Latest and Advanced Treatment options for Brain Tumor in India

There are many different types of brain tumors. They are usually categorized by the type of cell where the tumor begins, or they are also categorized by the area of the brain where they occur. 

The most common types of brain tumors include the following:

• Gliomas. The most common type of primary brain tumor is a glioma. Gliomas begin from glial cells, which are the supportive tissue of the brain. There are several types of gliomas, categorized by where they are found, and the type of cells that originated the tumor. The following are the different types of gliomas:
  
  
• Astrocytomas. Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor, and the most common type of primary brain tumor in adults. Astrocytomas are generally subdivided into high-grade, medium-grade, or low-grade tumors. High-grade astrocytomas (glioblastomas) are the most malignant of all brain tumors. Astrocytomas are further classified for presenting signs, symptoms, treatment, and prognosis, based on the location of the tumor. The most common location of these tumors in children is in the cerebellum, where they are called cerebellar astrocytomas. These people usually have symptoms of increased intracranial pressure, headache, and vomiting. There can also be problems with walking and coordination, as well as double vision. In adults, astrocytomas are more common in the cerebral hemispheres (cerebrum), where they commonly cause increased intracranial pressure (ICP), seizures, or changes in behavior.
  
  
• Brain stem gliomas. Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure (ICP), but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination.
  
  
• Ependymomas. Ependymomas are also glial cell tumors. They usually develop in the lining of the ventricles or in the spinal cord. The most common place they are found in children is near the cerebellum. The tumor often blocks the flow of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing increased intracranial pressure. This type of tumor mostly occurs in children younger than 10 years of age. Ependymomas can be slow growing, compared to other brain tumors, but may recur after treatment is completed. Recurrence of ependymomas results in a more invasive tumor with more resistance to treatment. Two percent of brain tumors are ependymomas.
  
  
• Optic nerve gliomas. Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in children who have neurofibromatosis, a condition a child is born with that makes him or her more likely to develop tumors in the brain. People usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures.
  
  
• Oligodendrogliomas. This type of tumor also arises from the supporting cells of the brain. They are found commonly in the cerebral hemispheres (cerebrum). Seizures are a very common symptom of these tumors, as well as headache, weakness, or changes in behavior or sleepiness. These tumors have a better prognosis than most other gliomas, but they can become more malignant with time. About two percent of brain tumors are oligodendrogliomas.
  
  
• Metastatic tumors. In adults, metastatic brain tumors are the most common type of brain tumors. These are tumors that begin to grow in another part of the body, then spread to the brain through the bloodstream. When the tumors spread to the brain, they commonly go to the part of the brain called the cerebral hemispheres, or to the cerebellum. Often, a patient may have multiple metastatic tumors in
  several different areas of the brain. Lung, breast, and colon cancers frequently travel to the brain, as do certain skin cancers. Metastatic brain tumors may be quite aggressive and may return even after surgery, radiation therapy, and chemotherapy.
  
  
• Meningiomas. Meningiomas are usually benign tumors that come from the meninges, the outer coverings of the brain just under the skull. This type of tumor accounts for about one third of brain tumors in adults. They are slow growing and may exist for years before being detected. Meningiomas are most common in older patients, with the highest rate in people in their 70s and 80s. They are commonly found in the cerebral hemispheres just under the skull. They usually are separate from the brain and can sometimes be removed entirely during surgery. They can, however, recur after surgery and certain types can be malignant.
  
  
• Schwannomas. Schwannomas are usually benign tumors, similar to meningiomas. They arise from the supporting cells of the nerves leaving the brain, and are most common on the nerves that control hearing and balance. When schwannomas involve these nerves, they are called vestibular schwannomas or acoustic neuromas. Commonly, they present with loss of hearing, and occasionally loss of balance, or problems with weakness on one side of the face. Surgery can be difficult because of the area of the brain in which they occur, and the vital structures around the tumor. Occasionally, radiation (or a combination of surgery and radiation) is used to treat these tumors.
  
