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Brain Tumors, Types, Symptoms, Diagnosis and Treatment Methods

In this content we have prepared about Brain Tumors, Types, Symptoms, Diagnosis and Treatment Methods, Superficial Metastatic Brain Tumors, Deep Metastatic Brain Tumors, Skull Base Tumors, Posterior Fossa Tumors Surgery, Corner Tumors Surgery, Skull Bone / Simple Tumoral Masses of Scalp, 3 Topics include Intraventricular Tumors, 4. Intraventricular Tumors, Convexity Tumors Surgery, Cervical Intramedullary Tumor Excision.

Superficial Metastatic Brain Tumors

Metastatic brain tumors are the name given when the tumor has spread to the brain from another part of the body. In superficial metastatic brain tumors, the area where the brain tumor is located is the outer surface of the brain. Metastatic brain tumors are the most common type among brain tumor types. Metastatic type brain tumors, which are more common than all other types of brain tumors, are seen in 20-50% of cancer patients according to autopsy studies.

The most common types of cancer that cause metastatic brain tumors are breast cancer in women and lung cancer in men.Metastatic brain tumors usually occur as a result of cancerous cells from another region reaching the brain through the blood. Cancerous cells mixed with the blood, progress to the brain and cause the formation of new cancerous cells in that area. Therefore, metastatic brain tumors occur most frequently in areas of the brain with more blood circulation.

Metastatic brain tumors often occur more than once. In this direction, the path to be followed in the treatment of metastatic brain tumors is planned according to the number, size and region of metastases.On the basis of metastatic brain tumors, since they consist of cancerous cells that grow and multiply abnormally, the area they cover in the brain causes an increase in intracranial pressure.

Therefore, the symptoms of metastatic brain tumors are similar to those of increased intracranial pressure. These symptoms can be listed as nausea, vomiting, visual disturbances, loss of strength in different parts of the body depending on the affected area of ​​the brain, tingling, loss of sensation and in some cases seizures. When such symptoms occur, especially in a patient with cancer, a doctor should be consulted quickly and necessary examinations should be performed.

After the detection of metastatic brain tumors, chemotherapy, radiotherapy, surgery or combinations of these treatment methods can be used depending on the patient’s condition during the treatment process. If metastatic brain tumors are not treated in a short time, they pose a very serious life-threatening risk. The most commonly used treatment method is radiotherapy.

In radiotherapy, the growth and proliferation of tumor cells is stopped by radiation and these cells are destroyed and the tumor is reduced. The effectiveness of radiotherapy varies depending on the cancerous cell type. While some cancer cells are intensely affected by the applied radiation and are easily controlled, some cancerous cell types are not sufficiently affected by radiotherapy. In such cases, surgical options may be required in addition to radiotherapy.

Surgery for metastatic brain tumors is mostly performed on tumors that are not diffuse, located in a certain region, and cause neurological symptoms. The fact that the metastatic brain tumor is superficial reduces the side effects and risks of surgery, as it facilitates the detection of the tumor before the surgery and the access to the tumor during surgery and causes less damage to the brain tissue.

Radiotherapy or chemotherapy treatment can be applied to support the treatment after metastatic brain tumor surgery. Although chemotherapy is not as effective as surgery or radiotherapy in metastatic brain tumors, it may contribute to prolonging the survival of some types of cancerous cells.

Deep Metastatic Brain Tumors

Deep metastatic brain tumors, on the other hand, are the deep tissue of the brain where the brain tumor is located. In metastatic brain tumors seen in the deep tissues of the brain, complex functions such as mood regulation, memory and learning functions of the patient may be affected depending on the region of the tumor. The fact that the metastatic brain tumor is deep increases the side effects and risks of surgery, as it makes it difficult to detect the tumor before surgery and to reach the tumor during surgery.

Skull Base Tumors

The skull base is a complex anatomical bone structure formed by the frontal, ethmoid, sphenoid, temporal and occipital bones, acting as a barrier between the brain and neck tissues. Since clinical evaluation of skull base tumors is limited, computed tomography (CT) and magnetic resonance imaging (MR) imaging methods play a very important role in the diagnosis and treatment process of such patients.

Especially in recent years, with the developments in imaging methods, it has been possible to clearly determine the borders of tumors before surgery, as well as to reveal the relationships of tumors with vital neural and vascular structures, and thus, surgeons have become able to develop approaches that will reduce vital risks as much as possible and ensure tumor cleansing in the best way possible.

It is important to know the anatomy of the skull base in detail in order to correctly evaluate the locations, extents and relations of the tumors in the skull base with the important tissues around them and to determine the characteristics of the tumors. The skull base consists of different bones called frontal, ethmoid, sphenoid, temporal and occipital.

