Brain Tumors

A brain tumor is an abnormal mass or growth of cells that grows and multiplies uncontrollably in the brain. Brain tumors may be classified as primary or metastatic and as malignant or benign. Primary brain tumors originate from brain cells, the membranes around the brain (meninges), nerves, or glands in the brain, and may be categorized as glial or non-glial. Metastatic brain tumors originate elsewhere in the body, such as the liver or the lungs, and usually migrate to the brain through the bloodstream. These are considered malignant.

Symptoms generally vary depending on the location of the brain tumor, but the following are possible symptoms that may accompany different types of brain tumors:

Headaches, which may be more severe in the morning
Seizures or convulsions
Difficulty thinking, speaking, or articulating
Personality changes
Weakness or paralysis in one part or one side of the body
Loss of balance or dizziness
Vision changes
Hearing changes
Facial numbness or tingling
Nausea or vomiting
Confusion and disorientation

Diagnosis

A multitude of sophisticated imaging techniques exist to pinpoint brain tumors. Diagnostic tools include computed tomography (CT or CAT scan) and magnetic resonance imaging (MRI). Intra-operative MRI is also used during surgery to guide tissue biopsies and tumor removal. Magnetic resonance spectroscopy (MRS) is used to examine the tumorís chemical profile and determine the nature of the lesions seen on the MRI. Positron emission tomography (PET scan) can help detect recurring brain tumors.

Sometimes, the only way to make a definitive diagnosis of a brain tumor is through a biopsy. The neurosurgeon performs the biopsy and the pathologist makes the final diagnosis, determining whether the tumor appears benign or malignant, and grading it accordingly. It is not known for certain what causes brain tumors, but there are many possible contributing risks.

Brain tumor treatment

Brain tumors are usually treated with surgery, radiation therapy (including Gamma Knife, CyberKnife, and other stereotactic radiosurgery), and chemotherapy, in various combinations. Dr. Berti will decided which treatment is best each patient on a case-by-case basis, depending on a number of factors including the type, size, and location of the tumor, the patientís age and state of health, and comorbidities, to name a few. Itís important to note that there are risks and side effects associated with each type of therapy.

It is generally accepted that complete or nearly complete surgical removal of a brain tumor is beneficial for a patient. The neurosurgeonís challenge is to remove as much tumor as possible Ė without injuring brain tissue important to the patientís neurological function (such as the ability to speak, walk, etc.). Traditionally, neurosurgeons open the skull through a craniotomy, to insure that they can fully access the tumor and remove as much of it as possible.

Dr. Berti may perform a stereotactic biopsy before performing a craniotomy. This is a minimally-invasive operation used to obtain tissue so that an accurate diagnosis can be made. A frame is attached to the patientís head, a scan is obtained, and then the patient is taken to the operating area where a small hole is drilled in the skull to allow access to the abnormal area. A small sample of the tissue is obtained for examination under the microscope.

Stereotactic Radiosurgery (such as Gamma Knife and CyberKnife) is a technique that focuses the radiation with many different beams on the target tissue. This treatment tends to incur less damage to tissues adjacent to the tumor. Currently, there is no data to suggest one delivery system is superior to another in terms of clinical outcome, and each has its advantages and disadvantages.

The following are types of brain tumors Dr. Berti operates:

Chordomas: A chordoma is a rare malignant tumor that arises from notochord remnants. Chordomas account for 1 to 4% of all bone tumors. They occur in older adults, usually between fifty and seventy years old.

Symptoms: The symptoms depend on the location of the tumor. For example, sacrococcygeal tumors present as lower back pain, or tumors in the cervical spine can present as pain at the base of the skull. The bone surrounding the tumor is gradually and completely destroyed.

Treatment: Treatment of chordomas can be difficult due to the location of the tumor. Complete resection of the tumor and subsequent radiation therapy are recommended.

Surgery
Stereotactic Radiosurgery


Craniopharyngiomas: Craniopharyngiomas are benign brain tumors that occur near the pituitary gland and pituitary stalk. They are typically both cystic and solid in structure, and can occur early in childhood and adolescence, or later in life. Theyíre usually not discovered until they compress nearby important structures. They are benign tumors, but they tend to adhere to structures around the pituitary gland and stalk, including the optic nerves, optic chiasm, intracranial arteries, and the brain itself.