  
• Pituitary tumors. The pituitary gland is a gland located at the base of the brain. It produces hormones that control many other glands in the body. These glands include the thyroid gland, the adrenal glands, the ovaries and testes, as well as milk production by pregnant women, and fluid balance by the kidney. Tumors that occur in or around the area of the pituitary gland can affect the functioning of the gland, or overproduce hormones that are sent to the other glands. This can lead to problems with thyroid functioning, impotence, milk production from the breasts, irregular menstrual periods, or problems regulating the fluid balance in the body. In addition, due to the closeness of the pituitary to the nerves to the eyes, patients may have decreased vision.

Tumors in the pituitary are frequently benign, and total removal makes the tumors less likely to recur. Since the pituitary is at the base of the skull, approaches for removal of a pituitary tumor may involve entry through the nose or the upper gum. Certain types of tumors may be treated with medication, which, in some cases, can shrink the tumor or stop the growth of the tumor.

• Primitive neuroectodermal tumors (PNETs). PNETs are much more common in children than in adults. They can occur anywhere in the brain, although the most common place is in the back of the brain near the cerebellum. When they occur here, they are called medulloblastomas.      The symptoms depend on their location in the brain, but typically the patient experiences increased intracranial pressure. These tumors are fast growing and often malignant, with occasional spreading throughout the brain or spinal cord.
  
  
• Primary CNS lymphoma. Lymphocytes are carried in lymph fluid in and out of the brain. A CNS tumor occurs when these cells turn malignant. A weakened immune system may increase the risk of this tumor.
  
  
• Medulloblastomas. Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually necessary to control these tumors.
  
  
• Craniopharyngiomas. Craniopharyngiomas are benign tumors that occur at the base of the brain near the nerves from the eyes to the brain, and the pituitary gland. These tumors are more common in children and comprise only about 1% of all brain tumors diagnosed in the U.S. Symptoms include headaches, as well as problems with vision. Hormonal imbalances are common, which may lead to poor growth in children. Symptoms of increased intracranial pressure may also be seen. Although these tumors are benign, they are hard to remove due to the sensitive brain structures that surround them.
  
  
• Pineal region tumors. Many different tumors can arise near the pineal gland, a gland that helps control sleep and wake cycles. Gliomas are common in this region, as are pineal blastomas (a type of PNET). In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. People with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size.
  
  
  Latest and Advanced Treatment options for
  
  Brain Tumor in India
  
  
  Brain Tumor is no more a scary health condition as modern technology and advanced surgical modalities now offer near perfect clinical outcomes and the patients can soon return to normal life after surgery.
  
  
  • Brain Suite - Intra-operative MR Navigation Microsurgery
  • Trans-Nasal Endoscopic Removal of brain Tumor through the nose
  • Stereotactic Radiosurgery - Gamma Knife & Novalis TX
  • Tumor Embolization using Neuro Interventional Radiology
  • CyberKnife Radiosurgery

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Advantages of Next Generation Technology over Conventional Neurosurgery to Remove Brain Tumor

