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Brain Tumour Biopsy

Brain Tumour Biopsy - What it is

Overview

Brain Tumour

  • A brain tumour is an abnormal growth of cells present from the brain or its nerves or its coverings
  • It can arise from cells inside the brain/nerves/brain coverings, and can be cancerous or noncancerous
  • It can also be a cancerous growth that has spread to the brain from a cancer present in another part of the body

Tumour Biopsy

  • In some brain cancer cases, removal of some tumour tissue (biopsy) to confirm its nature and its suitability for further treatment (radiation therapy, chemotherapy) may be all that can be done
  • This biopsy is done with MRI-guidance using a special metal frame (frame-based) or a computerised neuronavigation system (frameless)
  • It can be done under Local or General anaesthesia
  • A small scalp incision is needed
  • A small opening, the size of a 10 cent coin, is made in the skull bone
  • A biopsy needle is inserted to take out samples of the brain tumour tissue

Brain Tumour Biopsy - Symptoms

Brain Tumour Biopsy - How to prevent?

Brain Tumour Biopsy - Causes and Risk Factors

Causes

Brain Tumour

  • Overall risk: 3-5%
  • Bleeding: Craniotomy to evacuate the clot may be necessary
  • Infection
  • Negative or inconclusive biopsy
  • Seizures
  • Stroke
  • Non-neurological risks:
    • Risks of general anaesthesia: Heart attack, lung problems, allergy to anaesthetic drugs, etc
    • Blockage of leg veins
    • Chest infection
    • Urinary tract infection
  • Death (remote possibility)

Brain Tumour Biopsy - Diagnosis

Brain Tumour Biopsy - Treatments

Treatment Options
  
After the Biopsy

  • Patients are expected to have same level of alertness as before procedure. They are not expected to be more awake or more drowsy
  • The scalp incision is covered with a small dressing
  • Histology results take a week or longer to be ready

What are the alternatives?

  • Observation i.e. non intervention: Proper treatment cannot be given as type of tumour is unknown. Repeat MRI/CT then biopsy if tumour has grown bigger
  • Radiation therapy/chemotherapy: Given usually when nature of tumour is known, because of risks

Craniotomy and Excision of Brain Tumour

  • This is a brain operation wherein the surgeon makes an opening in the skull bone and removes the brain tumour
  • It may be done under General or Local anaesthesia
  • A scalp incision is made over the area of the brain tumour
  • An opening will be made in the skull bone
  • The outer covering of the brain is opened to expose the brain and the tumour
  • Symptomatic relief from mass effect
  • Improve neurological condition
  • Decrease tumour size of the tumour to improve results of adjuvant therapy (radiation therapy, chemotherapy)
  • Histological diagnosis: No sampling error
  • Complete cure (benign) or improved survival (malignant)
  • The tumour is separated from normal brain and other important structures such as blood vessels and nerves, then removed
  • In cancerous tumours, tumour cells often spreads beyond tumour boundaries into adjacent “normal” brain, so it would not be possible to remove all of it
  • The aim is to remove as much tumour as is safely possible, without injuring the normal brain and other important structures
  • Tumour may be left
    • If stuck to important brain structures, blood vessels, or nerves,
    • If there is excessive bleeding or brain swelling during the operation
  • Second operation or other measures e.g. Radiotherapy/chemotherapy may be required to treat the remnant tumour

Risk Factors

Risks of Craniotomy and Excision of Brain Tumour

  • Overall risk: 5-10%
  • Bleeding: May need second operation to evacuate the blood clot
  • Infection
  • Seizures
  • Stroke
  • Brain swelling
  • Weakness on one side of the body
  • Inability to speak/understand speech
  • Inability to take care of oneself
  • Visual impairment
  • Hormonal and fluid and electrolyte problems (hypothalamic/pituitary tumours)
  • Risks of craniotomy and excision of brain tumour
  • Non-neurological risks:
    • Risks of general anaesthesia: Heart attack
    • Lung problems, allergy to anaesthetic drugs
    • Inability to pass urine
    • Blockage of leg veins
    • Chest infection
    • Urinary tract infection

Risks of Craniotomy amd Excision of Brain Tumour (Infratentorial)

  • Injury to the brainstem
    • Impaired consciousness
    • Possible need for ventilator support
  • Injury to cranial nerves
    • Double vision
    • Facial numbness, facial asymmetry
    • Loss of hearing
    • Difficulty swallowing
    • Slurring of speech
  • Hydrocephalus
    • May need to undergo a ventriculo-peritoneal shunt operation
  • Inability to speak (cerebellar mutism)
  • Involuntary head movements (titubation)
  • Difficulty with walking and balance

Brain Tumour Biopsy - Preparing for surgery

Brain Tumour Biopsy - Post-surgery care

Brain Tumour Biopsy - Other Information

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