The field of neurosurgery focuses on the central and peripheral nervous systems which include both the brain and the spinal cord, as well as the surgical conditions related to these systems. Professor Necmettin Pamir, the head of the Neurosurgery Department at Acıbadem Kozyatağı Hospital, states that the mortality rate associated with brain tumor operations has decreased rapidly with the introduction of microsurgery to the field in 1960s and that the current rate is under 1%. In this article, Professor Pamir shares with us the answers to the common questions on the treatment of brain tumors, which develop in 5 out of every 100.000 people every year.
The majority of brain tumors are neuroepithelial tumors which are formed by the cells that are present in the brain tissue itself. There are also tumors that are formed in the meninges that cover the brain or the nerves that are close to the brain. Metastatic tumors that develop when cancer in another part of the body spreads to the brain and tumors that develop due to congenital remnants are also among tumors that can occur in the brain, as well as the tumors that develop in the hypophysis tissue or the ones that develop in other tissues close to the brain and apply pressure on the brain from their locations.
The imaging systems used during brain tumor operations ensure for surgeons to perform successfully by preserving the nervous systems that are responsible for movement in the body and leaving no tumor residue at all.
Brain tumors develop 5 out of every 100.000 people every year. While the rate of incidence for the majority of tumors is not too high, there is an increase in the rate for metastatic tumors due to the increase in human lifespans. The most common tumors during childhood are congenital remnant tumors and neuroepithelial tumors, which are being tumors formed by the cells in the brain tissue itself. The rate of incidence for malign and metastatic tumors increases in those of advanced ages.
The general symptoms are similar in all tumor types. The skull is just like a closed box and the brain is settled right inside it. When a benign or malign tumor develops in the brain, it creates the demand for an extra volume inside the skull and applies pressure on the brain. The increase in the intracranial pressure leads to the most significant symptoms of brain tumors. These are listed as headaches, vomiting, changes in the fundus (papillary stasis), and seizures. The brain operates with an electrical system and when there is an extra volume applying pressure on the brain, the said system gets affected and causes seizures in brain tumor patients.
Naturally, not every headache indicates a brain tumor. Some headaches can be due to blood pressure, otorhinolaryngology conditions or visual impairments. There can also be vascular headaches, referred to as migraines. The headaches arising from an increase in the intracranial pressure, however, are very different in that they make the sufferer experience a crushing sensation. These headaches increase when the person coughs, strains or sneezes. They can be more frequent at certain periods throughout the day. Brain tumor patients tend to vomit violently but without nausea.
The tumor in the skull is scanned through tomography or MRI. MRI makes it possible for us to say whether the tumor is malign or benign at an accuracy rate of 92 or 93%.
The manner of treatment is planned in accordance with many factors such as the patient’s age and tumor’s type, size, and location. If the tumor has not spread too much and is at a size which leads to increase in the intracranial pressure, it is essential for it to be treated. The first option for treatment is always surgery. Most tumors originating in the meninges or the nerves that are close to the brain, as well as some of the congenital remnant tumors, are benign. It is possible to remove being tumors completely through surgery and patients can continue their lives as if nothing happened after such surgery. Research has shown that when the tumor is malign, the earlier it is removed, the longer the patient’s lifespan will be. Therefore, the aim of current medicine is to remove both benign and malign tumors with as much success as possible and without causing additional harm to the patient.
Simple medical follow-up can be sufficient in cases of benign tumors with sizes less than 1 cm. The patient’s age is a very important factor in taking this decision. Patients of advanced age with benign and adequately small tumors can be monitored with scans that are performed once or twice every year. Currently, all calculations are made with the assumption that the patient will live until age 80. Therefore, treatment plans can vary even among patients with the same type of tumor whose ages are between 20 and 30.
There are many methods for elimination of tumors in the best possible way. For instance, the ultrasound method which has been successfully in use in Turkey for 25 years makes it possible to see whether there are any tumors or tumoral residue in an area before or after surgery. The most advanced technology in this field is Intraoperative MRI. Our clinic has been using Intraoperative 3 Tesla MRI since 2004. In the past, we would remove the tumor first and produce images the next day. This meant that even if we noticed residues in the images, there was nothing we could do. Now, however, we do our best to eliminate the tumor completely and before closing up the skull, we produce intraoperative images of the area and continue cleaning the area from tumor residue if we see any on the images. Since this also enables us to see the nerves that ensure body movements clearly, we can perform procedures without harming any fibers. This technology is a great development for both surgeons and patients.
Let’s assume that we made a decision to perform surgery, carried out the planned surgery and verified that the tumor was eliminated in the best possible way through MRI. In cases of malign tumors, patients need to receive chemotherapy and radiotherapy as well. Currently, radiotherapy on brain tumors is very successful. We also have a great method such as Gamma Knife. It is mostly used on benign and round tumors with proper margins and sizes that do not exceed 3 cm. Some being tumors can be treated without surgery by solely using Gamma Knife. There are great advancements in conventional radiotherapy as well. It is now possible to radiate only the tumor area through detailed calculations and avoid harming healthy tissues that surround tumors. When we take a look at all that has changed, we see that the mortality rate for the first month following a brain operation, which was around 30% before the 1960s during which microsurgery was integrated into neurosurgery, was reduced to 2% by 1966 and is now under 1%. The advancements in surgical techniques and the developments in technology and alternative methods have decreased mortality rates and increased the lifespans of patients. The complication rate of brain operations has been reduced to under 5% as well. The life expectancy for stage 1 and 2 in malign neuroepithelial tumors has risen to 12 years from 6 years. In stage 4 patients, the life expectancy is now 14 years and there are many patients who have continued to live over 2 years.