Symptoms: While not malignant, craniopharyngiomas can cause a variety of problematic symptoms depending on their location. One of these tumors can cause partial or complete pituitary hormone deficiency if the tumor compresses the pituitary stalk or gland, which may lead to stunted growth, delayed puberty, loss of normal menstrual function or sexual desire, increased sensitivity to cold, fatigue, constipation, dry skin, nausea, low blood pressure, and depression.

The compression of the pituitary stalk can also cause diabetes insipidus, a condition where the kidneys cannot conserve water, and can increase prolactin levels, causing a milky discharge from the breast (galactohhrea). A person can experience loss of vision if the tumor compresses the optic chiasm or nerves. If the tumor encroaches on the hypothalamus, an area at the base of the brain that controls body temperature, hunger, and thirst, may result in obesity, increased drowsiness and temperature regulation abnormalities. Other, rarer symptoms may include personality changes, headache, confusion, and vomiting.

Treatment: Surgical resection

Glomus jugulare: Glomus jugulare tumors may occur in the temporal bone in the skull, in an area called the jugular foramen, or the glomus bodies located within the ear. They are the most common tumors of the middle ear, and can affect the ear, upper neck, base of the skull, and the surrounding blood vessels and nerves. These tumors are slow-growing and involve the surrounding blood vessels, and are most common in women.

Symptoms: Symptoms include hearing loss with pulsing ringing in the ear, dizziness, weakness or loss of movement in the face, ear pain and difficulty swallowing. Physical exams will find hearing loss and abnormalities of the cranial nerves that control swallowing, gagging, shoulder shrugging and tongue movements. A red/blue pulsing mass can often be seen upon examining the eardrum.

Treatment: Glomus jugulare tumors are rarely cancerous and do not tend to spread to other parts of the body. However, treatment may be needed to relieve symptoms. The main treatment is surgery. Surgery is complex and is usually done by both a neurosurgeon and a head and neck surgeon (neurotologist). In some cases, a procedure called embolization is performed before surgery to prevent the tumor from bleeding too much during surgery. After surgery, radiation therapy may be used to treat any part of the tumor that could not be removed completely.

Surgery
Stereotactic Radiosurgery

Meningiomas: A meningioma is a tumor that grows from the meninges, layers of tissue that cover your brain and spinal cord. Meningiomas are graded from low to high; the lower the grade, the lower the risk of recurrence and aggressive growth. The majority of meningioma cases are noncancerous (benign), although a meningioma can be cancerous (malignant) in rare cases.

Meningiomas typically arise in adulthood and are more common in women, but they can occur at any time. The causes of meningiomas arenít clear, but a few predisposing factors, such as genetics, trauma, and exposure to radiation (for example, the survivors of Hiroshima have an increased incidence of these tumors).

Symptoms: Include changes in vision, such as seeing double or blurriness, headaches that worsen with time, hearing loss, memory loss, behavioral and cognitive changes, seizures, and weakness in the arms or legs.

Treatment:

Surgery is the standard treatment. If the surgeon cannot completely remove the tumor, he or she may recommend radiation therapy.
Stereotactic Radiosurgery


Pineocytomas: A pineocytoma, also known as a pinealocytoma or pinealoma, is a rare, slowly-growing, benign tumor of the pineal gland of the brain. This brain tumor arises from the cells of the pineal itself. Since pinealocytoma is rare, other types of tumors are more common in the pineal region, such as a pineal germinoma or even a glioma. There is usually no known cause for pineal tumors.

Most pineocytomas are considered low-grade or benign tumors. However, tumors of the pineal gland itself can very in aggressiveness with high-grade or malignant variants also occurring. These high-grade variants are termed pineoblastomas and display much more primitive or undifferentiated pathology.

Symptoms: For this reason, as a pineal tumor, such as a pineocytoma, enlarges it can compress the aqueduct and block the normal flow of cerebrospinal fluid. This can lead to a condition known as hydrocephalus which results in enlargement of the ventricles and increased pressure in the head. This can lead to symptoms such as headache, nausea, vomiting and finally neurological deterioration as it becomes more severe.

Other symptoms which can occur in some patients include a paralysis of upward gaze of the eyes (due to compression of part of the brain stem called the superior colliculi), disturbances of gait and precocious puberty in children.

Treatment:

Surgical Removal via craniotomy
Chemotherapy
Gamma Ray Therapy
CyberKnife Therapy

Pituitary Adenomas: Pituitary adenomas are typically benign, slow-growing tumors that arise from cells in the pituitary gland. They rarely spread to other parts of the body. Pituitary adenomas are relatively common in the population, occurring in 1 out of every 1000 people, typically in people in their 30s and 40s. Pituitary tumors may be hormone-producing (functioning) or hormone-inactive (non-functioning).