The skull base is a very complex anatomical structure with many different holes and grooves formed and possessed by these bones, and it acts as a barrier between the intracranial tissues and the extracranial soft tissues. In addition, it is the most important structure that protects the vital structures in the head from external factors. Benign and malignant bone tumors and metastases in the skull base can be seen. Metastatic tumors are among the most common types of tumors in the skull base in adult patients.

Since metastatic tumors often spread through blood, they occur mostly in skull base structures where bone marrow is dense, such as the clivus, petrous apex, sphenoid triangle, and diploic cavity in the calvarium. Apart from that, the most common malignant tumor in the skull base is osteosarcoma, and it is usually seen in people who have received radiotherapy before and in patients with Paget’s disease.

Osteosarcomas are characterized by bone formation and the accompanying aggressive osseous membrane response. Apart from these, skull base tumors can be seen in many different regions and shapes. They can cause different symptoms depending on the area they occur, the type, extent, and size of the tumor, and in advanced cases, they can pose a life-threatening risk and cause permanent damage to the patient.

Depending on the region of the tumor, anatomical structures such as frontal fossa, temporal fossa, sphenoid bone, and clivus may be affected. Among these, frontal fossa tumors are types of tumors that affect the anterior region of the skull base. Temporal fossa tumors are tumors that arise on the lateral sides of the skull base. Sphenoid bone, which is another region where skull base tumors can be seen, is a bone located both in the middle of the skull base and contributing to the formation of the anterior part of the temples.

Another structure, the clivus, is responsible for protecting the brain and separating the brain from other structures around the face and neck. Skull base tumors can occur in many different regions in this way. They can cause different effects both in the brain and in the surrounding tissues, depending on the region they are located in. In this direction, skull base tumors can manifest themselves with many different symptoms in the patient they occur in, and in some cases, they can pose serious life risks if they are not controlled.

Posterior fossa tumors surgery

The posterior fossa is the name of the anatomical structure that corresponds to the posterior one-third of the head. The regions where brain tumors occur may vary according to age. Posterior fossa tumors can be found in two regions as supratentorial and infratentorial. Approximately 70-75% of brain tumors in adult patients are seen in the region called the supratentorial region, between the cerebellum and the brain, but close to the brain.

In childhood, the rate of tumors located between the cerebellum and the brain, but close to the brain, called the infratentorial region, is at the level of 60-70%. The symptoms and signs of posterior fossa tumors develop primarily due to increased intracranial pressure and secondarily to pressures on the cerebellar nuclei and neurological structures called the brain stem.

In addition, cerebrospinal fluid (CSF) found in our body along our brain and spinal cord can cause a health problem in which the cerebrospinal fluid, called hydrocephalus, accumulates and causes an increase in intracranial pressure by blocking the circulation pathways, and the patient may consult a doctor with the signs and symptoms of hydrocephalus.

Different findings can be seen in patients with posterior fossa tumors depending on the location, type, size of the tumor and the general condition of the patient. However, in general, patients apply to the doctor with symptoms such as headache, nausea, vomiting, dizziness, balance disorder, ataxia with impaired coordination in movements, diplopia, which is a kind of visual disorder that causes multiple vision, loss of strength, and visual impairment. Due to the structure of the posterior fossa, the time between the appearance of the patient’s complaints and the diagnosis of posterior fossa tumor is very short compared to other brain tumors.

Depending on the severity of the tumor, this period can be shortened even more and can be reduced to 1 week. However, in some benign tumors, this period may extend up to 1 year. After the diagnosis of posterior fossa tumor is finalized, the method of treatment is decided. When surgical treatment is decided, the tumor should be determined in detail before posterior fossa tumor surgery, the surrounding tissues should be mastered, and support should be obtained from advanced imaging methods while creating the surgical procedure.

After the surgical procedure is determined by the surgeon, surgery in posterior fossa tumors is mostly performed in a sitting position with the help of a nail head. However, this may vary depending on the general condition of the patient and the surgeon’s viewpoint. Depending on the location of the tumor, the tumor can be removed by entering from different areas. In the same way, depending on the region and structure of the tumor, all or part of it can be removed.

In cases where the tumor is malignant or cannot be completely removed, treatment methods such as chemotherapy and radiotherapy are also used in addition to surgical treatment. The treatment of posterior fossa tumors has made great progress in recent years with the development of diagnosis and treatment methods, the advancement of surgical techniques and surgical technologies, advances in supportive treatments, and the support of treatments such as chemotherapy and radiotherapy, and thus, promising results are achieved for patients with treatment.

