A brain tumor is a space-occupying lesion within the skull that affects adults and children. The cells that make up the mass tend, by compressing or infiltrating the cerebral parenchyma, to alter the different functions of the brain, depending on the type, stage, size, and location of the tumor.
To understand what a brain tumor is, it is necessary to make an assessment based on different criteria (location, degree, size, constitutive cells).
Depending on the place of origin, there are two broad categories –
- Primary brain tumors
- Secondary brain tumors, also known as metastatic (tumor of another organ with metastasis to the brain)
A primary brain tumor is that which is born and develops directly from the cerebral nervous tissue, from the cranial nerves, from the cerebral vessels, from the glands and meninges.
This category, therefore, includes the types of brain tumors that arise directly from the brain parenchyma, the meninges, the cranial nerves, and other intracranial structures.
They can be –
- Benign brain tumor
- Malignant brain tumor
Secondary tumor with brain metastases originates from neoplasms arising in other organs of the body, which spread secondarily to the nervous tissue and then to the brain, through blood circulation. The tumors that most frequently give brain metastases are those of the breast, the melanomas, and cancers of the lung.
Brain tumor symptoms
The symptoms of a brain tumor depend on the type and degree of the lesion, the size, and location of the mass. Usually, they occur with headache (which tends to worsen in the morning and with the performance of activities), epileptic seizures, dizziness, difficulty in walking and in language, visual problems and loss of strength of a limb on one side of the body.
- The brain MRI with contrast is the most crucial radiological examination for the determination of different types of brain tumor. It allows the direct visualization of the tumor, its compressive effects on the cerebral parenchyma, the dilation of the ventricular system and the involvement of the most critical endocranial vessels. In many cases it allows to understand with absolute precision the histological type of the neoplasm and to which of the four degrees the brain tumor is attributable, consequently providing useful information for the surgical strategy to be adopted.
- Functional MRI – exploited to detect the activation of various cortical areas simultaneously with the execution of certain actions. This exam allows the neurosurgeon to understand how close the tumor is to important areas.
- MRI with spectroscopy is an essential investigation to evaluate acetylcholine and N-acetylaspartate in the tumor for the grading of malignancy.
- Magnetic resonance angiography is particularly useful in the case of vascular tumors such as angiomas or hemangioblastomas
Surgery is the treatment of choice for brain tumor
Surgery makes it possible to clearly define the diagnosis, remove the mass and reduce the increase in intracranial pressure caused by a brain tumor (among the initial symptoms, certainly one of the most relevant), all significantly improve the quality of life of the patient.
Brain neurosurgery interventions consist of craniotomy (usually under general anesthesia), that is, opening the skull and removing the lesion, but it is not always possible to altogether eliminate the mass and, sometimes, surgery cannot be proposed.
Surgery is not proposed for patients with a brain tumor located in a site that involves functionally fundamental structures for life or when the spread of the cancer is too advanced having involved more cerebral lobes, or when the patient’s general and neurological conditions do not allow surgical maneuvers.
Today, the types of brain tumors located in critical areas can be removed, thanks to the development of a technique that is called awake surgery. These are innovative brain neurosurgery interventions that allow awake patients to operate and consequently allow active monitoring of movement and speech functions, to preserve them and allow maximum tumor removal.
The cost of brain tumor surgery varies depending upon the location, type, and degree of the affliction. The usual cost of craniotomy is between INR 3 and 5 lakhs that is USD 4,200 and 7,000. The cost of microsurgery that is minimally invasive is up to INR 10 lakhs or USD 14,000. The therapy may include chemotherapy and radiotherapy which is separate and varies depending on the number of cycles required. There are several centers of advanced neurosurgery in India from AIIMS at Delhi to Medanta Hospital at Gurgaon.