Symptoms: Functional adenomas will generally present with symptoms related to endocrine imbalance or dysfunction. For example, an overproduction of growth hormone will result in giantism. Non-functioning adenomas may present with symptoms related to the tumor encroaching on surrounding structures. A growing adenoma can compress important vascular and neurological brain structures. Some of these symptoms include visual loss (from the adenoma encroaching on the optic nerve), pituitary failure, headache, and pituitary apoplexy, a surgical emergency.

Treatment:

Microsurgery
Surgical resection
Radiation Therapy (Gamma Knife, CyberKnife)
Medication Therapy


Schwannomas: These tumors arise from schwann cells which form a protective sheath around the bodyís nerve fibers. Also known as vestibular schwannomas, neurilemmoma, or acoustic neuromas, these tumors may grow on one or both sides of the brain and are potentially curable with surgery or stereotactic radiosurgery. Theyíre typically benign and surgically removed when possible. They usually appear as a single tumor, only rarely developing into multiple tumors.
One of the more common forms of this tumor affects the eighth cranial nerve, which contains nerve cells important for balance and hearing. Hearing loss on the side where the tumor grows is a common symptom. Schwannomas can also appear on the roots of the nerves that come off of the spinal cord. Symptoms depend on which nerve is affected, and may include tinnitus or balance problems.

Treatment:

Surgical removal
Radiotherapy


Gliomas: The most common form of primary brain tumor is called a glioma. They arise from glial (or non-neuronal) cells, which provide support and protection for neurons. There are four types of gliomas: astrocytomas, ependymomas, oligodendrogliomas and mixed gliomas.

Astrocytomas are the most common glioma and can occur in most parts of the brain (and occasionally in the spinal cord). Types of astrocytomas include pilocytic astrocytoma (grade 1), low-grade astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma (grade IV). Glioblastoma multiforme is the most common and aggressive astrocytoma, and typically penetrates the surrounding area of the brain where it is located. This particular tumor affects adults, and is more common in males.

Symptoms of some astrocytomas may include seizures or convulsions, trouble speaking, headaches, difficulty thinking or speaking, loss of vision or vision changes, nausea or vomiting, and others. Surgery is the standard treatment, and may be used in combination with chemotherapy and radiation therapy, depending on the grade of the tumor.

Ependymomas begin in cells lining the brain ventricles which contain cerebrospinal fluid (CSF), a fluid that protects the brain and spinal cord. These tumors are rare and slow-growing, and can be found anywhere in the brain or spine, although in adults its location is typically spinal.

Symptoms of ependymomas in the brain vary depending on its location. Some symptoms include seizures and raised intracranial pressure, which will cause headaches, neck pain, vomiting, and irritability. Surgical removal is typically recommended for low-grade brain and spinal tumors. After surgery, any leftover tumor tissue in the brain is usually treated with radiation therapy.

Oligodendrogliomas begin in cells called oligodendrocytes, which support and nourish the cells that transmit nerve impulses. Oligodendrogliomas are normally found in the main part of the brain (cerebrum), and occur primarily in adults. Symptoms depend on where the tumor is located, but seizures, visual loss, and motor weakness are a few of the more common types. Treatment options include surgery, radiation and chemotherapy.

Mixed gliomas have more than one type of tumor cell, including astrocytes, ependymomas and oligodendrocytes. The most common site for a mixed glioma is the cerebrum, and are more common in men than women. Symptoms may include headache, speech or motor change, and seizures. Treatment recommendations are based on which of the cell types is most aggressive.

Treatment:
Treatment depends on the type of tumor being treated. Surgical removal is typically recommended for most low-grade brain and spinal tumors. After surgery, any left over tumor tissue in the brain is usually treated with radiation therapy.

Surgery
Chemotherapy
Radiation therapy

Medulloblastomas: A brain tumor usually located in the cerebellum or brain stem, this tumor can spread to the spinal cord through cerebrospinal fluid. It may obstruct the fourth ventricle, causing hydrocephalus. It is more common in children, but may occur in adults.

Symptoms: Include headaches, lethargy, early morning vomiting, lack of coordination, double vision, behavioral or personality changes, and signs of pressure seen behind the eye when examined with an ophthalmoscope.

Treatment:

Surgery
Chemotherapy
Radiation Therapy

 

 

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