Brain Tumor Diagnosis and Treatment

Doctors refer to some brain tumors by grade - from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells look under a microscope. Research and advancement in surgical techniques over the last 20 years have greatly increased the survival rates for patients with brain tumors. Targeted radiation and a better understanding of optimal chemotherapy regimens have not only lengthened the patients’ lives, but also produced less side effects and quicker recoveries. Treatment for a brain tumor depends on a number of factors. Among these are the type, location, and size of the tumor, as well as the patient's age and general health. Brain tumors are treated with surgery, radiation therapy, and chemotherapy; depending on the patient's needs, several methods may be used.

Before treatment begins, most patients are given steroids, which are drugs that relieve swelling (edema). They may also be given anticonvulsant medicine to prevent or control seizures. If hydrocephalus is present, the patient may need a shunt to drain the cerebrospinal fluid. A shunt is a long, thin tube placed in a ventricle of the brain and then threaded under the skin to another part of the body, usually the abdomen. It works like a drainpipe: Excess fluid is carried away from the brain and is absorbed in the abdomen. (In some cases, the fluid is drained into the heart.)

Surgery is the usual treatment for most brain tumors. To remove a brain tumor, a neurosurgeon makes an opening in the skull. This operation is called a craniotomy. Whenever possible, the surgeon attempts to remove the entire tumor. However, if the tumor cannot be completely removed without damaging vital brain tissue, the doctor removes as much of the tumor as possible. Partial removal helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy.

Some tumors cannot be removed. In such cases, the doctor may do only a biopsy. A small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cells it contains. This helps the doctor decide which treatment to use and decide if targeted therapy is an option. In certain cases the biopsy is done with a needle, also known as stereotaxis. The surgeon uses robotic navigation to make a small hole in the skull and then guides a needle to the tumor.

Many patients and their families want to learn all they can about brain tumors and the treatment choices so they can take an active part in decisions about medical care. The doctor is the best person to answer these questions. When discussing treatment, the patient may want to talk with the doctor about research studies and clinical trials of new treatment methods.