Benign or malignant neoplasms can be localized in various parts of the brain. Since the tumor is limited by adjacent tissues, its development leads to crushing of the brain centers and functional impairment.
In some cases, such a neoplasm leads to the death of the patient. The most priority treatment method is surgery to remove a brain tumor. However, only a doctor should prescribe an intervention, taking into account the available indications and contraindications.
Varieties of operation
In the presence of a neoplasm, an operation to remove a brain tumor is required. However, it is worth remembering that such an intervention is rather traumatic and often impossible to carry out, especially if vital departments are located nearby. The surgeon should conduct the procedure as carefully as possible, without touching healthy tissue. Among the main methods of tumor removal, it is necessary to highlight such as:
- craniotomy;
- endoscopy;
- stereotactic trepanation;
- excision of individual bones of the cranium.
Trepanation is an operation in which access to the work area is performed directly in the skull, creating a hole. To provide direct access, the surgeon removes part of the bone tissue along with the periosteum.
This is a classic technique and the total duration of the procedure is 2-4 hours. At the end of the operation, the hole in the skull is closed with previously removed bones, and then they are fixed with screws and titanium plates.
An endoscopic operation to remove a brain tumor is performed using an endoscope, which is inserted into the cranium through a small hole. The progress of the intervention is controlled by displaying the image on the monitor. At the end of the main manipulations, the excised tissues are removed by the use of a micro-pump, a suction device or electric tweezers.
Stereotactic trepanation implies that open intervention is not required. Instead of the usual surgical scalpel, photons, a gamma ray, and protons are used. Such radiation removal of a brain tumor is less traumatic and helps to destroy the neoplasm. This method is mainly used for cancer. It is worth noting that the intervention is painless and does not require the use of anesthesia.
Excision of individual bones of the skull refers to a type of craniotomy. During the operation, some skull bones are removed to gain access to the tumor. However, upon completion of all these manipulations, the excised bones are not put into place. They are permanently deleted.
Indications and contraindications
An operation to remove a brain tumor is indicated in cases such as:
- actively developing neoplasm;
- a tumor that does not have a tendency to growth, but negatively affects the brain;
- located in an easily accessible area of the brain;
- benign neoplasm, which can degenerate into malignant.
Despite the fact that conservative treatment in almost all cases ends with the death of the patient, sometimes doctors refuse the patient to undergo surgery. Such a decision is made only if the intervention can be dangerous due to the presence of pathologies. These include such as:
- exhaustion of the body;
- old age of the patient;
- metastases pass into the surrounding tissue;
- the tumor is located in an inaccessible place;
- the prognosis after removal is worse.
It is worth noting that the decision regarding the operation is made by the surgeon after diagnosis.
Diagnostics
The diagnosis is established after a whole complex of examinations. If a tumor is suspected, a diagnosis should be made. For this, such types of studies as tomography and radiography are used.
If neoplasms are detected, a histological examination should be performed. Encephalography is also performed.
Preparation
The main stage of preparation is a thorough calculation of access to the affected area and selection of excision technique. The surgeon must always calculate the risk of injury. If necessary, before the operation, such measures are performed as:
- decrease in intracranial pressure;
- stabilization of the patient’s well-being;
- biopsy.
The pressure is reduced by the use of medications or directly on the operating table. A biopsy is an analysis that involves taking a small piece of neoplasm tissue to study its structure. It is worth noting that such a procedure can be of some complexity and some danger to the patient. That is why a similar type of study is used only for certain types of tumors.
Operation
Often the intervention is performed under general anesthesia. A tube is inserted into the patient's throat to maintain normal breathing. However, it is worth noting that with some localizations of the neoplasm, it is necessary that the person remains conscious. For this, local anesthesia or temporary removal of the patient from sleep can be used. The doctor will ask questions to determine if the brain centers responsible for thinking, memory, and speech are affected.
Stereosurgical techniques are performed without anesthesia or under local anesthesia. This is due to the absence of punctures or cuts.
With an open operation, the doctor marks green parts or iodine with certain parts on the patient's head. This is required for more precise operations of the surgeon. A line is drawn that connects the ears, as well as from the bridge of the nose to the base of the skull. The resulting squares are divided into smaller ones. According to this marking, the surgeon also holds a scalpel.
After the soft tissue dissection procedure, bleeding is stopped. Vessels are sealed by heating or by applying an electric discharge. Then the surgeon bends the soft tissue and removes the bony segment of the skull.
Removal of a brain tumor is performed without dissection with a scalpel or scissors. This reduces the risk of damage to brain structures. Then the vessels feeding the neoplasm are cut.
If more complete removal of the tumor is required, then additional removal of bone tissue may be necessary. If the bone is affected by metastases and cannot be restored, then it is replaced with an artificial prosthesis. After the tumor is removed, bone sites or prostheses are put in place and fixed. Soft tissue and skin are sutured.
