Brain tumour treatment in India
Introduction to brain tumour
A brain tumour is defined as an abnormal growth of brain cells (neural or connective cells). They may be malignant (cancerous) or benign (non-cancerous). Suspicion of a brain tumour may first arise from headaches, abnormal behaviour or a variety of other symptoms. The symptoms would need to be investigated with a series of tests aimed at making a diagnosis. Generally, we are able to distinguish between the malignant or benign nature of the tumour on the basis of imaging.
Symptoms of brain tumour
The symptoms of brain tumours vary widely depending on the type and location of the tumour. However, some of the most common symptoms are headaches, associated with vomiting or nausea. These are often caused by increased intracranial pressure. Besides the increase in intracranial pressure, tumours encroach on and/or compress the surrounding brain tissue. This would be responsible for the additional symptoms noted by the patients.
- First headache complaint from patient over 50
- First migrane attack in patient over 40
- Headache from patient under 6
- Stiffness of the neck / nruological dysfunction
- Heache with signs of elevated ICP
- Focal neurological dysfunction
- Early morning vomiting or vomiting unrelated to headache or other illness
- Behavioural changes or rapid decline in school results
- Aura migraine always on one side
Symptoms associated with the main parts of the brain may include one or more of the following:
- Memory loss
- Impaired sense of smell
- Vision loss
- Behavioural, emotional and cognitive changes
- Impaired judgement
- Impaired speech
- Inability to write
- lack of recognition
- Vision loss in one or both eyes and seizures
- Impaired speech
- Some patients may not exhibit any symptoms
- Difficulty speaking and swallowing
- headache, especially in the morning
- Muscle weakness on one side of the face or body
- Vision loss, drooping eyelid or crossed eyes
- Increased intracranial pressure (ICP)
- Vomiting (usually occurs in the morning without nausea)
- Uncoordinated muscle movements
- Problems walking (ataxia)
Diagnosis of brain tumour
Neurological examination: This helps us establish the increased intracranial pressure, and the focal deficit would help us localise the probable site of the tumour.
Magnetic Resonance Imaging (MRI): MRI is perhaps the most valuable test used to diagnose brain tumours. MRI is useful for diagnosing brain tumours because it provides an accurate anatomical location of the tumour, including proximity to important areas (DTI and functional MRI) and probable pathology of the tumour (with the help of spectroscopy/perfusion studies).
Computed Tomography(CT): A CT scan may be an alternative, it is less expensive, is good enough to detect the location of the tumour, but has its limitation, as compared to an MRI study. However, it is advantageous in lesions with calcification or blood in the lesion. Thus, on occasions when any of this is suspected, we may need CT.
Benign or Malignant brain tumour?
Benign brain tumours:
These are often extra-axial in location. Surgery is the only treatment for benign tumours. Of course, at times, due to mere location of the tumour, the surgeon may not be able to excise the tumour completely, and then additional radiotherapy or radiosurgery may have to be considered as adjuvant therapy.
Malignant brain tumours
Malignant brain tumours can be slow or fast-growing and are usually life-threatening due to their ability to invade and destroy surrounding normal brain tissues.
There are two kinds of malignant brain tumours:
Primary brain tumours:
primary brain tumours originate from cells in the brain and there many types of these. The most common type of malignant primary brain tumour is glioblastoma multiforme (grade IV astrocytoma), which make up approximately 20% of all primary brain tumours.
Metastatic brain tumours:
Metastatic brain tumours are any cancers that have spread from other areas of the body to the brain. These tumours are the most common, occurring as much as four times more frequently than primary brain tumours. Cancers that commonly spread to the brain include breast and lung cancers.
The prognosis depends on the grade of the malignant tumour, generally, grade 1 or pilocytic tumours behave like a benign one, and the patient could be cured of the disease. However, they do need long term to follow up. The grade 2-4 lesions would generally recur. The tumour free period depends on the grade of the tumour, and also the response of the lesions to the radiation and chemotherapy. In the present era with immunohistology, tumour marker, modern radiotherapy techniques and newer, less toxic chemotherapy, the outlook of the disease has improved.
Treatment of brain tumour
Brain tumours are typically treated with surgery, radiation therapy, chemotherapy, or some of these three modalities.
