Benign or malignant neoplasms can be localized in different parts of the brain. Since the tumor is limited to adjacent tissues, its development leads to compression of the brain centers and functional disorders.
In some cases, such a neoplasm leads to the death of the patient. Surgery to remove a brain tumor is considered the highest priority treatment. However, only a doctor should prescribe an intervention, taking into account the available indications and contraindications.
Varieties of operation
In the presence of a neoplasm, an operation is required to remove a brain tumor. However, it is worth remembering that such an intervention is quite traumatic and often impossible to carry out, especially if vital departments are located nearby. The surgeon must carry out the procedure as carefully as possible, without hitting he althy tissue. Among the maintumor removal methods should be highlighted such as:
- trepanation of the skull;
- endoscopy;
- stereotactic trepanation;
- excision of individual bones of the cranium.
Trepanation is an operation in which access to the working area is performed directly in the skull, thus creating a hole. To provide direct access, the surgeon removes part of the bone along with the periosteum.
This is a classic technique and the total duration of the procedure is 2-4 hours. Upon completion of the operation, the hole made in the skull is closed with previously removed bones, and then they are fixed with screws and titanium plates.
Endoscopic surgery to remove a brain tumor is performed using an endoscope, which is inserted inside the skull through a small hole. The course of the intervention is controlled by displaying the image on the monitor. Upon completion of the main manipulations, the excised tissues are removed using a micro-pump, a suction device or electrotweezers.
Stereotactic trepanation implies that open intervention is not required. Instead of a conventional surgical scalpel, photons, a beam of gamma radiation, and protons are used. Such radiation removal of a brain tumor is less traumatic and helps to destroy the neoplasm. This method is mainly used for cancer. It is worth noting that the intervention is painless and does not require anesthesia.
Excision of individual bones of the skull refers totypes of craniotomy. During the operation, some bones of the skull are removed to gain access to the tumor. However, upon completion of all these manipulations, the excised bones are not set in place. They are permanently deleted.
Indications and contraindications
An operation to remove a brain tumor is indicated in cases such as:
- an actively developing neoplasm;
- a tumor that does not tend to grow, but negatively affects parts of the brain;
- located in an easily accessible area of the brain;
- a benign neoplasm that can degenerate into a malignant one.
Despite the fact that conservative treatment in almost all cases ends in the death of the patient, sometimes doctors refuse to perform an operation on a patient. Such a decision is made only in the case when the intervention can be dangerous due to the presence of pathologies. These should include such as:
- exhaustion of the body;
- old age of the patient;
- metastases move to surrounding tissues;
- the tumor is located in a hard-to-reach place;
- prognosis after deletion is worse.
It is worth noting that the decision regarding the operation is made by the surgeon after the diagnosis.
Diagnostics
The diagnosis is established after a whole range of examinations. If a tumor is suspected, a diagnosis should be made. For this, such types of research as tomography and radiography are used.
When neoplasms are detected, a histological examination should be performed. Encephalography is also performed.
Preparation
The main stage of preparation is a careful calculation of access to the affected area and the selection of excision techniques. The surgeon must necessarily calculate the risk of injury. If necessary, before the operation, such measures are taken as:
- decrease in intracranial pressure;
- stabilization of the patient's well-being;
- biopsy.
Pressure is reduced by the use of medications or directly on the operating table. A biopsy is an analysis that involves taking a small piece of neoplasm tissue to study its structure. It is worth noting that such a procedure can be a certain complexity and some danger to the patient. That is why this type of study is used only for certain types of tumors.
Operating
Often, the intervention is performed under general anesthesia. A tube is inserted into the patient's throat to maintain normal breathing. However, it is worth noting that with some localizations of the neoplasm, it is necessary for the person to remain conscious. For this, local anesthesia or temporary withdrawal of the patient from a state of sleep can be used. The doctor will ask questions to determine if the brain centers responsible for thinking, memory and speech are affected.
Stereosurgical techniques are performed without anesthesia or under local anesthesia. It's connectedwith no punctures or cuts.
During an open operation, the doctor marks certain parts on the patient's head with brilliant green or iodine. This is required for more precise actions of the surgeon. A line is drawn that connects the ears, as well as from the bridge of the nose to the base of the skull. The resulting squares are divided into smaller ones. According to this markup, the surgeon draws a scalpel.
After the soft tissue incision procedure, the bleeding is stopped. Vessels are sealed by heating or applying an electric discharge. The surgeon then folds back the soft tissue and removes the bony segment of the skull.
Removal of a brain tumor is carried out without dissection with a scalpel or scissors. This reduces the risk of damage to brain structures. Then the vessels that feed the neoplasm are cut.
If more complete removal of the tumor is required, additional bone removal may be necessary. If the bone is affected by metastases and cannot be restored, then it is replaced with an artificial prosthesis. After the tumor is removed, the bone sections or prostheses are put in place and fixed. Soft tissues and skin are sutured.
