A brain tumor is a cancerous or a non-cancerous growth of cells in the brain. This growth of abnormal cells can take place in any part of the brain or it can happen in any other body party and spread to the brain.

It is a fairly common condition that affects millions of people around the world. An undiagnosed brain tumour can prove fatal and therefore, it is necessary to undergo specific tests and initiate treatment as soon as the diagnosis is confirmed.

The symptoms of a brain tumour can be confused with some other medical condition, especially migraine. Increasingly strong headache and blurred vision are the two most common symptoms of a brain tumour. People with this condition can also experience seizures, confusion, nausea, vertigo, impaired voice, and loss of balance.

Treatment for a brain tumour depends on several factors. The type, size, and the location of a tumour, in addition to the overall health of the patient and his or her age, are some of the considerations made by the doctor while preparing a brain tumour treatment plan.

Different treatment modalities can be used to treat brain tumour patients and surgery, chemotherapy, and radiation therapy are among them. Usually, a combination of treatment modalities is used to conduct brain tumour treatment.

Craniotomy surgery is one of the most common types of brain surgery conducted to treat a brain tumor. It mainly aims at removing a lesion, tumor, or a blood clot in the brain by opening a flap above the brain to access the targeted area. This flap is removed on a temporary basis and again put in place when the surgery is done. Around 90 percent of the cases of brain tumors are diagnosed in adults aged between 55 and 65. Among children, a brain tumor is diagnosed within an age range of 3 to 12 years.

Craniotomy procedures are conducted with the help of magnetic resonance imaging (MRI) scans to reach the location precisely in the brain that requires treatment. A three-dimensional image for the same is achieved of the brain in conjunction with localizing frames and computers to view a tumor properly. A clear distinction is made between abnormal or tumor tissue and normal healthy tissue and to access the exact location of the abnormal tissue.

Who requires a craniotomy?

In a minimally invasive craniotomy procedure, a burr hole or a keyhole may be created to access the brain to fulfill the following purposes:

• To drain out cerebrospinal fluid in case of hydrocephalus by inserting a shunt into the ventricles
• To treat Parkinson’s disease by inserting a deep brain stimulator (DBS)
• To insert an intracranial pressure monitor
• To conduct needle biopsy, where a small sample of abnormal tissue is removed for study
• For stereotactic hematoma aspiration, in which a blood clot is drained out
• For insertion of an endoscope to clip aneurysms and for the removal of small tumors

When there are complex craniotomies involved, the procedure may be referred to as a skull base surgery.  In this kind of surgery, a small portion of the skull is removed from the bottom of the brain. This is the region where delicate arteries, veins, and cranial nerves exit the skull. Complicated planning is done to plan such craniotomies and understand the location of the lesions. This type of approach is usually employed for:

• The removal or treatment of large brain tumors and aneurysm in the brain
• Treatment after a skull fracture or major injury like a gunshot
• The removal of a malignant tumor affecting the bony skull

Primary brain tumors are much less common than secondary brain tumors. Primary ones are found to originate very close to the brain itself or in the tissues very close to it, such as the covering membranes of the brain, including the meninges, cranial nerves, pineal, or pituitary gland. It begins with normal cells, which at a later period undergoes some mutational errors in their DNA. The mutation triggers cells to grow and divide at a very high rate while healthy cells keep dying around it. This results in a mass of abnormal cells which gives rise to a tumor. Unlike primary tumors, the secondary tumors begin as cancer elsewhere and spread to the brain.

Symptoms of brain tumor

• Different patterns of a headache
• Headaches get more frequent and acutely painful
• Nausea
• Blurred vision, double vision, or loss of peripheral vision
• Loss of sensation in the arm or any leg gradually
• Balance difficulty
• Speech problems with confusion in simple matters
• Hearing problems
• Personality change
• Sudden seizures and attacks or bouts of pain
  
  

Types of Craniotomy

No matter what the goal of the surgery is, it is best to ensure that the incision is made to address the intracranial lesion keeping some principles in mind. A wide variety of intracranial processes can be done via a craniotomy with a different variety of incisions. Some of these variations include frontal craniotomy, pterional craniotomy, temporal craniotomy, decompression craniectomy, and suboccipital craniotomy.

