A brain tumour is a mass inside the brain, originated from the abnormal and uncontrollable growth of the cells, either from brain components as such, or from tumoral cells placed in other body parts (metastasis). It can be a benign lesion (normally a slow growth one that can be cured if dried out with neurosurgical treatments), or bad (fast growing, cannot be cured with chirurgical treatment, so it can reproduce after surgery).
Symptoms may vary depending on where the tumour is located. Common symptoms include: headache, neurological defects -usually: strength loss on one side of the body, speech problems, etc.-, epilepsy, behavioural disorder… These symptoms are due to the compression that the tumoral mass causes and to the oedema (inflammation) that the tumour produces on the healthy brain that surrounds it (the proper medication can be administered to that oedema -generally corticoids-, resulting on a big -although non-permanent- improvement in most patients).
Brain tumour is diagnosed using imaging tests like Computerized Tomography (CT) or Magnetic Resonance Image (RMI). Both indicate the size and location of the affected area, and -while uncertain, it- can also suggest the nature of the tumour.
Which is the aim of the procedure?
To partially or totally remove and then analyze the lesion to reach a diagnosis, because it could be due to multiple causes (irregular growth of brain -or other body parts- cells, inflammation, or other diseases), and also to decompress (reduce the pressure from) the brain. The result of that test will be ready in about a week. With that firm diagnosis, an appropriate treatment can then start. In some cases, a cure is reached. In others, the following can be achieved:
- To diagnose the type of tumour,
- To reduce its size, by alleviating the compression symptoms caused by nearby nerves, in order to try a symptoms improvement or to stop their deterioration,
- Set up the area for subsequent treatments, making them more effective (radiotherapy and/or chemotherapy).
Which is the surgery procedure?
The skull is open (craniotomy) to access the affected area. A cut is made (different depending on where the tumour is located) in the head, and after opening the skull, and reaching the affected area (in the covering of the brain or inside it), the tumour is partially or totally removed. This also decompresses (lowers the pressure of) the brain. Surgery time varies, even though, it lasts 3 to 4 hours on average.
Which are the risks, complications and common after-effects?
1. Overall risks:
•Neurological disorders: they depend on the location of the affected area: Hemiparesis (weakness on one side of the body): 0.5 to 12%. Or visual field alteration: 0.2 to 11%. Or speech problems: 0.4 to 10%. Or sensitivity defect: 0.3 to 10%.
•Hemorrhage inside the skull. This can either cause a neurological disorder or aggravate an existing one (0.1 to 3%).
• Brain oedema (inflammation) or heart attack (death of cells in the surgery area) in 5 to 10%.
• Epileptic crisis after surgery: 1 to 10%.
• Wound´s surface infection (0.1 to 7%). Serious infection or cerebritis (brain inflammation), with brain abscess formation (pus concentration).Osteomyelitis (bone infection).Meningitis.
• Operative mortality (0.5 to 3%). If a complication were to happen, all available medical means from this hospital are prepared to try to solve it.
2. Customized risks: Further complications, apart from the illness related aforementioned, can occur.
Brain Tumor postoperative
The postoperative recovery relies mainly on the patient's overall level of health and fitness before surgery. Once the patient leaves the surgical room, he/she will go to the Reanimation Unit, or Intensive Care Unit (ICU). That way the patient could slowly recover from anesthesia after surgery. It also allows a better surveillance of the patient during the first hours after the operation, and whether or not another surgery is needed.
Back in the neurosurgery floor, the patient will gradually incorporate (24 to 48 hours after operation). The postoperative of this sort of head surgery is not particularly painful. It can be neutralized with a conventional analgesic. 7 to 8 days after surgery, stitches are removed, and the results of the pathologic anatomic study of the removed tumour will be provided (they tends to be similar to the one provided at surgery). A specific therapeutic strategy will be chosen depending on the result.
What happens after leaving the hospital?
The patient will leave the hospital -depending on the sort of tumor and his health prior surgery- 4 to 7 days after surgery. Neurosurgeon's instructions after leaving the hospital should be followed rigorously. During the first month after the procedure, the patient should live a quiet life, without efforts or any sort of physical exercise. It is advised to be with someone at all times. Reading or watching TV for a while, without stress -the effort that comes from focussing in an activity can result in headaches-, is also a possibility. It is recommended to progressively increase the pace of activity during the first month.
At the third week, and conditioned upon the clinical condition, the patient can go outside and walk for 15 minutes without getting tired. After four weeks, the patient should attend the neurosurgeon's clinic to control the evolution after surgery. The patient might need -depending on the sort of tumour, and on the results of the pathologic anatomy- complementary treatments (chemotherapy and/or radiotherapy). Those treatments will be under the supervision of one or more oncologists, and usually start 4 to 5 weeks after the procedure, once the brain surgery scarff is cured.