MRI Guided Brain Tumor Surgery - Most Advanced Brain Tumor Surgery in IndiaA brain tumor is a group (mass) of abnormal cells that start in the brain. Primary brain tumors can arise from the brain cells, the membranes around the brain, nerves, or glands.
Tumors can directly destroy brain cells. They can also damage cells by producing inflammation, placing pressure on other parts of the brain, and increasing pressure within the skull. The cause of primary brain tumors is unknown. There are many possible risk factors that could play a role.
Advanced imaging technique now developed to enable Neurosurgeons with intra-operative MRI to aid in the removal of complex and hard-to-access brain tumors during surgery. This new technique relies on a powerful computer system, which assists the surgeon in precisely localizing a lesion, in planning each step of the procedure on the computer screen, and in calculating the ideal access to the tumour before the operation.
This is particularly useful in reaching a tumour located deep inside the brain, areas traditionally considered to be difficult to reach. During the procedure, the computer tracks instrument movement with an extremely high precision, providing the surgeon with total control inside the brain at all times using "real-time" imaging. The surgeon can also check if the tumor has been removed as planned. This improves the outlook for the patient.
“BRAIN SUITE” in India – Amongst very few such facilities worldwide
It is the most advanced Neuro-Surgical Operating Room with high field MR. This system permits the neurosurgeon to have an MRI study on the patient during surgery, and if tumor has remained which was hidden to the human eye, can be detected by special MRI sequences, and can be targeted using neuro navigation (which works on the same principle as the GPS system).
The Brain Suite has two main parts. There is a high-intensity MRI scanner integrated with an image-guided surgical system. The MRI scanner has a wide-bore opening allowing a patient to lie on his or her side. Previously, tumors that could only be accessed from the side of the skull were not easy to scan. This special MRI system lets doctors repeat scans during the operation to get more accurate information on the location, shape and size of the tumor. This minimizes problems associated with brain tumors shifting during excision.

Advantages of Next Generation Technology over Conventional Neurosurgery to Remove Brain Tumor:-

• The surgeon is guided during the surgery by live Advanced New Generation computer assisted MRI and thus knows exactly where tumor ends and normal brain begins.

• Enhanced ability of Neurosurgeon to excise the complete tumor. Less risk of post operative complications. Functional image guidance with MRI allows for accurate, non-invasive preoperative assessment and planning for brain tumor surgery.

• MRI guided Brain Tumor Surgery allows a more complete tumor removal with much less risk to surrounding brain tissue.

• "Inoperable" tumors (inoperable by conventional surgical techniques) can be resected with MRI Guided Brain Tumor Surgery. Frequently, these are deep seated-relatively benign tumors in children and young adults or elderly patients. Many of these tumors can be cured with this most advanced technology.

Advanced Technology for Brain Tumor : Best Cancer Hospitals in India offer the World's Advanced Brain Tumor Treatment in India

Indian Hospital are providing comprehensive medical and surgical care for patients with disorders of the brain, brain tumor surgery is routinely carried out with results at par with the best centers globally. As we all know that India is now becoming a medical hub and a growing destination for Brain Tumor surgery. Hospitals of brain tumor surgery India provides international quality of medical healthcare services by the best brain surgeons in India who are equipped with the most advanced medical treatment and brain tumor healing techniques. 

Brain tumor is one an abnormal mass of tissue in which cells grows and multiply, seemingly unchecked by the mechanisms that control normal cells. Indian Neurologists and Neurosurgeons are supported by the most extensive neuro-diagnostic and imaging facilities including Asia's most advanced MRI and CT technology. Along with providing general diagnostic X-ray imaging, Hospitals of brain tumor surgery in India offers you a magnitude of imaging services like EEG, EMG, Sensation 10 CT Scanner, Functional MRI with Spectro-scopy, OPMI Multivision etc.

Treatment

People diagnosed with a CNS tumor generally need to seek treatment as soon as possible. The pressure caused by a growing CNS tumor can cause severe symptoms, including a backup of CSF and problems with blood circulation, which can damage delicate nerves and deprive cells of nourishment.

Treating brain and spinal cord tumors can be difficult. The blood-brain barrier, which normally serves to protect the brain and spinal cord from damaging chemicals entering those structures, also keeps out many types of potentially beneficial chemotherapeutic drugs. Surgery can be difficult if the tumor is near a delicate portion of the brain or spinal cord. Radiation therapy can damage healthy tissue. However, research in the past two decades has improved the survival rates of patients with brain tumors. More refined surgeries, a better understanding of what types of tumors respond to chemotherapy, and precise delivery of radiation have resulted in a longer life span and better quality of life for patients with brain tumors.