Deep brain stimulation (DBS) is a neurosurgical procedure that involves implantation of electrodes within the specific targeted areas of the brain. It is used to treat a variety of disabling neurological symptoms. Deep brain stimulation procedure can be opted for treating a number of neurological conditions, including Parkinson's disease, Essential tremor, Dystonia, Epilepsy, Tourette syndrome, obsessive-compulsive disorder and chronic pain. Deep brain stimulation uses a neurostimulator, commonly referred to as deep brain stimulator,  to deliver electrical stimulation to targeted areas in the brain that control movement.

The impulse sent by deep brain stimulator interferes with and blocks the electrical signals that cause tremor and other Parkinson’s disease symptoms. The targeted areas most often include the thalamus, subthalamic nucleus and globus pallidus. Deep brain stimulation procedure has a long history of research. It was first introduced in 1987 and The Food and Drug Administration (FDA) approved deep brain stimulation treatment for essential tremor and Parkinson's disease in 1997.

What is deep brain stimulation treatment?

Deep brain stimulation treatment is recommended for people who have had Parkinson’s disease for at least four years, are still getting benefited from medications, but have motor complications, such as significant on-off time periods. Brain stimulation therapy works by inactivating the parts of the brain that cause Parkinson's disease symptoms. However, DBS Parkinson does not damage the healthy brain tissue by destroying nerve cells. It blocks electrical signals from targeted areas of the brain.

Deep brain stimulation treatment has proven effective in most of the cases, but it could potentially result in serious complications and side effects. This is the main reason why deep brain stimulation treatment is used only for patients whose symptoms are not appropriately controlled with medications.

The spinal cord is a linear arrangement of many small bones known as vertebrae. These vertebrae consist of spaces between them known as intervertebral spaces. They are filled with cartilaginous structures that provide a cushioning effect to the vertebrae and support the movement of the spine. These cartilaginous structures are called Intervertebral discs.

Any pathology of the intervertebral discs such as disc herniation (slipping of the disc from between the vertebrae), ruptured disc, or degenerative disc disease may cause severe back pain due to nerve impingement, indicating the need for either partial or total disc replacement. In partial disc replacement surgery, only a portion of the cartilaginous disc is replaced by the artificial disc, while the total disc is replaced in the total disc replacement surgery.

Cervical disc degeneration and disc rupture may cause chronic neck pain radiating towards the arm.  Thoracic disc degeneration may cause chronic upper/ mid back pain while lumbar disc degeneration may cause chronic lower back pain.

Conditions that indicate the need for a disc replacement surgery:

• Discitis (Inflammation of the intervertebral disc)
• Scoliosis (abnormal spinal curve laterally)
• Herniated disc in back (slipping of the cartilaginous disc into surrounding tissue)
• Disc degeneration and disc rupture (infection of the intervertebral disc causing its degeneration.

Kyphoplasty is also known as balloon kyphoplasty. It is a minimally-invasive surgical procedure that can repair spinal fractures caused by cancer, osteoporosis, or benign lesions. It is not used for spinal stenosis treatment.

Kyphoplasty procedure is designed to relieve the intense pain caused by vertebral compression fractures, to stabilize the bone or to bring back some or all of the lost vertebral body height due to the compression fracture. Kyphoplasty or balloon kyphoplasty is a superb replacement of the typical conventional therapies such as analgesic use, bed rest, and bracing. It is a quick remedy for severe pain due to vertebral compression. It eliminates the pain almost immediately and the risk of complications during kyphoplasty is low. However, it is not intended for the treatment of arthritis or intervertebral disc disease. Kyphoplasty is different from discectomy, which is conducted in case of a herniated disc. Discectomy completely removes the damaged or herniated disc from the vertebrae of the patient.

Laminectomy and vertebroplasty are two other procedures that follow different techniques for stabilizing fractures. Laminectomy works by removing the lamina to create space, vertebroplasty works by injecting cement into the broken or cracked spine. For the same reason, vertebroplasty cost is different from kyphoplasty cost.

Who is the best candidate for kyphoplasty?

Kyphoplasty is typically suggested in case of:

• Severe pain that cannot be controlled by pain-relieving medications
• Severe functional restraints such as inability to walk or stand
• Fractures resulting in loss of height and alignment
• Multiple fractures in spine
• Fractures with radical collapse
• Fractures located at the thoracolumbar junction
• Spondylolisthesis, that is, displacement of one vertebra over another

Laminectomy is also known as decompression surgery. In this surgical procedure, a part of the vertebral bone called lamina is removed to create additional space. The lamina is the back part of the vertebrae that covers the spinal canal. Removing the lamina enlarges the spinal canal and thus, helps relieve pressure on the nerves and the spinal cord. Bony growths, especially in people with spinal arthritis, may put an additional pressure on the spinal cord. It may cause severe back pain and in some severe cases, can even cause paralysis. Narrowing of the space between the vertebrae is also known as spinal stenosis.

