Surgery
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For the vast majority of brain tumours, neurosurgical removal using microsurgical techniques is the procedure of choice whenever feasible.  This includes all benign tumours, as well as Grade I tumours. 

If a tumour is infiltrative it cannot be totally removed by surgery.  This is so because, amongst other things, there is no clear boundary between normal and pathological tissue, and there will always be tumour cells beyond what can be seen through the operative microscopically visualised. However, a lot depends on access for removal, as well as the location of the tumour.

For tumours with higher grades of malignancy (Grade III and IV), except in a very few cases, operative treatment followed by either radiotherapy and/or chemotherapy is the procedure of choice. The treatment of Grade II tumours is disputed, and different authorities are proponents of different strategies.

The goal of surgery, besides to obtain a diagnosis, is clinically useful in reducing symptoms due to the mass effect for compression and the use of steroids and to increase the survival. It is always better to try to remove as much as tumour as possible, but sometimes only a partial removal can be performed.

Some tumours, at the time of first presentation and diagnosis, are already characterised either by extensive infiltration, or by multiple locations.  In such cases, a stereotactic biopsy may be indicated to ascertain the histological nature of the tumour prior to commencement of the therapy regimens.  In other cases, small wafers may be implanted within the tumour mass for local delivery of chemotherapy.

There are some scanners linked to operating theatres to enable the surgeon to be more accurate. This is available in select clinics worldwide, including the International Neuroscience Institute Hannover.

Should the tumour be located in what is often termed as an “eloquent” area (implying an area of the brain which is known to be responsible for an important function), special scans known as neuronavigation scans may have to performed. These are based either on magnetic resonance imaging with or without fibre tracking, functional magnetic resonance imaging, computerised tomography, or in various combinations together.

In certain cases, an intra-operative magnetic resonance imaging scanner may be used. This is still a relatively new tool, and not widely available yet.

Following treatment, whatever the regimen used, control magnetic resonance imaging scans are usually recommended at regular intervals ranging from three to six months depending on the individual case both to keep track of possible recurrences, as well as to control the effectiveness of continuing chemotherapy or radiotherapy.

With the exception of benign brain tumours and Grade I gliomas, intervention is aimed mostly at maximising life expectancy with minimal compromise on quality of life.  To date, despite the impressive arsenal of therapeutic strategies available at our disposal, “cure” per se for gliomas cannot yet be achieved.   To this end active and promising research in the field of immunology and genetics is being carried out in many centres across the globe.

last changed 27/05/2011.

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