Surgery

Surgery is the most common type of treatment for a brain tumor and is often the only treatment performed for a benign brain tumor. Even if the cancer cannot be cured, its removal can relieve symptoms if it is creating pressure on parts of the brain. There have been rapid advances in surgery for a brain tumor, including the use of cortical mapping and enhanced imaging devices to give surgeons more tools to plan and perform the surgery. For a tumor that is near the speech center, it is increasingly common to perform the operation under awake conditions. Typically, the patient is awakened once the surface of the brain is exposed, and special electrical stimulation techniques are used to locate the speech center and thereby avoid causing any damage while removing the tumor.

Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient's own bone will be used to cover the opening in the skull. Gliadel wafers that deliver chemotherapeutic drugs (see below) require surgery to put the wafers in the tumor bed site. This may be done at the same time as a craniotomy.

In addition to removing or reducing the size of the brain tumor, surgery can provide a tissue sample for analysis. For some tumor types, the results of the analysis can help in showing if chemotherapy or radiation therapy will be useful.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Oncologists may use radiation therapy along with surgery to slow the growth of aggressive tumors. Radiation can be directed in the following ways:

The linear-accelerator machine provides external-beam radiation therapy from outside the body to target the tumor within the brain; this is becoming increasingly more precise with the addition of multileaf collimators (a device that restricts and confines the x-ray beam to a given treatment area).

In stereotactic radiosurgery, a computer assembles images from CT scans or MRI scans to locate the tumor and help direct the radiation. This may involve the use of an external head device to "marry" the patient's head/tumor location to the incoming radiosurgery beams.

Brachytherapy uses radioactive seeds implanted directly in the tumor site; however, this treatment technique is rarely used at this time for a brain tumor.

Radiation techniques

The following radiation techniques may be used:

Conventional radiation therapy. The treatment location is determined based on anatomic landmarks and x-rays. In certain situations, such as whole brain radiation therapy for brain metastases, this technique is appropriate. For more precise targeting, more elaborate techniques are required. Chemotherapy may be used in conjunction with this type of radiation therapy.

Three-dimensional conformal radiation therapy. Based on CT and MRI images, a three-dimensional model of the tumor and normal tissues is created on a computer. Beam size and angles are determined that maximize tumor dose and minimize normal tissue dose.

Stereotactic radiosurgery. Stereotactic radiosurgery involves delivering a single, high dose of radiation directly to the tumor and not healthy tissues. It works best for a tumor that is only in one area of the brain and certain benign tumors, but is also used for multiple metastatic brain tumors. There are three methods by which stereotactic radiosurgery is performed:

• A modified linear accelerator is a machine that creates high-energy radiation by using electricity to form a stream of fast-moving subatomic particles.
• A gamma knife is another form of radiation therapy that concentrates highly focused beams of gamma radiation on the tumor.
• A cyber knife is a robotic device used in radiation therapy to guide radiation to the tumor target-particularly targets in the brain, head, and neck regions.

Fractionated stereotactic radiation therapy. Radiation therapy is delivered with stereotactic precision but divided into small daily fractions over several weeks using a relocatable head frame, in contrast to the one-day radiosurgery. This technique is used for tumors located close to eloquent or sensitive structures, such as the optic nerves or brain stem.

Intensity modulated radiation therapy (IMRT). Radiation therapy is delivered with greater intensity or dose to thicker areas of the tumor and with less intensity to thinner areas of the tumor. This is accomplished by placing tiny metal leaves in the beam to reduce the intensity of the beam in order to customize the shape of the dose to the shape of the tumor.

All of these more elaborate techniques are designed to achieve greater precision and minimize the dose to the surrounding normal brain tissue. Depending on the size and location of the tumor, the radiation oncologist may choose any of the above radiation techniques. In certain situations, a combination of two or more techniques is appropriate.