Laminectomy surgery, which is a form of spinal stenosis treatment, helps relieve pressure on the spinal cord and the nerves by creating a room between the vertebrae and the cord. When the pressure on the spinal cord in the case of lumbar spinal stenosis is relieved by creating a space between the lumbar vertebrae, the procedure is known as lumbar laminectomy. During a lumbar laminectomy, the surgeon may even remove the ligaments or bone spurs pressing the spinal cord.

Microdiscectomy is also known as microdecompression or cervical microdiscectomy. It is one of the most commonly performed spine surgery procedures.

Microdiscectomy or cervical microdiscectomy is preferred for patients with a lumbar herniated disc. The main goal of a discectomy is to relieve the pressure on a spinal nerve root by removing the material causing the pain. Traditionally, this purpose was solved by an open technique called lumbar discectomy surgery, which involves making a large incision to cut some of the back muscles, leading to a slow and painful recovery. Nowadays, an advanced form of surgery called microdiscectomy can achieve the same goal that too with the help of a small incision and fewer injury to back muscles. As a result, the recovery takes less time and is less painful.  A special microscope is used in microdiscectomy to view the disc and nerves. The larger view allows the surgeon to make a smaller incision, causing less damage to the surrounding tissues.

When is microdiscectomy needed?

Sciatica is a condition caused by compression of the spinal nerve, which generally results in chronic pain in the legs of the patients. This compression of the spinal nerve is frequently the result of a herniated lumbar disc.  As a herniagrows, the damaged tissue extends into the spinal column and pushes on the nerves. This condition causes the nerves to send pain signals to the brain and the brain interprets the pain source to be coming from the legs.

Most commonly, sciatica heals naturally or with the help of medication in a few weeks. But, if sciatica lasts more than 12 weeks after taking oral medicines, patients may benefit from discectomy. Discectomy is also used for the treatment of spondylosis and lumbar spinal stenosis. While spondylosis occurs due to degenerative osteoarthritis of the vertebrae, lumbar spinal stenosis occurs due to narrowing of the spinal canal leading to nerve compression. The latter may also warrant the need for a spinal stenosis surgery.

Scoliosis is a medical condition, characterized by an abnormal curve of the spine. There are different types of scoliosis, depending on the exact location of the abnormal curve and the age of the patient. The abnormal curvature of the spin is the most common symptom of scoliosis.

The spinal curve looks straight when looking from the front. The normal curved of the spine visualized from the sides are known as kyphosis and lordosis. People with scoliosis develop an additional curve in their spine to five it a C-shaped or an S-shaped appearance.

Scoliosis can affect adults as well as children. However, it is most common in patients aged above 10. Additionally, this condition is more common in girls than boys. A sideways curvature of the lumbar vertebrae is also known as lumbar scoliosis.

The most common test used to diagnosed scoliosis is Adam’s Forward Bend Test. During this test, the doctor asks the suspected patient to bend at the waist with palms touching the floor and knees straight. In this position, any abnormality in the curvature of the spine is clearly visible.

Symptoms of Scoliosis

There are no specific symptoms of scoliosis. The appearance of the abnormal curvature of the spine is most often the first sign of scoliosis. The diagnosis of this condition most commonly takes place during an examination at school and college.

In severe cases of scoliosis, breathing difficulty, chest pain, and shortness of breath may appear. Scoliosis is not usually painful. But it can cause neck pain, back pain, abdominal pain, rib pain, and muscle spasms.

Spinal fusion surgery is a type of a spinal procedure used to join two or more bones permanently in the spine and to prevent movement between them. The bones that are joined are called as vertebrae. Spinal fusion surgery is performed along with other surgical procedures such as foraminotomy or laminectomy and after diskectomy in the neck. It is required if the patient has an injury or a fracture of the vertebrae. The spine will become weak due to an infection or tumors. Spinal fusion is also performed in abnormal curvatures that result from scoliosis or kyphosis.