarely, they can cause a metastasis to other organs. If they are malignant then they are more aggressive and have more frequent recurrence. In certain cases they can be multiple or part of syndromes that are associated with other tumors, such as neurofibromatosis.

 

Tumors of the pituitary gland

These tumors are located in an anatomical area at the base of the brain; they include many different types of tumors, the most common of which is pituitary adenoma (~ 10% of brain tumors). This is usually diagnosed by the hormonal or vision disorders it causes. They are benign, but often difficult to remove completely. They are related to, and cause diseases such as Cushing’s syndrome, amenorrhea, galactorrhea, sexual desire disorders, acromegaly, and others. Some of these syndromes (such as prolactinoma) can only be treated with medication with satisfactory results. Other tumors in the area are craniopharyngiomas, Rathke pouch cysts, meningiomas, etc.

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