Very young children (younger than 5) are not usually appropriate candidates for radiation therapy because of high risk of damage to their developing brains.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce symptoms.

Advanced/recurrent brain tumors

If, in spite of initial treatment, the brain tumor does not go into remission (the temporary or permanent disappearance of symptoms) or if it recurs, patients can still receive care to manage the symptoms caused by the tumor. Symptom management is always important since the symptoms of a brain tumor can interfere with quality of life.

Since a brain tumor is so rare, it can be hard for doctors to plan treatments unless they know what has worked in treating other patients with a brain tumor. Clinical trials are research studies that compare the standard treatments (the best treatments available) with newer treatments that may be more effective. Investigating new treatments involves careful monitoring using scientific methods and all participants are followed closely to track progress.

Due to advances in research, new drugs are being created to combat brain tumors. Many of these new drugs are called "small molecules" or "molecularly targeted therapies" because they are small in size (and can therefore be taken orally) and/or can attack a specific molecule or target within the brain tumor cells. These new drugs are being tested either alone or in combination with standard chemotherapy

Medical tourism in India is a boon for abroad patients who are searching for cost effective brain tumor surgery in India operated by the best Brain surgeons. Medical tourism companies has been providing valuable information and guidance regarding neurosurgery or brain tumor surgery in India to international patients as the number of patients having brain disorders have started coming to the neuro surgeons of India for brain tumor surgery at an affordable price. When it comes to price, abroad patients consider India as the best place for this surgery. Medical tourism has broad appeal as it is providing best medical healthcare facilities during this brain tumor surgery in India at very low cost as compare to western countries. 

International patients are looking forward to India just because of first class medical facilities at third class rates. Many of India's surgery hospitals and clinics offer international-standard brain tumor surgery in India at local prices, no waiting list and a high quality holiday. India is a land of art and culture and it is always seemed that abroad people are always attracted to it because of its variety.  

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Advanced MR imaging helps in interpretation of Brain Tumours

Advanced MR imaging techniques such as perfusion and functional imaging have been a great help in improving the diagnosis and staging of brain tumours. Unlike conventional MR techniques, advanced MR techniques can be used to obtain information not only on the morphological, but also on the functional characteristics of tumours.

One of the most common types of brain tumour is glioblastoma, which is highly malignant and has a high cell reproduction rate due to the fact that it is nourished by a large network of blood vessels. there are two types of glioblastoma: primary glioblastomas, which tend to form and make their presence known quickly by growing aggressively, and secondary glioblastomas, which are also aggressive but show slower growth and only represent 10% of all diagnoses.

Due to a lack of effective of therapies, the prognosis in cases of glioblastoma remains poor, and so there is an urgent need to find new therapeutic approaches.

One of the reasons why the treatment of glioblastoma is such a challenge is that it consists of various cell types, which may react differently to various forms of treatment. As a result, the treatment, in most cases, combines several methods.

“Overall there is no effective treatment for high-grade glioblastoma. The current therapeutic approaches are surgical resection of the tumour bulk if possible, depending on the location of the tumour, followed by radiation and chemotherapy. One of the main difficulties is that it can be difficult to exactly measure the tumour‘s extent, since malignant tumour cells often infiltrate the brain parenchyma beyond the tumour’s contrast-enhanced portion, which makes it difficult to completely surgically resect the initial tumour .

Radiation and chemotherapy are used to slow the growth of tumours that cannot be removed surgically. Chemotherapy may also be used in young children to delay the need for radiation.

Despite achievements in the field of advanced imaging techniques it still remains difficult to predict and monitor brain tumour response in individual patients, especially when it comes to the use of anti-angiogenic therapies, during which uncommon patterns of tumour response and progression can be seen.

Pseudoprogression for example usually occurs early while treating a brain tumour with radiation and Temodar, which makes the tumour appear to progress due to its increased size and contrast enhancement. This is a common reaction to the treatment, but the lesion will decrease in size and concentration on its own if the initial treatment is continued without any change.

