Brain Tumors Treatment
In this article, we have covered the following:
- Best Hospitals for Treatment of Brain Tumors
- Top Neuro Surgeons for Treatment of Brain Tumors
- Cost of Brain Tumor procedures
- Understanding Brain Tumors
- Variants of Brain Tumors & their treatment:Astrocytoma, Brainstem tumors (glioma’s), Craniopharyngiomas, Ependymomas, Glioblastoma multiformae, Meningioma , Pituitary tumors, Spine cord tumors
Best Doctors and Hospitals for Treatment of Brain Tumors
Following is a list of the most reputed specialists in India for the treatment of Brain Tumors.
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Cost of Brain Tumor procedures
Unfortunately, we are not able to share the cost of brain tumor treatment as we are still awaiting response from few hospitals before publishing the cost (considering the complexity of procedures). However, you may share your medical reports and we will share the cost of treatment from the hospital recommended for you.
Understanding Brain Tumors
Brain Tumors are abnormal cell formations within the brain. They may be malignant (cancerous) or benign tumors.
Key Facts about Brain Tumors
- Brain tumors may originate from neural elements within the brain, insidious onset.
- 95% of all brain tumors are Gliomas, metastases, meningiomas, pituitary adenomas, and acoustic neuromas.
- Metastatic tumors to the brain are more common. Pituitary adenomas are common exceptionally, but are incidental findings.
- In children, Brain tumors are considered second most common cancer(most prevalent solid tumor)
- Meningiomas and pituitary adenomas are more common in females as compared to males.
- Male: female ratio in brain cancer is 1.5:1
- Low-grade gliomas like astrocytomas, are more prevalant in younger people.
- High-grade gliomas (anaplastic astrocytoma and glioblastoma multiforme)originate in the fourth or fifth decade
- Headache (associated with nausea/vomiting; early morning headache)
- Altered mental status
- Gait disturbance
- Focal seizures
- Fixed visual changes
- Speech defects
- Focal sensory abnormalities
Diagnosis of Brain Tumors
- Focal or generalized deficit based on location of tumour
- Papilledema (swelling of optic disc due to increased intracranial pressure)
- Diplopia(double vision)
- Partial visual field deficits
- Anosmia-loss of the sense of smell
- Ataxia(lack of muscle coordination affecting speech, eye movements, the ability to swallow, walking, and other voluntary movements), incoordination, nystagmus/dancing eyes(involuntary eye movement) , and sensory deficits
- Complete blood cell count (CBC)
- Coagulation profile
- Electrolyte levels
- Skull x-ray
- CT scan
- MRI scan of brain
- Management varies greatly depending on tumor location, tissue type, and other co-morbid conditions
- Surgical treatment options may include tumor removal or debulking, putting ventricular shunt
Types of Brain/Spine Tumors & their Management
Symptoms are same as those of brain tumour.
They are central nervous system (CNS) tumors. Regional effects of astrocytomas include compression, invasion, and destruction of brain
A slight male predominance.
- Complete blood cell count (CBC)
- Prothrombin time (PT)
- Activated partial thromboplastin time (aPTT)
- Computed tomography (CT) and magnetic resonance imaging (MRI), with and without contrast, are helpful in the diagnosis
- MRI is considered the standard criteria, but a CT scan may be useful in the acute setting or when MRI is contraindicated
- Angiography may be used to rule out vascular malformations and to evaluate tumor blood supply
- Electroencephalography (EEG)
- Radionuclide scans like positron emission tomography (PET), single-photon emission tomography (SPECT)
- Electrocardiogram (ECG) and chest x ray are indicated to evaluate operative risk
Surgical intervention and the use of chemotherapy along with radiation therapy
Treatment of low-grade astrocytomas remains more controversial. The role of maximal surgical resection, timing of radiotherapy along with appropriate agents of chemotherapy are not clear.
Anticonvulsant therapy is given to patients suffering from astrocytoma or patients having history of seizures
Total resection of astrocytoma is often impossible because the tumors often invade into adjacent parts of the brain
Brainstem tumors (glioma’s)
10-20% of all central nervous system (CNS) tumors in the pediatric population.
