The term brain tumor is a collective term for all benign and malignant tumors within the brain skull (intracranial tumors).
The basic treatment options for a brain tumor are
or a combination of these options. Surgical removal of the tumor is usually the preferred option.
In the narrower sense, brain tumors are all tumors of the neuroectodermal tissue. These are tumors that originate, for example
tissue. These neuroepithelial tumors include, for example
In a broader sense, meningeal tumors are also brain tumors. These develop, for example, in the meninges(meningiomas) or fatty tissue cells (lipomas).
Brain tumors also include brain metastases that can be traced back to a primary tumor outside the brain. For example, cells from a breast tumor can enter the brain via the bloodstream and settle there. This is known as a brain metastasis or secondary tumor.
In adults, brain tumors account for a relatively small proportion compared to other types of cancer such as breast cancer, bowel cancer and others. In children, however, they are one of the more common types of tumor.
The most common brain tumors are meningiomas and gliomas.
The reasons why a brain tumor develops are not yet fully understood.
Certain genetic defects (e.g. hereditary neurofibromatosis) are associated with a higher incidence of brain tumors. Researchers therefore also assume a genetic predisposition to the development of brain tumors.
Exposure to carcinogenic substances also increases the risk of brain tumors. These include, for example, some pesticides, but also radiation therapy.
The first symptom of a brain tumor is usually a headache. Lying down increases the volume of blood in the head, which leads to an increase in pressure in the brain at night. This leads to nocturnal headaches.
These improve during the day, but are often accompanied by nausea and vomiting. Within a short time, the headaches caused by the brain tumor increase in frequency.
The other symptoms also depend on the area of the brain where the tumor is located. Depending on which nerves it is pressing on and which areas it is growing into, other, more or less typical symptoms will appear. These often include
If the brain tumor grows larger, consciousness disorders and personality changes also develop.
Some symptoms indicate which area of the brain is affected by the brain tumor. For example, if paralysis occurs in the right leg, this is a sign that the tumor is located in the left hemisphere of the brain. Certain symptoms of paralysis can also indicate the location of the brain tumor in the brain.
The diagnosis begins with a medical history and a physical examination. If a brain tumor is suspected, imaging procedures are of crucial importance. In particular
should be mentioned here. This enables doctors to determine the exact location and extent of the brain tumor.
Depending on the findings and symptoms, further diagnostic measures may be necessary in order to obtain more precise findings. These include, for example
Occasionally, the back of the eye is also examined (ophthalmoscopy).
An MRI creates layered images of the brain so that a tumor can be easily detected © Chinnapong | AdobeStock
The basic treatment options for brain tumors are
possible. The ideal treatment depends, among other things, on the type of tumor, its location in the brain and its size.
If the size and location of the brain tumor allow, the aim is to remove it completely.
If functionally important areas of the brain are already affected, there may be an increased risk of neurological deficits when the tumor is removed, such as
In these cases, only part of the brain tumor is often removed. This is followed by chemotherapy and/or radiotherapy to further combat the residual tumor.
The primary objectives of brain tumor surgery are
It is crucial that the patient is not endangered by the operation and that no healthy brain tissue is destroyed.
In the case of benign brain tumors, surgical removal of the tumor is usually sufficient. Malignant tumors are often followed by radiotherapy and/or chemotherapy.
There is an indication for brain tumor surgery (i.e. brain tumor surgery should be performed) if
In addition to removing the tumor, the main aims of brain tumor surgery are to
Brain tumor surgery is usually performed under general anesthesia. If the brain tumor is located very close to the speech center or other important functional centers, the procedure is usually performed as an awake operation (awake craniotomy).
The patient is awakened from anesthesia for a short time after the skull has been opened. The doctors use various tests to determine how much tumor tissue can be removed without causing any symptoms of loss of consciousness.
By having the patient read, speak or name objects during the operation, for example, serious speech disorders can be avoided.
The risks of brain tumor surgery depend mainly on the size of the tumor and its location in the brain. The involvement of brain vessels, the age and the general condition of the patient also play a role.