Pseudo-response on the other hand occurs during anti-angiogenic therapy, for example the use of Avastin, which causes significant reduction in contrast enhancement due to changes in vascularity, but should not be mistaken for a real reduction in the extent of the lesion.

“Both can be best detected with advanced MR imaging especially diffusion-weighted imaging, which looks at the random motion of water molecules and perfusion imaging, which studies the cerebral blood volume and cerebral blood flow in the brain, including the tumour. Though MR spectroscopy is less helpful.”

Confusion and incorrect interpretation can, in part, be avoided by having good clinical information about the original tumour type; tumour extent, as seen through MR imaging after contrast administration; current course of chemotherapy treatment; radiation dose; and the time between radiation treatment and imaging findings. It is also helpful to use perfusion and diffusion imaging as part of the MR imaging protocol. The use of PET imaging might also be valuable, as well as a combination of information gained from both modalities.

Despite the fact that the long-term prognosis remains poor, there have been recent studies which have shown an increase in the overall survival rate for glioblastoma patients treated with Avastin .

Especially in recurrent glioblastoma, the treatment options have mainly been limited to high-dose chemotherapy. The administration of Avastin alone or in combination with CPT-11 has shown a significant improvement in response rates, progression-free survival times and overall survival.

A more recent study has shown that Avastin alone was nearly as effective as it was in combination with chemotherapy, but with much milder side effects. When dealing with patients suffering from terminal glioblastoma a stand-alone Avastin therapy may lead to an improvement in quality of life, without the common toxic side effects of chemotherapy.

When asked about whether we need advanced imaging techniques in daily practice, Yes, I strongly advocate the use of advanced MR imaging in the work-up and follow-up of a patient with brain tumour. It is helpful for the radiologist or neuroradiologist to give the correct interpretation and it is helpful for the clinician in the treatment of the patient.

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MRI Guided Brain Tumor Surgery in India : Advantages of Next Generation Technology Over Conventional Neurosurgery to Remove Brain Tumor

MRI Guided Brain Tumor Surgery in India

A brain tumor is a group (mass) of abnormal cells that start in the brain. Primary brain tumors can arise from the brain cells, the membranes around the brain, nerves, or glands.

Tumors can directly destroy brain cells. They can also damage cells by producing inflammation, placing pressure on other parts of the brain, and increasing pressure within the skull. The cause of primary brain tumors is unknown. There are many possible risk factors that could play a role. MRI Guided Brain Tumor Surgery is an advanced imaging treatment technique developed to enable neurosurgeons with intra-operative MRI to aid in the removal of complex and difficult-to-access brain tumors during surgery.  The technique involves use of a powerful computer system that precisely helps neurosurgeon locate a lesion, plan each step of the procedure on computer screen and find out the ideal access to the tumor before performing the operation. The technique is particularly helpful in treating a tumor that has difficult accessibility such as it is located deep inside the brain. During the procedure, the instrument movement is tracked very precisely by the computer providing surgeon with total control inside the brain with the help of real-time imaging. The technique also helps the surgeon to check if the tumor has been removed. The Brain Suite has two main parts. There is a high-intensity MRI scanner integrated with an image-guided surgical system. The MRI scanner has a wide-bore opening allowing a patient to lie on his or her side. Previously, tumors that could only be accessed from the side of the skull were not easy to scan. This special MRI system lets doctors repeat scans during the operation to get more accurate information on the location, shape and size of the tumor. This minimizes problems associated with brain tumors shifting during excision. Advantages of Next Generation Technology over Conventional Neurosurgery to Remove Brain Tumor Conventional Neurosurgery to remove Brain Tumor MRI Guided Brain Tumor Surgery in a Brain Suite, Next Generation Technology Conventional neurosurgical procedure like conventional craniotomy relies on surgeon's visualization of the tumour. The surgeon has to spend time and significant effort to find the tumor. The surgeon is guided during the surgery by live Advanced New Generation computer assisted MRI and thus knows exactly where tumor ends and normal brain begins. In some types of tumours, surgeons may not completely visualize the tumour and there is a risk that surgeon can resect normal brain tissue along with the tumor, which can result in neurologic deficit, paralysis, loss of speech, blindness etc. Enhanced ability of Neurosurgeon to excise the complete tumor. Less risk of post operative complications. Functional image guidance with MRI allows for accurate, non-invasive preoperative assessment and planning for brain tumor surgery. Normal brain tissue can be damaged unnecessarily. This can result in neurologic deficit and prolonged stay in the hospital MRI guided Brain Tumor Surgery allows a more complete tumor removal with much less risk to surrounding brain tissue. A surgeon performs a subtotal removal of the tumor . The consequence is only partial tumor resection that will result in a faster recurrence of the tumor and neurological symptoms. "Inoperable" tumors (inoperable by conventional surgical techniques) can be resected with MRI Guided Brain Tumor Surgery. Frequently, these are deep seated-relatively benign tumors in children and young adults or elderly patients. Many of these tumors can be cured with this most advanced technolog

