Just the mention of the term ‘brain tumour’ sends shivers down most people’s spine. Being diagnosed with a brain tumour used to prompt patients to get their final matters in order. It was considered a death sentence. Thankfully things have changed and advances made in recent years in surgical technique, chemotherapeutic drugs and targeted radiotherapy have made the prognosis and survival improve in leaps and bounds.

This good news is for malignant brain tumours. Benign tumours if resectable are curative, and again recent advances in surgical techniques and instruments to aid in complete resection safely has reduced the complication rate significantly. With early diagnosis and removal and regular follow-up, patients can live a long and healthy life.

Having a brain tumour is a serious diagnosis and several factors determine the outcome.Where it is: The deeper within the brain it is, the less accessible but new navigation equipment and surgical techniques allow safe access, but the risks maybe slightly higher compared to those closer to the surface.

How big it is: A big tumour at the surface of the brain can be easier to remove than that which is deeper. At the same time it must be considered that there is more potential for a large tumour to bleed more than a smaller tumour so extra precautions may need to be taken.

What important structures it’s attached to: The tumour being attached or in close proximity to important structures can make removal difficult and this increases the chance of complications.

Whether it’s benign or malignant: As a general rule if a tumour is benign and in an accessible location, complete removal can be carried out and thereby the patient cured. If a benign tumour is attached to delicate structures, removal maybe difficult without causing neurological deficits thereby taking into consideration the fact that the patient maybe left with a permanent deficit the surgeon may remove as much as possible which can be done safely and the remainder treated with radiation treatment. When it concerns a malignant tumour the best outcome for the patient is to remove more than 95% as this will affect the life expectancy. So the objective is to remove as much as possible safely in one sitting.

The patient’s general condition:If the patient is generally fit and well, they tolerate the anesthesia and the operation well and this helps with post operative recovery and discharge from the hospital.
Whether the tumours are primary brain tumours or secondary tumours: The latter are tumours, which spread from the rest of the body. Although having secondary brain tumours was thought to be a death sentence current evidence indicates that if the tumours are up to three in number and are in resectable locations, removal will extend life significantly.

The grade of the tumour and type: Brain tumours that arise from the brain tissue itself are called gliomas and there are four grades identified. A grade 4 is called a glioblastoma multiforma and these have the worse life expectancy. But again things have changed. A few years ago the survival was limited to a few months after diagnosis but currently if the tumour is resected more than 95% and treated with chemotherapy and radiotherapy together, this can be increased to a couple of years. In some patients it could be longer.

So in conclusion, having a brain tumour isn’t ‘The End’. If you are diagnosed with one don’t give up – seek help and talk to someone who is able to explain the management options that are available. This information would be available from a consultant neurosurgeon, neurologist or oncologist.

(The writer is a Consultant Neurosurgeon, Lanka Hospitals and Hope hospital, Manchester, U.K.)

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