Endoscopic surgeries are rare. Indications are pituitary tumors. Depending on the size and location of the neoplasm, it is possible to do without incisions or minimize their number. Access is through the nasal passage or oral cavity. The operation is attended by a neurosurgeon and an ENT.
After the insertion of the endoscope, the doctorgets an image of the internal structures on the screen. The tumor is removed and then removed. After this, coagulation of the vessels may be required. If the bleeding cannot be eliminated, then the doctor performs an open intervention. After the operation, there are no stitches and cosmetic defects, and there are no painful manifestations.
Stereosurgery is characterized by the fact that no incision or puncture is made during the intervention. A beam of a certain wavelength is used as a tool. The cyberknife system is considered a modern technique. With its application, radiation is directed directly at the tumor. Initially, special immobilizing devices are prepared. A series of images is then created to create a highly accurate model of the tumor. This allows you to calculate the optimal dose of radiation and determine how it is delivered. The course of therapy is 3-5 days, and during this period there is no need for hospitalization.
Post-operative period
Rehabilitation is required after removal of a brain tumor. A set of restorative techniques and measures is selected separately for each patient, depending on the severity of the intervention and individual parameters.
Rehabilitation after brain tumor removal surgery implies:
- relapse prevention;
- restoration of lost or impaired brain functions;
- psycho-emotional adaptation;
- life skills training for lost function.
Rehabilitationimplies the complex work of specialists such as:
- neurosurgeon;
- neurologist;
- psychologist;
- physiotherapist;
- speech therapist;
- ophthalmologist.
Rehabilitation after removal of a brain tumor basically begins immediately after the operation and, with a successful outcome of the intervention, lasts 2-4 months. During this period, you need to be patient. Depending on the type of neoplasm, violations of certain functions can be assigned such measures as:
- physiotherapy treatments;
- massage;
- physiotherapy exercises;
- reflexology;
- classes with a speech therapist;
- chemotherapy course;
- spa treatment.
After removal of a brain tumor, rehabilitation implies the limitation or exclusion of certain factors, such as:
- physical overwork;
- contact with chemicals;
- impact of adverse external factors;
- bad habits.
Carrying out all the required measures and observing the restrictions increases the patient's chances for a successful recovery.
Radiation therapy and chemotherapy
Chemotherapy is indicated after removal of a brain tumor. Such a treatment technique implies the use of medications, the effect of which should be aimed at the rapid destruction of pathological cells. This type of therapy is usedalong with surgery. Among the main ways of administering drugs, it is necessary to highlight:
- oral;
- intravenous;
- directly into the tumor or nearby tissues;
- intramuscular.
The choice of drug for treatment largely depends on the sensitivity of the neoplasm to it. Therefore, chemotherapy is prescribed mainly after a histological examination of the tumor tissue.
After surgery to remove a brain tumor, radiation therapy is also prescribed. Cancer cells are more sensitive to radiation than he althy ones due to the active metabolic process. This type of therapy is used not only for malignant, but also benign tumors in case they spread to areas of the brain that do not allow surgery.
Risks of the operation
The risks after removal of a brain tumor are mainly related to the size of the tumor and its location in the brain. The involvement of the vessels of this organ also plays a very important role. If the neoplasm is small and located in a favorable area, the risk of intervention is negligible. The risk is greatly increased if a very large tumor is to be removed.
Proceeding from this, it is important to consult specialists before the operation. Thanks to modern techniques, the risk of removing the tumor is significantly reduced.
Forecast
The state after removal of a brain tumor depends onfeatures of the neoplasm, the professionalism of the surgeon, as well as the features of the rehabilitation. In about 60% of patients, all functions are fully restored. Mental disorders are very rare and occur within about 3 years after surgery. Only in 6% of cases there is a violation of brain activity and a person loses personal service skills, as well as the ability to communicate.
Depending on the condition of the patient, he may be assigned a degree of disability, restrictions on work and extended sick leave. Survival after surgery largely depends on the age of the patient and the nature of the neoplasm.
Possible Complications
After removal of a brain tumor, the consequences can be very different, in particular, such as:
- partial impairment of brain function;
- epileptic seizures;
- deterioration of vision.
All these signs are associated with disruption of connections in nerve fibers. With the help of long-term drug and therapeutic correction, it is possible to achieve a complete restoration of the functional capabilities of the brain. Among the consequences of the operation to remove a brain tumor, the following should be highlighted:
- disruption of the digestive system;
- paralysis;
- memory deterioration;
- infection.
Patients may experience recurrence after tumor removal. The chances of recurrence of the tumor are much higher if it is not completely removed.
Cost and reviews
The cost of surgery is calculated separately for each patient and depends on many different factors. In foreign clinics, the cost of the intervention is about 25 thousand dollars, and in domestic clinics - about 8 thousand. The cost of endoscopic intervention is approximately 1.5-2 thousand dollars.
Reviews about the removal of a brain tumor are mostly positive, especially when the intervention is performed by qualified surgeons. However, not all reviews are good, as some patients are not able to lead a normal life. And sometimes there are relapses and complications.