Understanding Brain Tumors : Types , Symptoms and Treatment of Brain Tumors

What is Brain Tumors?

The human brain is the hub of the nervous system. The function of the brain is to supervise and control the actions and reactions of the body. It controls the bodily functions as it obtains sensory information rapidly analyzes such data

Abnormal growth of cells within the brain or the central spinal canal is called brain tumor. Brain tumors can initiate anywhere from the brain cells, the membranes around the brain (known as meninges), nerves, or glands. Tumor causes inflammation, consequently placing pressure within the skull and compressing the brain tissues. Because of its insidious and infiltrative character in the intracranial cavity all such tumours are intrinsically serious and life-threatening.

Factors used to classify Brain tumors include the sites of the tumour, the type of tissues involved. They can either be cancerous or non-cancerous. Different types of brain tumors include:

·         Acoustic neurinoma : Benign tumor occurring in the 8th cranial nerve (the acoustic nerve) between the pons and the cerebellum. Possibly associated with neurofibromatosis. The term "acoustic neuroma" is actually a misnomer since it this a primary intracranial tumor of the myelin forming cells called "Schwann cells" (schwannoma).

·         Astrocytomas : represent the most common type of glioma. They develop from the supporting cells of the brain, which are star-shaped glial cells called astrocytes.

·         Oligodendroglioma : These are tumours that are made up of cells known as oligodendrocytes, which produce the fatty covering of nerve cells: the myelin sheath. They are usually slower-growing than astrocytic tumours.

·         Ependymoma : Tumor arising from the ependymal cells found along the ventricles and central canal of the spinal cord.

·         Brain stem glioma : The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and middle-aged adults.

·         Craniopharyngioma :This is a benign, congenital tumor. It is cystic and occurs primarily in children and adolescents. Craniopharyngiomas occur in the sellar region. They often involve the third ventricle, optic nerve, and pituitary gland. These are localized tumors that grow by expansion. Malignancy and metastasis are unknown.

·         Medulloblastoma : This tumor usually arises in the cerebellum. It is the most common brain tumor in children. It is sometimes called a primitive neuroectodermal tumor.

·         Meningioma : Benign tumor arising from the meninges, the membranes covering the brain and spinal cord. Meningiomas represent approximately 20% of all primary brain tumors and occur most commonly in middle-aged women.

·         Germ cell tumor of the brain : The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger than 30. The most common type of germ cell tumor of the brain is a germinoma.