Corner Tumors Surgery

In medical terminology, the junction of the cerebellum and brain stem is defined as the corner. Many different types of tumors can occur in this region. However, the most common type of tumor that comes to mind when the corner tumor is mentioned is the tumors arising in the sheath of the eighth cranial nerve, the vestibular nerve, which is responsible for balance and hearing. These types of tumors are usually benign and slowly progressive tumors.

Corner tumors often cause hearing and balance problems because they press on the vestibular nerve. If the corner tumor grows too much, it can spread to the face and press on the nerve responsible for perceiving the facial sensation. In such cases, facial numbness may occur. Tumors that grow even more can cause pressure on these nerves, which can cause serious damage, and the findings can reach up to facial paralysis.

In the same way, an overgrown corner tumor can cause life-threatening injuries to the patient by pressing on the brain stem and may cause serious permanent damage to the patient. Corner tumors are mostly seen unilaterally. However, in the presence of a disease called neurofibromatosis type 2, corner tumors can also be seen bilaterally.

Among all brain tumors, the rate of corner tumors is 8%. Early diagnosis is very important so that the tumor does not grow and cause permanent damage or life-threatening findings. In most corner tumor patients, the first symptom appears as hearing loss. Symptoms such as dizziness, headache, and tinnitus may also occur due to vestibular nerve involvement. In corner tumors that reach serious sizes, facial paralysis, double vision, swallowing disorders, facial pain and numbness can be seen .

For this reason, it is important to consult a doctor while the symptoms are still at an early stage for early control of the disease. While planning the surgical treatment of corner tumors, the surgical procedure is determined according to the type of tumor, its relationship with other nerves, and the condition of the surrounding tissues. Surgical treatment is easier in small tumors detected with early diagnosis and the risk of undesirable side effects such as hearing loss after surgery is very low.

However, surgery is more difficult in large tumors, and the nerves and surrounding tissues in the region may be permanently damaged due to the intense pressure created by the tumor. In such cases, even if the tumor is completely removed by surgery, the damage caused by the tumor may be permanent. Surgical treatment gives very good results for corner tumors and the risk of recurrence of corner tumor after surgery is less than 5%. Apart from the damage that the tumor may leave, the surgical treatment itself may have some complications.

These complications can be listed as leakage in the cerebrospinal fluid, meningitis, which is the inflammation of the membrane called the meninges that surrounds the brain and spinal cord, hydrocephalus, which is an excess of cerebrospinal fluid, and wound infection. Apart from these, another complication that is more common especially during the surgery of large corner tumors is facial paralysis.

The risk of facial paralysis in corner tumor surgeries has been reported as 5-30%. After the corner tumor is removed with surgery, even if there is no permanent damage, balance problems and headache may continue for a long time. Today, thanks to the developing surgical techniques and surgical technologies, corner tumors can be treated with much less complications and much more effectively.

3. Intraventricular Brain Tumors

Ventricles are chambers in the brain filled with spinal fluid. There are 4 ventricles in the human brain. Brain tumors can develop within these ventricles. The incidence of intraventricular tumors is 12-20% among all types of intracranial tumors.

15% of intraventricular tumors are located in the third ventricle . Symptoms may be delayed in patients with intraventricular tumors due to the slow growth of intraventricular tumors over time. In addition, due to the late appearance of symptoms, the diagnosis may be delayed and large tumors may be encountered.

In intraventricular tumors, preoperative evaluation, patient planning, patient management and the type of surgical treatment are important issues. The location, size and cellular structures of intraventricular tumors, their spread in the ventricle, the main nutrients of the tumor structure, the functional brain areas affected by the tumor and the degree of neurological disorders in the patient are important topics.

The aim of intraventricular tumor surgeries is to reach and remove the relevant tumor in a way that will most protect the important vessels and brain tissues in the brain. Headache, vision problems, difficulty in speaking, confusion, irritability, urge to vomit, high fever, sensory loss and tingling sensation, neck stiffness, seizure symptoms such as diarrhea may occur.

Apart from these, depending on the characteristics of the tumor, symptoms such as movement disorders, paralysis of some nerves, partial or complete visual disturbances and hormonal disorders may occur in the patient. It makes use of these symptoms, clinical tests and imaging methods during the detection of intraventricular tumors.

With the help of computerized brain tomography and magnetic resonance spectroscopy, the region of the intraventricular tumor can be detected and treatment can be planned accordingly. Surgical planning of the tumor, in which its location and characteristics are determined, is a challenging and vital procedure. In this planning, the surgeon considers the characteristics of the brain tissues that may be damaged, the importance of these tissues in the functioning of the body, and the complications that may occur after surgical treatment, while determining the surgical route to be used to reach the intraventricular tumor.

