Long Term Problems After Brain Surgery
Some people recover well after brain surgery, but this can take some time. Other people have some problems, or long term difficulties.
The problems you may have depends on the area of the brain where the tumour was . Problems might include:
- difficulty walking
Depending on the problems you have, you might get help and support from different healthcare professionals.
Overview Of Brain Tumor Surgery
The specific procedure you undergo will depend on the type of brain tumor you have been diagnosed with, as well as its size and location. Your surgeon may remove all or part of the tumor, depending on the proximity of nearby structures and whether or not you will be having adjunct therapy following your surgery.
Generally speaking, there are two reasons for brain tumor surgery: biopsy and resection. In a biopsy, your surgeon will take a small section of tumor and send it to a pathologist, who will look at it under a microscope to make or confirm a brain tumor diagnosis. Resection is the surgical removal of all or part of the tumor itself. Surgeons will often perform a biopsy and resection at the same time.
To access your brain tumor, a craniotomy is usually completed at the start of surgery. This is the removal of a small section of skull to allow the surgeon to reach the tumor. Your surgeon will remove as little bone as possible, which will be replaced following surgery and secured using a plate and/or screws. Sometimes the surgeon can limit the craniotomy to a keyhole-sized incision in the skull and use specialized instruments to remove the tumor, utilizing a minimally invasive approach.
Remission And The Chance Of Recurrence
A remission is when the tumor cannot be detected in the body. A remission can be temporary or permanent.
For most primary brain tumors, despite imaging tests showing that the tumor growth is controlled or there are no visible signs of a tumor, it is common for a brain tumor to recur.
Patients will often continue to receive regular MRI scans to watch for a recurrence. This uncertainty causes many people to worry that the tumor will come back. It is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.
If the tumor returns after the original treatment, it is called a recurrent tumor. A recurrent brain tumor generally comes back near where it originally started. Rarely, it may come back in another place or in several areas, which is called a multifocal recurrence.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, radiation therapy, chemotherapy, and targeted therapy, but they may be used in a different combination or given at a different pace. Options may include:
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When Is Brain Tumor Surgery Performed
Brain tumor surgery is usually performed after a brain tumor is found on an imaging scan. For certain tumors that are small and asymptomatic, close observation may be recommended without further intervention, but for most brain tumors, including pediatric brain tumors, the first step in treatment is surgery to remove the tumor.
Surgeons resect as much of a tumor as possible while preserving brain tissue and overall function. Complete resection may be the outcome however, sometimes, only subtotal resection is advisable because otherwise, normal brain tissue could be at risk of harm. Our highly skilled neurosurgeons remove as many tumors as possible while maintaining brain function.
Common brain tumors that may be treated with surgery include gliomas, meningiomas, acoustic neuromas, pituitary tumors, primitive neuroectodermal tumors, medulloblastomas, craniopharyngioma, pineal region tumors, clival tumors, and esthesioneuroblastomas.
Learn What To Expect After Your Treatment
After any surgery or brain tumor treatment, it is not unusual to feel worse than you did before. Though this is temporary, it can be depressing.
Brain surgery is a lot for your body to cope with. Swelling in the brain after an operation means it will take some time before you feel the benefit from having your tumor removed. You may experience dizzy spells or get confused about where you are and whats happening. These episodes can come and go and are a normal part of the recovery period.
For some people, recovery may be complete after a few weeks or months for others, you may have to learn to adjust and manage permanent changes in your life including not being able to work or accomplish all of the tasks you did before. Your surgeon can give you some idea, but ask as many questions as you can about what to expect for your recovery.
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Types Of Brain Tumors
The World Health Organization developed a classification and grading system to standardize communication, treatment planning, and predict outcomes for brain tumors. Tumors are classified by their cell type and grade by viewing the cells, usually taken during a biopsy, under a microscope.
Cell type. Refers to the cell of origin of the tumor. For example, nerve cells and support cells give rise to tumors. About half of all primary brain tumors grow from glial cells . There are many types of gliomas because there are different kinds of glial cells.
Grade. Refers to the way tumor cells look under the microscope and is an indication of aggressiveness . Tumors often have a mix of cell grades and can change as they grow. Differentiated and anaplastic are terms used to describe how similar or abnormal the tumor cells appear compared to normal cells.
Table 1. Glioma Grading Scale
More Tools To Cope With Cognitive And Behavioral Changes Include:
Cognitive RehabilitationCognitive rehabilitation is designed to help people regain as much of their mental, physical and emotional abilities as possible.
- Compensation techniques are methods to develop alternate skills to make up for those that have been lost, such as exercises to strengthen sight, speech, and movement. When full recovery is not possible, treatment includes compensation techniques like learning to live with memory loss by keeping calendars, reminder systems, and organizers. Neuropsychologists are cognitive experts that can help identify compensation solutions or suggest medications to enhance mental functioning .