Types of Brain Tumors

Meningioma

A meningioma is a slow-growing tumor that develops from the membrane that surrounds the brain and spinal cord. These tumors are usually benign but some may be malignant. However even "benign" tumors can grow and constrict and affect the brain, which may cause disability and may even be life threatening. Because meningiomas grow slowly, it may reach a relatively large size before it causes symptoms. Other meningiomas grow rapidly or have sudden growth spurts. Standard treatment is to remove the tumor, the portion of the lining of the brain or spinal cord where it is attached and any bone involved. Complete removal of the tumor is sometimes possible.

Pituitary Tumor

A pituitary tumor is an abnormal growth in the pituitary gland, the part of the brain that regulates the body's balance of hormones. The most common treatment for pituitary tumors is surgery. The decision to pursue surgical treatment depends on the type, location and size of tumor, and the patient's age and overall health. Most of the time, pituitary tumors can be removed through the nose and sinuses without an exernal incision. However, some tumors cannot be removed this way and will require removal through the skull with an incision in the scalp. Astrocytoma Tumors Astrocytoma tumors are the most common glioma, accounting for about half of all primary brain and spinal cord tumors.

Other symptoms for Brain Tumours can include:

·         Headaches

·         Nausea and/or vomiting

·         Difficulty speaking or remembering words

·         Disturbed vision, hearing, smell or taste

·         General irritability or a change in personality - this is sometimes noticed only by family or friends

·         Drowsiness

How is Brain Tumors Diagnosed?

·         Magnetic resonance imaging (MRI) scan. MRI is a technique that uses a magnetic field and radio waves to create detailed images of the brain. Sometimes a special dye is injected into the bloodstream to make tumors appear different from healthy tissue (MR angiography).

·         Computerized tomographies (CT) scan. A CT scan uses a sophisticated X-ray machine linked to a computer to produce detailed, two-dimensional images of the brain. A CT scan can be very helpful in certain types of tumors, especially ones close to or involving bone.

·         Other brain scans. Other tests - such as magnetic resonance spectroscopy (MRS), single-photon emission computed tomography (SPECT) or positron emission tomography (PET) scanning - help doctors gauge brain tumor activity and blood flow.

·         Angiogram. A special dye is injected into the arteries that feed the brain, making the blood vessels visible on X-ray. This test helps locate blood vessels in and around a brain tumor.

·         Biopsy - A biopsy involves removing a piece of the tumor for viewing under a microscope. Oncologist needs to know the tumor type and grade to plan proper treatment.

Whatare the advances in radiation therapy of Brain Tumours?

·         3-Dimensional Conformal Radiation Therapy (3D-CRT) and Intensity Modulated Radiation Therapy (IMRT):CT scan and MRI are used to delineate the tumour and computers are used for radiation planning. Only the tumour and the high-risk region surrounding the tumour is radiated, avoiding radiation to the normal structures in the brain.

·         Stereotactic Radio-surgery (SRS) and Stereotactic Radiotherapy (SRT): Highly precise immobilization and image guidance system is used for treatment of selected brain tumours . Stereotactic radio-surgery delivering high-dose of radiation in single or a very few sessions is performed in adults with tumours such as metastatic residual glioma, meningioma and schwannoma. Novalis-Tx and Cyberknife are advanced machines to deliver such high-precision therapy.

·         High-definition Rapid Arc: This is the latest software advancement in radiation planning technology. Radiation is delivered in continuous fashion moving the machine head and its small components simultaneously around the patient's head targeting the tumour by infinite small radiation beams.

·         Proton beam therapy: Proton therapy avoids spillage of radiation dose to the surrounding brain. It is preferred in children as well as in patients with recurrent tumours who have received radiation therapy earlier.

MostAdvanced Technology for Brain Tumours Treatment in India

·         MRI Guided Brain Tumor Surgery - Advanced imaging technique now developed to enable Neurosurgeons with intra-operative MRI to aid in the removal of complex and hard-to-access brain tumors during surgery.

·         Gamma Knife Radio Surgery in India - Gamma knife radio surgery is a non-invasive procedure to treat benign and malignant brain tumors.

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