0 Health Sense: How to treat brain and spinal tumors

Brain and spinal tumors damage the central nervous system and cause severe disability, even death, if undetected and left untreated. The number of people diagnosed with these tumors is on the increase through better detection and because of our ageing population. These tumors can also affect children. There are two categories of brain and spinal tumors. Some benign and often slow growing such as meningiomas, pituitary tumors and acoustic neuromas. 

These are most often seen in adults and can sometimes reach a large size by the time symptoms appear and are recognized. Early detection means smaller tumor size at diagnosis, making treatment more effective and safer. The second category of tumor is more malignant. They either start in the brain or spinal cord or migrate from elsewhere to that location. Breast or lung cancer can metastasize to the brain or spine. Brain tumors can cause headaches, seizures, weakness of limbs, loss of sensation, and loss of one the senses (smell, taste, vision, hearing, balance). 

However, remember that headaches are common and are more often due to tension and migraine than brain tumors. The presence of the other problems mentioned above should lead one to a doctor for a neurological and spinal examination. Spinal tumors can cause back or neck pain, loss of strength or feeling in the arms or legs or sometimes combinations of these symptoms. Again, neck and back pain is usually brought on by slipped discs, spinal degeneration or bad posture rather than a spinal tumor. 

Evaluation of the problem by a qualified specialist and proper tests, including MRI (magnetic resonance imaging) and CT (computed tomography), can help in diagnosis. MRI does not use radiation but a magnetic field to generate images of the nervous system, brain, and any tumors. The size and location of tumors can be precisely determined. A biopsy is often needed and can either be done during the operation to remove the tumor or by using a needle. 

Needle-type biopsies are often computer-guided using MRI or CT technology for navigation and precision. In the past, treatment for brain and spinal tumors in adults and children was often limited to surgery alone frequently radical removal with large openings. Modern surgery includes high-end neuromicroscopes, computer guidance via MRI and CT scans, and fine tools for tumor removal. New generation laser systems and even technology superior to lasers is now available. 

Parts of the tumor that are difficult or risky to remove can be treated later in other ways, such as radiosugery. Radiosurgery has become a major tool in the treatment of both kinds of tumor. Radiosurgery uses precision, guided energy beams that penetrate painlessly and invisibly to the tumor site without any open operation. In the past, we had the Gamma Knife but now there is a wide range of radiosugery tools including Tomotherapy, LINAC (linear accelerator) systems with micro-multileaf collimators for high precision. Some tumors can be treated by radiosurgery alone without open surgery as the first step. 

Malignant tumors may need several modalities of treatment including surgery, radiation and chemotherapy. There is a new generation of anti-tumor biologics which have fewer side effects than conventional chemotherapy and can be used for malignant tumors including malignant astrocytomas and gliomas. Although brain and spinal tumors can be dangerous — devastating, even — in both adults and children, early diagnosis and the use of advanced technological tools including microsurgery, robotics and radiosurgery are saving many lives throughout the world.

Prem Pillay is the senior consultant neurosurgeon at Singapore Brain, Spine and Nerve Centre in Mount Elizabeth Medical Centre, Singapore.
source : the jakarta post