- Anger management training, counseling or medication can help a patient who experiences behavioral and personality changes such as impulsiveness, frustration, or moodiness.
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What Kind Of Treatment Follow
Regular follow-up treatment is extremely important after brain tumor treatment. Besides regular physical and neurological exams and blood tests, you may need periodic MRI, MR spectroscopy, perfusion or diffusion MRI, and/or CT exams. Doctors rarely use positron emission tomography scans in brain tumor patients. However, they may use PET to monitor disease outside of the brain . Your doctor may also recommend home care, occupational or vocational therapy, pain management, physical therapy, and participation in support groups.
This follow-up care will help your doctor to:
- spot any sign that the tumor is returning
- monitor the health of your brain
- identify and treat the side effects of chemotherapy or radiation therapy
- detect the presence of other types of cancer at the earliest possible stage
What Are Some Types Of Brain Surgery
These are some of the most common operations involving the brain or areas around it. Some of the explanations below are derived from information obtained from the National Cancer Institute.
Some brain cancer patients are treated with stereotactic radiosurgery, which may include use of a Gamma Knife, but this is not a surgery in the common understanding of the term, and the âknifeâ is not actually a knife. Radiosurgery is an external radiation treatment that does not involve an incision. Special equipment, like the brand-name Gamma Knife, precisely delivers a high dose of radiation that targets tumors or other lesions, minimizing damage to surrounding healthy tissue.
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Types Of Surgery For Treating Brain Cancer
The most common types of surgical procedures used to treat brain cancer include:
- Biopsy. A biopsy is when a small tissue sample is taken to be analyzed under a microscope. This helps doctors figure out whether a tumor is cancerous and what type of cancer it is.
- Craniotomy. A craniotomy involves the surgical removal of part of your skull to let surgeons operate on your brain and remove the tumor.
- Endonasal endoscopy. During an endonasal endoscopy, a surgeon accesses the brain through the nose with a thin tube called an endoscope.
- MRI-guided laser ablation. MRI-guided laser ablation is a minimally invasive surgery that involves making a small hole in your skull and inserting a fiber-optic laser. Surgeons then use heat from the laser to destroy cancer cells.
- Neuroendoscopy. A small section of your skull is removed to insert a thin tube called an endoscope. This is used to treat conditions like obstructive hydrocephalus, hamartomas, and .
What Are The Complications Associated With A Brain Tumor
Some people with a brain tumor â whether it is benign or malignant â experience complications as the tumor grows and presses on surrounding tissue. These complications include:
- Faster or slower breathing and pulse rates.
- Numbness that interferes with feeling pressure, heat or cold on the body.
- Weakness or inability to move a leg or arm on one side of the body.
- Vision, hearing and smelling problems.
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Does Brain Surgery Change Your Personality
A major surgery and its treatments can cause changes in a personality and ability to think. Patients may experience challenges with their communication, concentration, memory and emotional abilities. Most brain tumor patients exhibit signs that are consistent with depression and agitation, especially post surgery.
How Well Does Surgery Work In Treating Brain Cancer
Surgery is an option for small or easily accessible tumors. Survival rates widely vary based on the type of cancer and tend to decrease with advancing age.
Looking at the predicted survival rates can help you understand what to expect, but many factors can influence your individual survival rate. Your medical team can help you get an idea of your particular chances of survival.
People who have brain tumors surgically removed tend to have higher survival rates than people who dont have surgery. For example, glioblastoma accounts for about
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What Causes A Brain Tumor
Doctors are not sure what causes most brain tumors. Mutations or defects in genes may cause cells in the brain to grow uncontrollably, causing a tumor.
The only known environmental cause of brain tumors is having exposure to large amounts of radiation from X-rays or previous cancer treatment. Some brain tumors occur when hereditary conditions are passed down among family members.
Surgery To Give Chemotherapy
During brain surgery, you might have chemotherapy into the area of the tumour as a wafer . Or you might have a ventricular access device put in. Ventricular access devices allow you to have chemotherapy straight into the fluid filled spaces of the brain .
We have information about chemotherapy wafers and ventricular access devices in the chemotherapy section.
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Brain Cancer Survival Rate
Survival rates in brain cancer vary widely. The major things that influence survival are the type of cancer, its location, whether it started in your brain or spread there from somewhere else in your body, whether it can be surgically removed or reduced in size, your age, and other medical problems.
What Are Possible Side Effects Of Radiation Therapy
The side effects of radiation therapy to the brain may not occur until two to three weeks after the start of your therapy. Many people experience hair loss, but the amount varies from person to person. Hair may grow back once therapy is finished.