Surgery: Surgery is the primary treatment for brain tumours that can be removed without causing severe damage. Many benign tumours are treated only by surgery but most malignant tumours requirer treatment in addition to the surgery, such as radiation therapy and/or chemotherapy.
The goals of surgical treatment for brain tumours are multiple and may include one or more of the following:
- Confirm diagnosis by obtaining tissue that is examined under a microscope
- Remove all or as much of tumour as possible
- Reduce symptoms and improve quality of life by relieving intracranial pressure caused by the tumour
- Provide access for implantation of internal chemotherapy or radiation
A stereotactic / navigation guided biopsy is used to access the tumour in deep-seated areas where is surgery is hazardous. This technique utilizes a computer and a three-dimensional scan to direct the placement of the needle.
Radiation in brain tumour:
Radiation therapy (RT) may be used alone or in combination with surgery and/or chemotherapy in the treatment of primary or metastatic brain tumours. External beam RTI is the conventional technique for administering radiation therapy for brain tumours.
The CyberKnife is a frameless robotic radiosurgery system used for treating benign tumours, malignant tumours and other medical conditions. The CyberKnife system is a method of delivering radiotherapy, with the intention of targetting treatment more accurately than standard radiotherapy. This system improves on other radiosurgery techniques by eliminating the need for stereotactic frames. As a result, the Cyberknife system enables doctors to achieve a high level of accuracy in a non-invasive manner and allows patients to be treated on an outpatient basis. The CyberKnife System can pinpoint a tumour’s exact location in real-time using X-ray images taken during the brain cancer treatment that reference the unique bony structures of a patient’s head. The CyberKnife System has a strong record of proven clinical effectiveness. It is used either on a stand-alone basis or in combination with other brain cancer treatments, such as chemotherapy, surgery or whole-brain radiotherapy.
Chemotherapy in brain tumour
Treating brain tumour with chemotherapy is more complicated than treating tumours elsewhere in the body because of a natural defence system called the blood-brain barrier that protects the brain from foreign substances. Furthermore, not all brain tumours are sensitive to or respond to chemotherapy, even if the drug dose penetrates the blood-brain barrier. Actively dividing cells are the most vulnerable to chemotherapy. Most tumour cells and some normal cells fall into that category.
Other supportive treatment options in brain tumour
Dexamethasome (Synthetic steroid)
Urea and mannitol (diuretic)
Analgesics or pain killers
To control cererbral edema or accumulation of fluid
To reduce brain swelling
To reduce pain
To reduce stress ulcers
To reduce seizures
Rehabilitation (to regain lost motor skills and muscle strength; speech, physical and occupational therapists may be involved in the healthcare team).
Continuous follow-up care (to manage the disease, detect recurrence of the tumour, and to manage late effects of treatment).
Latest drugs and therapies for brain tumour treatment
- Chemotherapy wafers in brain tumour treatment – Wafers containing a cancer-killing drug are inserted directly into the area of the brain tumour during surgery.
- Immunotherapy treatment in brain tumour treatment is under research and in future may change the way we treat brain tumours.
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BEST DOCTORS FOR BRAIN TUMOUR TREATMENT & SURGERY IN INDIA
Dr. Anil Kumar Kansal is Director & HOD Neurosurgery & Neuro spine surgery, BLK Super Specialty Hospital, New Delhi. His expertise includes complex Spine Surgery and Instrumentation, Minimal invasive Spine Surgery, Endoscopic Brain and Spinal Surgery, Microscopic and Vascular Surgery, Epilepsy Surgery and Functional Neurosurgery. He has done Advanced Spinal Training from Seoul St. Mary’s Hospital, South Korea, Training in Advance MIS (minimally invasive spine surgery) from Philadelphia, USA & Training in Advance Stereotactic & Functional Neurosurgery, Freiburg, Germany.
Dr. ANIL KUMAR KANSAL
Dr. Aditya Gupta is Chief – Neurosurgery & CNS Radiosurgery & Co-Chief – Cyberknife Centre at Artemis hospital, Gurugram, Delhi (NCR). Dr Aditya Gupta has not only developed excellent surgical techniques for a wide variety of brain tumors, with an emphasis on microsurgery and radiosurgery, but also has special and unique skills in managing patients of Movement Disorders with Deep Brain Stimulation (DBS), Surgery for Epilepsy, Nerve and Brachial Plexus Surgery, Brain aneurysms and AVMs.