Intraventricular tumor surgeries are challenging surgeries both as a planning stage and as a practice. It is important that the surgeon has a high command of all structures directed to the ventricle. In line with the surgical planning, the surgeon determines the intracranial route to be used to reach the intraventricular tumor and where to enter the intracranial cavity.

Depending on the characteristics of the surgery and the procedure to be followed, the risks of complications that may occur during or after the surgery may vary. As a result, the aim of this type of surgery is to remove the intraventricular tumor in the most effective way, with the least possible problem for the patient. After the surgical intervention, depending on factors such as the removal of the effect of the tumor on the area where the tumor is located, and the decrease in intracranial pressure, improvement in symptoms and full recovery can be observed without any dysfunction.

4. Intraventricular Tumors

5% of intraventricular tumors are located in the 4th ventricle . 4. Headache, vision problems, difficulty in speaking, confusion, nervousness, urge to vomit, high fever, sensory loss and tingling sensation, neck stiffness, seen in increased intracranial pressure depending on the size, shape and region of the tumor in intra-ventricular tumors and symptoms such as seizures. It is important that the surgeon has a high command of all structures related to the ventricle, especially since there are structures around the 4th ventricle that can cause serious permanent health problems in the patient if damaged. .

Simple tumoral masses of skull bone/scalp

Since clinical evaluation of skull tumors is limited, computed tomography (CT) and magnetic resonance imaging (MR) imaging methods play a very important role in the diagnosis and treatment process of such patients. It is important to know the skull anatomy in detail in order to correctly evaluate the locations, extents and relationships of the tumors in the skull with the important tissues around them, and to determine the characteristics of the tumors.

The skull consists of different bones called frontal, ethmoid, sphenoid, temporal and occipital. The skull is a very complex anatomical structure with many different holes and grooves formed and possessed by these bones, and acts as a barrier between the intracranial tissues and the extracranial soft tissues. Benign and malignant bone tumors and metastases can be seen in the skull. Metastatic tumors are among the most common types of tumors in the skull in adult patients.

Because metastatic tumors often spread through the blood, they occur mostly in skull structures where bone marrow is dense, such as the clivus, petrous apex, sphenoid triangle, and diploic cavity in the calvarium. Apart from that, the most common malignant tumor in the skull is osteosarcoma, and it is usually seen in people who have received radiotherapy before and in patients with Paget’s disease. Apart from these, skull tumors can be seen in many different regions and shapes.

Apart from the skull, some tumoral formations can also be seen on the Approximately 2% of skin tumors are seen in the scalp. These tumors can arise directly on the scalp or metastatically transmitted from another body region. The presence of hair on the skin often complicates the detection of the tumor and delays the diagnosis.

This situation can cause the tumor that occurs on the scalp to progress too much until it is detected and the treatment of the disease can be difficult. While 1-2% of all scalp tumors are malignant, 13% of all malignant skin tumors are scalp tumors. Factors that may pose a risk for malignant tumors in the scalp can be listed as exposure to ultraviolet, receiving radiotherapy, and genetic predisposition.

In some studies, it is stated that especially men with short hair are at more risk because they are exposed to more ultraviolet, while women are at less risk thanks to the protection of their hair from ultraviolet. For this reason, measures such as not being exposed to the sun for a long time when the sun is so intense that it can be harmful and wearing a hat if necessary are important to protect from the risks of scalp tumors.

Convexity tumors surgery

Convexity tumors appear as convexity meningiomas. Meningiomas are slow-growing and mostly benign tumors that occur in the membranes surrounding the brain. For this reason, it may show a slight improvement in the findings.

Due to the development of imaging techniques such as computed tomography and magnetic resonance imaging, and more frequent radiological examinations, the incidence of incidental detection of these types of tumors has increased. Meningiomas are technically not brain tumors, as they arise in the lining of the brain, not inside the brain.

However, meningiomas cause brain-related symptoms due to the pressure they create on the brain. Patients with meningioma most often consult a doctor because of a slowly progressing headache. However, in most cases, meningiomas can remain silent for life without causing any symptoms. In such cases, these meningiomas are detected only after check-up or during examinations performed for other reasons.

Although convexity meningiomas generally occur in the upper and outer parts of the brain, they may cause different findings in the patient depending on the area they occur. These findings can be listed as headache, seizure, weakness in the arms and legs, vision and hearing loss, difficulty in thinking clearly, walking problems, and loss of smell. However, due to uncontrolled growth, tumors that grow too much can cause very serious life problems by causing intense pressure on the brain and even the spinal cord.