Skin irritation is the second most frequently reported side effect. The skin around your ears and scalp may become dry, itchy, red, or tender. Do not try to treat this side effect on your own. Seek professionalism medical treatment as soon as it occurs. Fatigue is another possible side effect. The best way to fight fatigue is to get on a daily exercise regimen that is tolerable and sustainable, eat a healthy diet, and rely on friends and family for support. Your normal energy levels should return about six weeks after you finish your therapy. Fatigue may be the worst two to three weeks after you complete prolonged radiation treatment
Edema is also a common side effect. Tell your oncologist if you have a headache or a feeling of pressure. The doctor may prescribe medications to help reduce brain swelling, prevent seizures, or control pain. If you receive chemotherapy and radiation therapy at the same time, you may experience more severe side effects. Your doctor can suggest ways to ease these symptoms.
Other possible side effects include:
- hearing problems
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Minimally Invasive Endoscopic Surgery
UCLA neurosurgeons pioneered the field of minimally invasive endoscopic brain tumor surgery. We perform more than 100 endoscopic procedures each year.
Endoscopic surgery uses a flexible tube with a light and camera attached to it and special instruments to access your internal organs through a small incision or natural body opening, such as your nose. We commonly use this technique to remove pituitary tumors.
Our recent efforts include new approaches that help us more accurately see the tumor during surgery. Using specialized endoscopes with high-resolution video cameras, we perform surgeries with improved accuracy. Doing so helps us completely remove the tumor and preserve surrounding tissue. Learn more about endoscopic endonasal surgery at UCLA.
Alternatives To A Craniotomy
In some situations, other procedures may be recommended as alternatives to a craniotomy. For instance, some brain tumors can be treated with stereotactic radiosurgery, in which highly precise beams of energy are delivered directly to the tumor with no need for a surgical incision. Other tumors can be surgically removed through the nasal passageways, which also eliminates the need to remove any skull bone.
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Surgery For Brain Tumors
UPMC neurosurgeons remove brain tumors surgically, whenever possible.
Several minimally invasive surgical options allow us to access areas that previously were difficult or impossible to reach.
- The Endoscopic Endonasal Approach is an innovative surgery that takes advantage of the nose and nasal cavities as natural pathways to your brain tumor. EEA is appropriate for tumors at the base of the skull or upper spine, including meningiomas, pituitary adenomas, and other conditions.
- Neuroendoport® Surgery offers a minimally invasive treatment option for deep-seated tumors within the ventricles or substance of the brain. A narrow tube allows doctors to access tumors, such as gliomas or brain metastases, through a tiny incision in the skull, in contrast to traditional, open brain surgery.
- Laser ablation: One of the newest minimally invasive techniques for treating deep-seated brain tumors, multiple metastases, and radiation necrosis is laser ablation, which uses heat to destroy the tumor or lesion. During the procedure, a laser fiber, guided by MRI technology, is directed toward the tumor through a small hole in the skull. Once the targeted area has been defined, surgeons use heat from the laser to destroy the tumor or lesion. The entire procedure is viewed in real time on MR images that display thermal s outlining the distribution of heat to ensure safety and successful target treatment.
What Are The Grades For Benign And Cancerous Brain Tumors
Doctors group brain tumors by grade. The grade of a tumor refers to the way the cells look under a microscope:
- Grade I: The tissue is benign. The cells look nearly like normal brain cells, and they grow slowly.
- Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a Grade I tumor.
- Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing .
- Grade IV: The malignant tissue has cells that look most abnormal and tend to grow quickly.
Cells from low-grade tumors look more normal and generally grow more slowly than cells from high-grade tumors . Over time, a low-grade tumor may become a high-grade tumor. However, the change to a high-grade tumor happens more often among adults than children.
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Radiation Therapy For Brain Cancer And Brain Tumors
Radiation therapy uses X-rays and other forms of light energy to destroy cancer cells in malignant tumors or to slow the growth of a benign brain tumor. Learn more about radiation therapy, or explore the types of radiation therapy used to treat brain tumors:
- External beam radiation therapy: The most common type of radiation therapy for brain tumors, it can be directed to the tumor and nearby brain tissue or to the whole brain. Whole-brain radiation is sometimes used to treat metastatic brain tumors, especially when there are multiple metastatic tumors throughout the brain, including tumors that are too small to be seen on a scan.
- Stereotactic radiosurgery: This form of radiation therapy uses smaller, more targeted beams of X-rays to spare healthy surrounding tissue. It is often used on areas of the brain that are difficult to reach.
- Proton therapy: This uses a particle, the proton, to deliver radiation. Proton therapy may be a good choice for certain types of tumors. Compared with other methods, it delivers less radiation to surrounding healthy tissue.
Cognitive And Behavioral Changes
A brain tumor and its treatment can cause changes in a persons behavior and ability to think. Patients may experience difficulties with their communication, concentration, memory, and their personality may change.
These difficulties may affect a patients ability to work or go about his/her daily life, and they do not always go away. This can cause stress for both the patient and his or her family.Medication may be prescribed to reduce problems with cognitive and behavioral changes, and counseling may help a patient recognize when they are experiencing cognitive problems.
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