Microneurosurgery

Glioma Overview

Glioma is a type of tumor that occurs in the brain and spinal cord. Gliomas begin in the gluey supportive cells (glial cells) that surround nerve cells and help them function.
Three types of glial cells can produce tumors. Gliomas are classified according to the type of glial cell involved in the tumor, as well as the tumor’s genetic features, which can help predict how the tumor will behave over time and the treatments most likely to work.

Types of glioma include:

Astrocytomas, including astrocytoma, anaplastic astrocytoma and glioblastoma
Ependymomas, including anaplastic ependymoma, myxopapillary ependymoma and subependymoma
Oligodendrogliomas, • including oligodendroglioma, anaplastic oligodendroglioma and anaplastic oligoastrocytoma A glioma can affect your brain function and be life-threatening depending on its location and rate of growth. Gliomas are one of the most common types of primary brain tumors.

The type of glioma you have helps determine your treatment and your prognosis. In general, glioma treatment options include surgery, radiation therapy, chemotherapy, targeted therapy and experimental clinical trials.

Types

Symptoms

The symptoms of glioma vary by tumor type as well as the tumor’s size, location and rate of growth. Common signs and symptoms of gliomas include:

Headache
Nausea or vomiting
Confusion or a decline in brain function
Memory loss
Personality changes or irritability
Difficulty with balance
Urinary incontinence
Vision problems, such as blurred vision, double vision or loss of peripheral vision
Speech difficulties
Seizures, especially in someone without a history of seizures

Like most primary brain tumors, the exact cause of gliomas is not known. But there are some factors that may increase your risk of a brain tumor.

Diagnosis

MRI brain with contrast :

It is best tool for diagnosis. Better than CT scan brain. Sometimes if tumour is in vital location , then tractography is useful as well as functional MRI is useful for further treatment planning.

Treatment

Surgery :

is best option for glioma.

Awake brain tumour surgery ( Craniotomy)

If brain tumours are removed under total anaesthesia, sometimes there may be side effects like paralysis or loss of speech after surgery. To prevent such side effects brain surgery may be performed without total anaesthesia. The patient is awake but feels no surgical pain. During surgery the surgeons makes the patient talk and move his/her limbs. This avoids paralysis and loss of speech of surgery.

Awake brain surgery, also called awake craniotomy, is a type of procedure performed on the brain while you are awake and alert. Awake brain surgery is used to treat some brain (neurological) conditions, including some brain tumors or epileptic seizures. If your tumor or the area of your brain where your seizures occur (epileptic focus) is near the parts of your brain that control vision, movement or speech, you may need to be awake during surgery. Your surgeon may ask you questions and monitor the activity in your brain as you respond.

Your responses help your surgeon to ensure that he or she treats the correct area of your brain needing surgery. The procedure also lowers the risk of damage to functional areas of your brain that could affect your vision, movement or speech.

Why it's done

If a tumor or section of your brain that causes seizures needs surgical removal, doctors must be sure that they are not damaging an area of the brain that affects your language, speech and motor skills. It’s difficult to pinpoint those areas exactly before surgery. Awake brain surgery allows the surgeon to know exactly which areas of your brain control those functions and avoid them.

Risks

Some of the risks of awake brain surgery include:

Changes in your vision
Seizures
Difficulty with speech or learning
Loss of memory
Impaired coordination and balance
Stroke
Swelling of the brain or too much fluid in the brain
Meningitis
Leaking spinal fluid
Weak muscles

What you can expect

Before Surgery

Doctors first will determine if awake brain surgery is the right choice for you. Doctors will also explain what you can expect during the procedure and the benefits and risks of awake brain surgery. Awake brain surgery offers many advantages. People who have brain tumors or seizure centers (epileptic foci) near functional brain tissue, whose conditions were once thought inoperable, may consider awake brain surgery to reduce complications and the risk of damage to functional brain tissue. Awake brain surgery may help safely reduce the size of growing brain tumors, which may prolong life and improve quality of life. As with any brain surgery, awake brain surgery has the potential for risks and complications. These include bleeding, brain swelling, infection, brain damage or death. Other surgical complications may include seizures, muscle weakness, and problems with memory and thinking. Before surgery, your neurosurgeon or a speech-language pathologist may ask you to identify pictures and words on cards or on a computer so that your answers can be compared during surgery.

During Surgery

Brain mapping

An anesthesia specialist (anesthesiologist) will give you some medication to make you sleepy for parts of your awake brain surgery. Your neurosurgeon will apply numbing medications to your scalp to ensure your comfort. During the procedure, doctors place your head in a fixed position to keep your head still and ensure surgical accuracy. Some of your hair will be clipped. Your surgeon then removes part of your skull to reach your brain. You’ll be sedated and sleepy while part of your skull is removed in the beginning of the surgery, and also when doctors reattach the skull at the end of the surgery. During the surgery, your anesthesiologist will stop administering the sedative medications and allow you to wake up. If your brain tumor or epileptic focus is close to areas of your brain that control vision, speech or movement, your doctor will conduct brain mapping. This provides your neurosurgeon with a map of the brain centers that control each of these functions. Your surgeon also can perform brain mapping deeper in your brain during surgery. Your neurosurgeon uses this map to avoid damaging these areas and preserve these functions. Brain mapping, along with 3-D computer images, allows your surgeon to safely remove as much of your brain tumor or epileptic focus as possible and lower the risks of damaging important body functions. During surgery, your neurosurgeon or a speech-language pathologist may ask you questions or ask you to identify pictures and words on cards or computer that you saw before surgery. Your doctor may ask you to make movements, identify pictures on cards, count numbers or raise a finger. Your responses help your surgeon identify and avoid the functional areas in your brain. Your medical team also uses detailed 3-D computer images of your brain taken before and during your surgery, including intraoperative MRI and computer-assisted brain surgery, to guide removal of as much of the brain tumor or epilepsy focus as possible. Your anesthesiologist and surgical team carefully monitor and assess your body and brain functions and alerts your surgeon if surgery affects brain function.

After surgery

After surgery, your surgeon may request an MRI to ensure that removal of the tumor or epileptic focus is complete. You’ll probably be in the intensive care unit for a while after surgery and spend about two to three days in the hospital. You generally may return to work and normal activities in six weeks to three months. You’ll have a follow-up appointment with your doctor about three months after surgery.

Results

If you had awake brain surgery to manage epilepsy, you generally should see improvements in your seizures after surgery. Some people are seizure-free, while others experience fewer seizures than before the surgery. Occasionally, some people have no change in the frequency of their seizures. If you had awake brain surgery to remove a tumor, your neurosurgeon generally should have been able to remove most of the tumor. You may still need other treatments, such as radiation therapy or chemotherapy, to help destroy remaining parts of the tumor.

Stereotactic Neurosurgery

Deep seated tumours can be removed

What does it mean?

The brain tumours easiest to remove are the ones located just underneath the skull.

They can be easily exposed by opening the skull. Also, while operating, other parts of the brain are not touched. For the same reason, one of the big- gest challenges in neu- rosurgery is operating deep seated diseases of the brain. Approaching deep tu- mours or other lesions involves moving aside upper brain organs and pinpointing the diseased portion and removing or curing it. Stereotactic Neurosur- gery was invented to pinpoint brain areas so as to reach them accu- rately. A special frame guides the neurosur- geon very precisely to deep seated diseases of the brain. As a result there is minimal damage to structures Stereotactic Surgery Frame