Management of brain tumors requires a comprehensive, multidisciplinary approach. Treatment is often made possible by the cooperation of a team comprised of neurosurgeons, oncologists, radiation oncologists, and neuropathologists. The initial phase of treatment following identification of a suspected tumor is usually handled by a neurosurgeon.
The first step in treating a suspected brain tumor involves making or confirming the diagnosis. This may include the use of advanced imaging techniques, beyond conventional CT and MRI scanning. In certain cases, a biopsy may be necessary as well. Once this workup is complete, a treatment strategy is formulated. This can range from observation with serial MRI scanning in the case of some benign tumors to resection of the tumor followed by chemotherapy and radiation. The specific treatment plan recommended will be dictated by a wide range of variables including the tumor type, location of the tumor, patient age, neurological condition, and any other existing medical conditions. There is no one-size-fits-all treatment plan. Even in the case of two tumors of identical type, appropriate treatment could differ radically based on other factors. This is why selection of a neurosurgeon who has experience treating brain tumors is essential to ensure that a proper treatment strategy is employed.
Before removal of a large meningioma
A wide variety of intracranial tumors are often referred to as "brain tumors". While many of these are, in fact, tumors arising from the brain, many are not. Many of these tumors are actually metastatic tumors, which have spread to the brain from cancer elsewhere in the body. Others are not actually within the substance of the brain, but rather grow from surrounding structures such as cranial nerves or the dura (the tissue lining the inside of the skull and surrounding the brain and spinal fluid). Tumors may also arise from the pituitary or pineal glands. Behavior of these tumors can range from very benign to extremely malignant. A benign tumor may grow very slowly, if at all, while some malignant tumors can double in size in a matter of weeks.
After removal of a large meningioma
Regardless of the origin of a brain tumor, all types can cause neurological problems and many can be life threatening. A primary tumor may grow by infiltrating functional brain tissue, causing dysfunction of that tissue and potential neurological deficit. A tumor that presses on eloquent brain tissue may interfere with the function of that tissue and cause problems such as weakness or speech difficulty. Any tumor that irritates the cerebral cortex, the outer layer of the brain, may lead to seizure activity. Tumors affecting other structures such as the pituitary gland or cranial nerves may cause dysfunction specific to those structures. Tumors may also lead to increased intracranial pressure and hydrocephalus due to large size or obstruction of normal spinal fluid outflow pathways. With very few exceptions, spread of brain tumors beyond the central nervous system is extremely rare.
Treatment options for brain tumors include both surgical and nonsurgical modalities. Craniotomy, which literally means to make an opening in the skull, is often indicated. This usually includes resection (removal) of the tumor but is done for biopsy (taking a small piece of tissue for examination) in certain cases. Stereotactic needle biopsy is sometimes done to make a diagnosis and to determine the correct treatment strategy. Radiosurgery (Gamma Knife) is a specialized type of radiation. Following initial treatment, many patients will require a more conventional type of radiation and/or chemotherapy as well. These specific treatment modalities will be defined and discussed ion more depth below.
