Brain tumors, difficult to reach tumor masses and the method that can successfully treat them. Decreased risk of complications by almost 15%
In the last 15 years, the risks of complications in the case of brain tumor removal have decreased very much, from 10-15 percent to only 2 percent. In addition, the mortality risk reached 0.1 percent.
All these performances are explained by the increasing experience of the teams of specialists in neurosurgery, by the development of the technology, but also by the personalization of the methods of treating the brain tumors.
These can be both benign and malignant. Regarding the incidence of cancers affecting the brain and nervous system, they are 17th in the list of malignant diseases, with almost 300 thousand new cases in 2018. The most common brain tumors are metastases, along with the primary glial tumors.
“There are 4 degrees of glial tumors, grade 4 being the malignant one, ie cancer. Currently, we have the possibility of early diagnosis of these tumors.
For example, patients with grade 1 glial tumors can be successfully treated if we remove these tumors using advanced techniques. It is not a good idea just to monitor them without intervening quickly. Our advice for all our neurosurgical colleagues is to remove these tumors as soon as possible. Often, these tumors occur in eloquent areas, responsible for vital functions, and patients are advised to return after 6 months for magnetic resonance imaging. And it happens that the tumors reach the 4th degree in this interval ”, warns Prof. Dr. Ilhan Elmaci, top neurosurgeon at ACIBADEM Maslak Hospital.
An important rule for successfully treating malignancies is for them to be evaluated and addressed within a complex team of physicians. At present, brain tumors are successfully treated by teams of at least 10 specialists. Along with the oncologist, neurosurgeons, neurologist, radiologist and radiotherapist, the presence of a neurosurgeon is extremely important.
“The anesthesia should be done so well that the patient will ask after the surgery if he has even undergone that intervention. All the steps of the intervention are like making a puzzle: if a single step is not done properly, to the highest standards, then the result has to suffer. For example, if an operation on the brain takes 4 hours, the neurosurgeon sleeps the patient and wakes him up when we, the neurosurgeons, reach the sensitive areas. Thus, with the help of the awake patient, we make sure that everything is fine and we continue the intervention ”, adds the reputed neurosurgeon.
An intervention to remove a brain tumor lasts on average 4-5 hours, but the operative time can reach 8 hours. One of the main goals of the medical team is the removal of tumors without affecting healthy tissues. At the brain level, they may be responsible for maintaining vital functions and any uninspired gesture may in future affect the quality of life of the patients. To avoid this, in large neurosurgery centers, medical teams use the best technology that ensures the accuracy of diagnosis and treatments.
“Neuromonitoring means, in fact, the continuous evaluation of the electrical activity of the brain in the operating room, under anesthesia or with the awake patient. In parallel with this, we also carry out neuroradiological examinations, and all the advanced techniques help us to accurately locate the eloquent areas responsible for the vital functions of the body and to evaluate the brain circuits. Each person has certain particularities at the brain level and we must evaluate and know them well before the operation. Thus, having all this data, we analyze them in the team before the operation and it is much easier for us to do the operations, according to the particularities of each case. We also perform pre-intervention simulations and determine the limits within which we can operate, in order not to affect the eloquent areas and the important brain circuits. Basically, before the intervention, we make a brain map that guides us during the intervention, in order to minimize the risks of the interventions ”, describes the expert neurosurgeon from ACIBADEM, the benefits of neuromonitoring that greatly reduced the risk of injury to fine structures in the brain.
At present, effective interventions for brain tumor removal are unthinkable without technology. Digitization, but also the use of instruments such as the microscope, neuroendoscope, intraoperative tomography scans, intraoperative magnetic resonance imaging and neuromonitoring contribute substantially to the complete removal of malignant tissues.
“We use intraoperative ultrasonography which helps us to be 100% sure, and this is possible due to experience. For someone who has been using these methods for a while, it is impossible to control them perfectly, but our team is experienced, and based on the imaging assessments made by the neuro-radiologist, we can know precisely how the intervention proceeds step by step. There are situations when we use intraoperative computed tomography, depending on the location. The technologies assist us in all the interventions for the extirpation of the brain tumors, in order to avoid the complications ”, adds Prof. Dr. Ilhan Elmaci.
Whether it is benign or malignant, a brain tumor gives symptoms when it exerts pressure on the surrounding tissues. These can be headaches, mood swings, loss of consciousness, moments of absence or numbness in various areas of the body. The visit to the doctor is obligatory, as is the regular monitoring of post-cancer therapy. It is known that certain malignant formations such as lung, breast, colon or skin can lead to brain metastases.
“For example, if there are 3 or 4 metastases in the brain, and the patient suffers from the largest because it makes a strong brain compression, then we remove it. On the other, we can treat them by radiotherapy. We adapt the treatment according to each individual case, we personalize it. We already have a long experience with Gamma Knife, we are practically the first group of doctors in the Middle East who started working with this technology. So our expertise allows us to use it in many situations, either on its own or after surgery, if there are still tumor residues. These can be addressed by Gamma Knife, Cyber Knife or other technologies from the LINAC system (linear accelerator that uses X-rays or electrons to destroy tumor tissues), "describes the advances in radiation therapy applied to the brain.
Prof. Dr. Ilhan Elmaci adds that the quality of life of the patients after the intervention is extremely important. Thus, at present, good communication with the patient plays an extremely important role in the therapeutic act, together with teamwork.
“My main mission as a neurosurgeon is to be a patient guide, to provide all the family information and to make sure all aspects of the intervention are understood. Neurosurgery is no longer a "one man show". We evaluate the patient step by step, within a large team. There are situations in other countries or hospitals when the neurosurgeon sends the patient further to the oncologist or radiotherapist, but they did not see the patient from the beginning and did not follow the case in detail.
But we work as a team and follow the evolution of each case separately. I am extremely pleased that I can work in a valuable team with my colleagues, that we can share professional experiences, the best expertise for solving cases and that we have advanced techniques available. And all this contributes to maximum chances of success and an extremely low rate of morbidity, given that we treat very serious cases, ”says Prof. Dr. Ilhan Elmaci.
Until now, the causes of brain tumors are not fully understood, but experts mention among the risk factors stress, certain eating habits, electromagnetic radiation, smoking and alcohol.