Dr. ADITYA GUPTA
Dr. Prathap Kumar Pani is Consultant Neurosurgeon at BGS Gleneagles Global Hospital, Bangalore. He has 30 years of experience in Brain Tumor Surgery, Complex Spine Surgery, Cerebrovascular Surgery, Deep Brain Stimulation, Brain Suite and Epilepsy Surgery. He completed MBBS from SCB Medical College, Cuttack, Odisha in 1982, MS- Neuro Surgery from SCB Medical College, Cuttack, Odisha in 1985 and M.Ch- Neuro Surgery from SCB Medical College, Cuttack, Odisha in 1991.
DR. PRATHAP KUMAR PANI
Dr. Gulam Muqtada Khan is Consultant – Neurosurgery at Global Hospital, Mumbai. His areas of specialisation include Endoscopic Brain Surgeries (Endoscopic third ventriculostomy, Endoscopic colloid cyst excision, Endoscopic intraventricular tumor excision, Transnasal transsphenoidal excision of pituitary adenoma, Endoscopic repair of CSF leak, Endoscopic optic nerve decompression, Endoscopic evacuation of intracerebral hematoma), Endoscopic Spine Surgeries (Endoscopic laminectomy, Endoscopic lumbar canal decompression, Endoscopic microdiscectomy, Endoscopic posterior lumbar interbody fusion, Endoscopic transverse lumbar interbody fusion), Minimally Invasive Brain Surgery (Stereotactic biopsy, Stereotactic evacuation of intracerebral hematoma, Deep Brain stimulation), and Minimally Invasive Spine Surgery (Percutaneous Trans – pedicular screw and rod fixation, Medial branch block and radiofrequency ablation, Sympathetic block and radiofrequency ablation for cancer pain – stellate, celiac, splanchnic, lumbar, hypogastric, Vertebroplasty and kyphoplasty, Spinal cord stimulation, Intrathecal drug infusion pump for spasticity and cancer pain.
Dr. GHULAM MUQTADA KHAN
Dr. Nigel P Symss is Consultant – Neurosurgery at Global Health City, Chennai. Dr. Nigel P Symss provides a comprehensive Neurosurgical and Spinal service at the Gleneagles Global Health City, Chennai. He is an Indian trained and educated neurosurgeon with multiple international fellowships, and 15 years of experience in cranial and spinal surgery. He has worked as consultant neurosurgeon at prestigious neurosurgical centres in Chennai. He is expert in general neurosurgery, surgery of pituitary tumours, brain tumours, deep brain stimulation, spinal surgery, and never conditions. He specialised in transcallosal approach to colloid cysts and ventricular tumours in the brain and has many publications on colloid cysts. He has done extensive research on hydrocephalus, shunt systems, and is a member of“Hydrocephalus Research World Record Ranking Committee”. With a special interest currently in functional neurosurgery, he has completed a fellowship at the Flinders Medical Centre, Australia. He has performed close to 3500 neurosurgical procedures post-qualification, both cranial and spinal in adults and children successfully. He is an Indian trained and educated neurosurgeon with multiple fellowships.
Dr.NIGEL P SYMSS
Dr. Binod Kumar Singhania (Apollo, Kolkata) is a renowned name in the super-specialty field of Neuro & Spine Surgery, He is an M.B.B.S., M.S. (General Surgery), M.Ch. (Neurosurgery) & has also done his Fellowship in Spinal Surgery at Royal Adelaide Hospital, Adelaide, Australia. Trained in the Department of Neurosurgery, School of Medicine, Louisiana State University, New Orleans, USA. Neurovascular Training at Royal North Shore Hospital, Sydney, Australia.
At present, he is working as Senior Consultant Neuro & Spinal Surgeon, Department of Neurosurgery, Apollo Gleneagles Hospitals. He is a senior most consultant neurosurgeon & spinal surgeon at Apollo Gleneagles Hospitals, Kolkata. He is doing all complex spine works including C1-C2 transpedicular screws.
He is trained in minimally invasive surgery including microscope and endoscopic. He is doing disc replacement, endoscopic excision of pituitary tumor and 3rd ventriculostomy for hydrocephalus & also all types of brain tumors, aneurysm clippings, and AVM surgeries. He is a well-known personality in the field of Neuro & Spine Surgery.
DR. BINOD KUMAR SINGHANIA
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