If the brain tumors are still small and located in favorable areas of the brain, the risk of brain tumor surgery is very low. With very large tumors, however, the risk increases significantly. Modern procedures have significantly reduced the risk of brain tumor surgery. These include, for example
Nevertheless, individual consultation with the patient is very important in the run-up to brain tumor surgery.
During brain tumor surgery, complications can occur that temporarily or permanently impair the ability to drive. For this reason, driving is prohibited until the doctor determines that it is safe to drive.
Other possible complications include
Intraoperative neuronavigation is a computer-assisted surgical procedure used in neurosurgery. It can be used to plan brain tumor operations and enables intraoperative spatial orientation.
This requires three-dimensional image data of the brain. These are acquired during the operation using
and displayed as a 3D image. The position of the surgical instruments is combined with the 3D images and also displayed. This means that the neurosurgeon knows exactly where he is in the brain during the operation without any time delay.
If necessary, a CT scan can be performed during the brain tumor operation and the image data can then be updated.
In preparation for the operation, the brain structures can be studied in detail so that the surgeon can choose the ideal access route to the brain tumor. The surgeon also gets an idea of the blood supply in the surgical area and identifies functionally important areas of the brain.
The planning of the brain tumor operation and the enormous precision during the procedure mean that
With the help of intraoperative neuromonitoring, important neurofunctions can be monitored electrophysiologically during the operation. This allows damage to nerve tissue to be detected in good time and functionally important areas to be localized before the brain tumour operation.
Intraoperative monitoring provides the neurosurgeon with continuous information about the function of the brain area he is currently operating on. This ensures that important brain structures are spared as much as possible.
Removal of the brain tumor using open brain tumor surgery is not always possible in the following cases:
However, the tumor type must be known in order to determine an effective therapy (chemotherapy, radiotherapy).
The tumor sample for histological examination is taken stereotactically and under computer control. This is a minimally invasive neurosurgical procedure.
The patient's head and the medical instruments are fixed in a firmly screwed frame. Stereotactic tissue removal is often combined with real-time imaging using neuronavigation. This enables precise, largely injury-free movement within the brain and the tissue sample can be removed safely.
Open surgery involves opening the skull and then removing the tumor as completely as possible.
Brain tumor surgery is usually performed under general anesthesia or as an awake operation. For this, the head is fixed in a three-point head clamp and the skin is cut open in a straight or curved shape. Part of the bone flap is then sawn out and the hard meninges are opened.
With the help of neuronavigation and under microsurgical conditions, the surgeon guides the instruments to the tumor and removes it. Occasionally, ultrasonic suction devices are also used, especially for larger tumors.
Fluorescence-assisted resection makes it easier to see the tumor. The patient ingests a substance in advance that accumulates in the tumor and is made visible using blue light.
During the operation, the surgeon removes as much of the tumor mass as possible. He takes care not to damage neighboring functional areas.
Surgeons perform brain tumor surgery © romaset | AdobeStock
Brain tumor surgery can take place in the vicinity of functional centers, nerve pathways and cranial nerves, e.g. areas for
control. Neurophysiological monitoring is then carried out intraoperatively by monitoring their function during the operation.
After the tumor has been removed, the bleeding is stopped and, if necessary, the result is checked intraoperatively using CT or MRI. The surgeon closes the hard meninges and the wound. After the brain tumor operation, the patient wakes up in the neurosurgical monitoring ward.
To determine the outcome of the brain tumor surgery, a CT or MRI scan is performed one or two days after the brain tumor surgery. If there are no complications and with physiotherapeutic support, the patient can leave the clinic after around 7 to 10 days. If necessary, the patient will receive further treatment at their home hospital or in a rehabilitation clinic.
The prognosis for a brain tumor depends on numerous factors, including
It can therefore vary greatly from patient to patient. A recurrence of the tumor (relapse) also has an unfavorable effect on the long-term prognosis.
A benign and slow-growing brain tumor that is easy to remove and does not recur has a favourable prognosis. In contrast, brain metastases worsen the prognosis of the primary tumor.
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