These problems can be listed as headaches that cannot be relieved with painkillers, paralysis, hormonal disorders, vision loss, epileptic seizures, brain hemorrhages. The exact causes of meningiomas are not known. However, studies suggest that factors such as genetic factors, radiation exposure, head trauma and hormonal changes are factors in the formation of meningioma.

Since meningiomas generally do not metastasize, progress slowly and are benign, their treatment and control can be done easily when detected early. However, this slow progression and the slow emergence of signs sometimes complicate the diagnosis and cause the tumor to progress. Therefore, imaging methods and neurological examinations are very important for early diagnosis.

After the diagnosis of a convexity tumor, surgical treatment is often the first treatment option. However, sometimes, depending on the shape, size, location and extent of the convexity tumor, it may not be possible to completely remove the tumor or surgical intervention may have high vital risks. Other than that, clinical follow-up may be preferred instead of surgical treatment in convexity tumors that are detected incidentally and are small in size, although they are asymptomatic.

If it is determined during the follow-up that the convexity tumor does not grow, does not reach the size that can harm the patient even if it grows, and is of the type that shrinks during the menopause, the patient can survive without treatment. However, if it is determined that the tumor has grown and caused the patient’s symptoms during the follow-up, surgical treatment option is applied. Surgery for meningioma often results in high success, and the patient’s findings improve greatly after surgical treatment.

Useful Source: https://www.turnog.com/turnogDATA/userfiles/file/Meningiomlar.pdf

Cervical intramedullary tumor excision

Spinal cord tumors are tumors that appear on the spinal cord. They are generally defined as benign and slow growing tumors. About 1 in 5 central nervous system tumors are found in the spinal canal. Spinal cord tumors are grouped as extradural, intradural extramedullary and intramedullary (inside the spinal cord) according to their location.

Extradural tumors are tumors located outside the dura mater membrane that surrounds the spinal cord. Intradural extramedullary tumors are tumors located outside the spinal cord, inside the dura mater. Intramedullary tumors are tumors located in the dura mater and spinal cord. While the majority of intradural extramedullary tumors are schwannoma-neurofibroma and meningiomas, a small portion of them are dermoid, epidermoid, angioma lipoma and ependymoma type tumors. Intramedullary tumors are usually of the ependymoma and astrocytoma type.

In addition, intramedullary tumors such as hemangioblastoma, dermoid, epidermoid, lipoma, teratoma and oligodendroglioma can be seen. Tumors of the ependymoma type are most common in adults. It often involves the lumbosacral region. Tumors of the astrocytoma type are more common in children and teenagers. They are usually located in the thoracic and cervical regions. Spinal cord tumors may show different findings according to their localization, nerve and spinal cord parts that they affect. The most common symptom of most spinal cord tumors is pain. Pain may occur in different parts of the spine, its localization may vary and may increase with physical activity. When the tumor presses on the spinal cord, signs of spinal cord compression occur.

Findings such as numbness, pain and tingling in the neck and arms are seen in a compression in the cervical region. Spinal cord tumors are characterized by progressive weakness, loss of sensation spreading to the arms and legs, pain and numbness. Depending on the nature of the tumor and its growth rate, the findings may worsen slowly or rapidly. Spinal cord tumors can be diagnosed with computed tomography, magnetic resonance, scintigraphy or positron emission tomography. A biopsy may be performed to examine the structure and type of the tumor. Various surgical treatment methods are applied in spinal cord tumors.

The aim of surgical treatment is to remove the tumor completely or partially and to relieve the pressure caused by the tumor. The surgical treatment method is decided by evaluating the characteristics such as benign or malignant character of the tumor and the structure of the tumor. In cervical intramedullary tumor excision, the area where the tumor is located on the spinal cord is excised. Intradural and intramedullary benign tumors that are not very large are easily removed. Cervical intramedullary tumor excision surgery can be performed together with laminectomy or laminotomy techniques when necessary.

When cleaning the spinal cord alone is not enough, the vertebral sections in its close neighborhood can also be removed. If the tumor is not completely removed after surgery, there is a possibility of the tumor regrowth. In this case, additional treatments such as chemotherapy and radiotherapy are applied to prevent the tumor from growing again. Hygiene of the operation area is very important after cervical intramedullary tumor excision.

Regular dressings, avoidance of heavy physical activity and not interrupting drug therapy will accelerate healing. After a successful cervical intramedullary tumor excision, the patient’s signs of spinal cord compression disappear. Recovery time varies depending on the size of the tumor.

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Our health guide contents have been prepared for informational purposes only and with scientific data on the date of sharing. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.

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