A primary brain tumour begins somewhere in your brain while a secondary (or metastatic) brain tumour originates from other parts of your body and spreads to your brain.
There are more than 125 different types of the brain tumours. Primary brain tumours are generally referred to by their grades:
- Low grade tumours are slow growing and less likely to spread to other parts of the brain, and have a lesser chance of recurring with the appropriate treatment.
- High grade tumours are fast growing and more likely to spread to other parts of the brain, and more likely to recur even if treated intensively.
Some tumours may contain a mixture of cells from different grades, and low grade tumours can progress to become high grade over time. A tumour of any grade can be serious if it expands into surrounding healthy brain tissues, or disrupts the normal flow of the fluid in the brain.
Symptoms often relate to the function that is responsible by the area of the brain where it developed. For instance, a tumour pressing on the optic pathway will cause visual impairment, while one that has invaded the corticospinal tracts that controls movement will lead to weakness in the hand, leg or both.
Other possible symptoms include seizures, headaches, speech problems, imbalance or difficulty walking, confusion in everyday matters, or trouble with memory.
Do note that symptoms of a brain tumour often resemble those caused by other conditions. If you experience these symptoms and have concerns, consult a specialist to get it checked.
Accurate diagnosis is critical to make an informed decision about the appropriate treatment plan.
- An magnetic resonance imaging (MRI) is commonly used to provide the neurosurgeon with valuable insights on the tumour characteristics such as size, location and possibly, grade.
- A comprehensive evaluation, inclusive of medical history and neurological examination, can provide clues to the parts of your brain that could be affected by the tumour.
Understanding the diagnosis
- Being diagnosed with a brain tumour is scary and devastating.
- You will be given lots of information, possibly by a few people, about the various treatment options. This can be confusing and difficult to comprehend within a short space of time.
- It is important to consult a brain tumour specialist who can give you the appropriate advice and provide care that can be tailored to your needs.
- The first-line treatment of brain tumour is often surgery. The goal of surgery is to remove as much tumour as possible with minimum damage to surrounding normal brain tissue. Surgery also provides the opportunity to take a sample of the brain tissue (“biopsy”) for further molecular and genetic tests. These tests will reveal valuable information for a more accurate diagnosis on the type of tumour and predict the patient’s response to certain treatments (such as chemotherapy and radiation).
- Sometimes, surgery may not be possible (or required right away), biopsies can be obtained using a needle (stereotactic biopsy).
- Other treatments, such as radiotherapy and chemotherapy may be considered, on their own or as additional therapies after surgery.
Development in the field of neurosurgery has made it possible for neurosurgeons to visualise exactly where the tumour is and safely access tumours with lesser risks of serious complications. You should discuss the different available surgical options and treatment plan with your neurosurgeon.
Additional surgical tools that can improve surgery outcomes:
Surgical planning with computer guided navigation
Dedicated software and hardware are used by the neurosurgeon to plan the surgical trajectory and implement it with accuracy in the operating theatre.
Awake surgery with intraoperative brain mapping and neuromonitoring
During parts of the procedure, electrical brain stimulation will be used to map out the areas of the brain critical for speech and movement. You will be awakened and asked to speak or perform certain movements. The functional map generated from the real-time testing and feedback will help identify “no-go zones” for the neurosurgeon and guide tumour removal.
Minimally invasive parafascicular surgery (MIPS)
MIPS employs minimally disruptive tools to gain a safe passage to hard-to-reach tumours. By using the brain’s natural folds to reach the tumour, we will be able to minimise cutting through and damaging normal brain tissue.
Enhanced visualization with microscope & fluorescence
Fluorescence is a special dye that helps to demarcate tumour margins when viewed through special filters under the neurosurgeon's operating microscope. Using such dyes can greatly facilitate tumour removal.
- Primary brain tumour can occur in any part of the brain
- Whenever possible safe maximal surgical resection is the goal
- Having additional surgical tools can help improve outcome