Endoscopic surgery is performed quite rarely. Indications are pituitary tumors. Depending on the size and localization of the neoplasm, it is possible to do without incisions or minimize their number. Access is via the nasal passage or oral cavity. At the operation there is a neurosurgeon and ENT.
After the introduction of the endoscope, the doctor receives an image of the internal structures on the screen. The tumor is removed and subsequently removed. After this, coagulation of blood vessels may be required. If the bleeding fails, the doctor performs an open intervention. After the operation, there are no seams and cosmetic defects, and there are no painful manifestations.
Stereosurgery is characterized by the fact that no incision or puncture is performed during the intervention. As a tool, a beam of a certain wavelength is used. The modern technique is the cyber-knife system. When applied, the radiation is directed directly to the tumor. Initially, special immobilizing devices are being prepared. A series of images is then created to create a highly accurate tumor model. This allows you to calculate the optimal dose of radiation and determine the method of its supply. The course of therapy is 3-5 days, and during this period there is no need for hospitalization.
Postoperative period
Rehabilitation after removal of a brain tumor is required. A set of restorative techniques and measures is selected separately for each patient, depending on the severity of the intervention and individual parameters.
Rehabilitation after surgery to remove a brain tumor implies:
- relapse prevention;
- restoration of lost or impaired brain functions;
- psycho-emotional adaptation;
- life skills training for lost functions.
Rehabilitation involves the difficult work of specialists such as:
- neurosurgeon;
- neurologist;
- psychologist;
- physiotherapist;
- speech therapist;
- ophthalmologist.
Rehabilitation after removal of a brain tumor mainly begins immediately after the operation and, with a successful outcome of the intervention, lasts 2-4 months. During this period, you need to be patient. Depending on the type of neoplasm, violations of certain functions, activities such as:
- physiotherapeutic procedures;
- massage;
- physiotherapy;
- reflexology;
- classes with a speech therapist;
- chemotherapy course;
- spa treatment.
After removal of a brain tumor, rehabilitation implies the restriction or exclusion of certain factors, namely such as:
- physical overwork;
- contacting with chemicals;
- exposure to adverse external factors;
- bad habits.
Carrying out all the required measures and observing the restrictions increases the patient's chances of a successful recovery.
Radiation therapy and chemotherapy
After removal of a brain tumor, chemotherapy is indicated. Such a treatment technique implies the use of medications, the effect of which should be aimed at the rapid destruction of pathological cells. This type of therapy is used in conjunction with surgery. Among the main methods of drug administration, it is necessary to highlight:
- oral
- intravenous;
- directly into the tumor or adjacent tissues;
- intramuscular.
The choice of drug for treatment largely depends on the sensitivity of the neoplasm to it. Therefore, chemotherapy is prescribed mainly after histological examination of tumor tissue.
After surgery to remove a brain tumor, radiation therapy is also prescribed. Due to the active metabolism, cancer cells are more sensitive to radiation than healthy ones. This type of therapy is used not only for malignant, but also benign tumors if they spread to areas of the brain that do not allow surgery.
Operation Risks
The risks after removal of a brain tumor are mainly related to the size of the tumor and its location in the brain. The involvement of the vessels of this organ also plays a very important role. If the neoplasm is small and located in a favorable area, the risk of intervention is negligible. The risk is significantly increased if a very large tumor is to be removed.
Based on this, before the operation, consultation of specialists is important. Thanks to modern techniques, the risk of tumor removal is significantly reduced.
Forecast
The condition after removal of a brain tumor depends on the features of the neoplasm, the professionalism of the surgeon, as well as the features of the rehabilitation. In approximately 60% of patients, all functions are fully restored. Mental disorders are very rare and occur approximately 3 years after surgery. Only in 6% of cases there is a violation of brain activity and a person loses personal service skills, as well as the ability to communicate.
Depending on the condition of the patient, a degree of disability may be assigned to him, restrictions on work may be imposed and the sick leave extended. Survival after surgery largely depends on the age of the patient and the nature of the neoplasm.
Possible complications
After removal of a brain tumor, the consequences can be very different, in particular such as:
- partial impairment of brain function;
- epileptic seizures;
- visual impairment.
All these signs are associated with a violation of the connections in the nerve fibers. With the help of prolonged medical and therapeutic correction, it is possible to achieve a complete restoration of the functional capabilities of the brain. Among the consequences of an operation to remove a brain tumor, it is necessary to highlight such as:
- violation of the digestive system;
- paralysis;
- memory impairment;
- infectious lesion.
In patients after removal of the tumor, relapses may occur. The chances of a tumor recurring are much higher with incomplete removal.
Cost and reviews
The cost of surgery is calculated separately for each patient and depends on many different factors. In foreign clinics, the cost of intervention is approximately 25 thousand dollars, and in domestic - approximately 8 thousand. The cost of endoscopic intervention is approximately 1.5-2 thousand dollars.
Reviews of the removal of a brain tumor are mostly positive, especially during the intervention by qualified surgeons. However, not all reviews are good, as some patients are not able to lead a normal life. And also relapses and complications are sometimes observed.