Treatment of brainstem gliomas may comprise the following:
- Focal radiotherapy
- Surgical resection
- They have a tendency to invade surrounding structures and can recur after total resection
- Usually presents as a single large cyst or multiple cysts
- Clinical behavior and the choice of surgical approach are dictated by the primary location of the tumor and its extension pattern
- Recurrences mainly occur at the primary site
- Approximate 5-10% of all childhood tumors
- Higher frequencies reported from Africa, the Far East, and Japan
- Excellent survival rates for patients younger than 20 years. Survival rate poor for those older than 65 years
- The time interval between the onset of symptoms and diagnosis usually ranges from 1-2 years
- Most common symptoms are headache, visual disturbance & endocrine dysfunction
CT scan (most sensitive) and magnetic resonance imaging (MRI), MR angiography (MRA), complete endocrinologic and neuro-ophthalmologic evaluation
Two main management options are attempt at total resection and planned limited surgery followed by radiotherapy.
Craniopharyngiomas have a high recurrence, mostly in the first 3 years post surgery
Ependymomas are Brain tumors that arise from ependymal cells within CNS. They are generally present in young children with a mean age of diagnosis at 4 years.
Medical management of ependymomas includes the following:
- Adjuvant therapy (conventional radiation therapy, radiosurgery, chemotherapy)
- Steroids for treatment of peritumoral edema
- Anticonvulsants should be given in patients with supratentorial ependymoma
The extent of tumor resection is the most important prognostic factor associated with long-term survival for patients
Most common and most malignant of the brain tumors.
Short duration clinical history.
Symptoms of Glioblastoma
- Slowly progressive neurologic deficit
- Generalized symptoms of increased brain pressure, including headaches, nausea and vomiting
Diagnosis of Gliobastoma
Imaging studies of the brain are essential for making the diagnosis, such as:
- CT scan
- Magnetic resonance imaging, with and without contrast
- Positron emission tomography
- Magnetic resonance spectroscopy
- Lumbar puncture (generally contraindicated but occasionally necessary for ruling out lymphoma)
No curative treatment is available.
Standard treatment consists of :
- Maximal safe surgical resection, radiotherapy and adjuvant chemotherapy
- Patients older than 70 years: Less aggressive therapy is considered.
Surgical options include gross total resection (better survival), subtotal resection, and biopsy.
Surgical goals in GBM are as follows:
- To establish a pathologic diagnosis
- To relieve any mass effect
- If possible, to achieve a gross total resection to facilitate adjuvant therapy
Mean survival is inversely correlated with age
Without therapy, patients die within 3 months.
- Meningiomas commonly are found at the surface of the brain Or within the spinal canal
- Frequency of meningiomas in Africa is nearly 30% of all primary brain tumors
- Meningiomas usually grow slowly, and they may produce severe morbidity before leading to death
- Affect females more often than males
- Imaging studies(CT Scan,MRI,MR ANGIOGRAPHY,MR VENOGRAPHY) are the mainstay of diagnosis
- Surgery is the only treatment modality which can help the patient if it’s totally resectable tumor. Stereotactic radio surgery provides excellent local tumor control with minimal toxicity.
- Pituitary tumors are common & mostly benign
- On the basis of size pituitary tumors can be divided into micro adenomas (< 1 cm diameter) and macro adenomas (>1 cm diameter)
- Clinical effects are due to hormone over production or hormone deficiency
- Incidence between 10% to 15% of all brain tumors
- Mortality is low due to advance treatment modalities
- Most pituitary tumors occur in young adults, but they may be seen in adolescents and elderly persons
- MRI of the brain and sellar region with multiplanar thin sections is of critical importance.CT scan is also helpful.
- Medical management is by hormonal therapy
- Surgery -Besides the transsphenoidal/translabial approach, an endoscopic transnasal approach has become an additional an increasingly favored option with a wider surgical field
Spine cord tumours
- Disease that involves the spine with spinal cord compression may be dangerous
- Besides metastasis; most primary intramedullary spinal cord tumors are astrocytomas or ependymomas
- Intradural extramedullary tumors include schwannomas, neurofibromas, and meningiomas
- Male predominance exists for primary spinal cord tumors
- MRI of the affected area is the procedure of choice
- In case of metastatic spinal cord compression radiotherapy treatment is done along with chemotherapy or steroid therapy.
Note (for foreign patients):
Besides South Asian countries (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, Pakistan, Sri Lanka), every year, India gets thousands of medical tourists from African countries- Nigeria, Kenya, Ethiopia, Sudan, Uganda, Ghana, Somalia,Gambia etc and Middle Eastern countries like Iraq, Iran, Saudi Arabia, Oman, UAE, Yemen etc. Hence, if you are a citizen of any of these countries, there is good likelihood that you will be meeting some fellow citizens or same language speakers in the major hospitals in India. Almost all the top hospitals have translators for people of these region. Our patient support team is also well placed to assist you.