Brain Tumour
Learn about what it is and about new advances in surgery. In this article, we will discuss about:
Often, individuals will receive lots of information, possibly from many people, about the various treatment options. This can be confusing and difficult to comprehend, and extremely distressing if a decision is to be made within a short space of time.
All these make it even more important to consult a neurosurgeon who specialises in the treatment of brain tumours and who can provide tailored advice about treatments and their alternatives.
Types of brain tumours
There are more than 125 different types of the brain tumours. They can be broadly classified into two categories: primary brain tumours and secondary (or metastatic) brain tumours. A primary brain tumour start somewhere in the brain, while secondary (or metastatic) brain tumour originates from other parts of the body and spreads to the brain.
Primary brain tumours are usually referred by their grades and can also be classified based on their cell origin. In Singapore, gliomas, which originates from glial cells, are the most common type of primary brain tumour. Gliomas account for 78% of malignant brain tumours (also known as glioblastoma).
Other common types of primary brain tumours include vestibular schwannoma (acoustic neuroma), meningioma, and pituitary adenoma.
Grades of primary brain tumours
Secondary brain tumours
Note
Symptoms of brain tumours
Symptoms of a brain tumour are closely related to its location within the brain.
For instance, a tumour pressing on the speech pathway will cause speech difficulties, while one that has invaded the tracts in the brain that controls movement can cause weakness in the hand, leg or both.
Other possible neurological symptoms include headaches, seizures, vision problems, imbalance or difficulty walking, confusion in everyday matters, or memory issues.
Do note that symptoms of a brain tumour often resemble those caused by other conditions. If you experience these symptoms and have concerns, consult a specialist to get it checked.
Diagnosis of brain tumours
Accurate diagnosis is crucial for making informed decisions about the appropriate treatment plan.
A comprehensive evaluation, inclusive of medical history and neurological examination, can provide clues to the parts of your brain that could be affected by the tumour.
These assessments guide the selection of the most suitable imaging techniques (such as MRI brain or spine).
Magnetic Resonance Imaging (MRI)
To enhance the visibility of blood vessels around and within the tumour, a contrast dye may be injected through a vein in your arm during the MRI study.
Several specialized MRI techniques, including magnetic resonance spectroscopy (MRS) and functional MRI (fMRI), can further assist your neurosurgeon to better evaluate the tumour and plan treatment.
Diffusion tensor imaging (DTI)
Research studies have shown that tumours grow along the direction of white matter tracts, making DTI important for surgical planning and predicting the likelihood of recurrence.
Knowing where the brain tumour lies in relation to these connections can help neurosurgeons know where to avoid damaging the major tracts during surgery.
Positron emission tomography (PET)
In Singapore, new radiotracers are available for PET scans. These tracers are considered to be safe, disappear from the body within a few hours after administration, and are highly specific.
This special type of PET using new tracers can more accurately determine whether tumour cells are present.
Treatment for brain tumours
Surgery
The first-line treatment of brain tumour is often surgery. Surgery is the standard of care for high grade glioma tumours. The goal of neurosurgery is to remove as much tumour as possible with minimum damage to surrounding healthy brain tissue.
Surgery also provides the opportunity to take a sample of the brain tissue (known as biopsy) for further molecular and genetic testing. These tests provide valuable information for a more accurate diagnosis on the exact type of tumour and predict the patient’s response to certain treatments (such as chemotherapy and radiation).
Advanced surgical techniques, such as minimally invasive brain surgery and awake surgery, are available to enhance precision and patient outcomes. In some patients, a shunt may be necessary before surgery to relieve pressure within the brain.
Alternatives to surgery
If surgery is not immediately possible or necessary, a biopsy can still be performed using a needle (stereotactic biopsy). For patients who may not be candidates for traditional surgery, non-invasive options such as Gamma Knife radiosurgery are available.
Gamma Knife Radiosurgery: This precise radiation therapy targets brain tumours without the need for an incision. It delivers focused radiation beams directly to the tumour, minimising exposure to surrounding healthy tissue. Gamma knife radiosurgery is ideal for small, difficult-to-reach tumours. It is performed as an outpatient procedure, allowing patient return to normal activities within a few days.
Post Surgery Therapies
After surgery, additional treatments such as radiation and chemotherapy may be necessary to target any remaining tumour cells. These therapies can be used alone or in combination to enhance their effectiveness and reduce the risk of recurrence.
Targeted Therapy
Targeted therapy is a new type of personalised cancer treatment that has been increasingly used as a standard of care at leading cancer centres worldwide, including ours. Targeted therapy drugs work by interfering with molecules that help cancer cells grow and spread. These molecular targets are identified with next-generation sequencing.
The difference compared to traditional chemotherapy drugs, is that targeted therapy drugs have a targeted effect on the cancer cells and generally leave normal, healthy cells alone. In contrast, chemotherapy drugs are cytotoxic to most cells, meaning they can damage and kill both normal, healthy cells as well as cancer cells.
Targeted therapy stops cancer cells from dividing and making new cancer cells, while traditional chemotherapy works by killing the cancer cells that have already been made. Hence, targeted therapy often have fewer side effects and, in some instances, is more effective than chemotherapy.
Tumour treating fields (TTF)
A wearable, portable device (Novocure) that produces electric fields (or tumour treating fields) can be used in combination with chemotherapy. The low-intensity electrical fields disrupt the ability of the fast-growing cancer cells to divide and multiply but don't harm the slow-growing normal brain cells.
TTF, when used with chemotherapy, has shown promising results for extending the life expectancy of patients with glioblastoma, the most common and aggressive type of adult brain cancer. This non-invasive therapy offers a new avenue of hope for patients facing this challenging diagnosis.
Watch a Summary
In this video interview, Dr Nicolas Kon answers frequently asked questions about brain tumours in Singapore and the available treatment options for brain tumours uncluding key-hole BrainPath surgery.
A new way of thinking about brain tumour patient care
When we hear about advancements in brain surgery, it’s often a report of a new technology, surgical approach, or techniqu. But, just as important are new ways of thinking that lead to shifts in how we care for patients.
in the last 20 years, the success of brain tumour surgery has mostly focused on how much tumour we remove or how long the patient live after diagnosis. These are still important factors to take into account.
But today, one of our most important goals in brain tumour surgery is to improve or maintain our patients’ quality of life.
Simply extending life expectancy alone is no longer good enough. As new minimally invasive tools become available, our aim is to offer patients improved quality of life on top of highly effective treatment.
Prognosis of brain tumours
Certain favourable factors can significantly improve the prognosis of brain tumours and has been shown to improve overall survival. Brain tumour patients who tend to live longer have:
What can be done to improve surgery outcomes?
Development in the field of neurosurgery has made it possible for neurosurgeons to better visualise exactly where the tumour is and to safely access tumours with lesser risks of serious complications. You should discuss the different available surgical options and a tailored treatment plan with your neurosurgeon.
Top 5 tools used by neurosurgeons in Singapore to improve brain tumour surgery treatment
Key-hole approach
Minimally invasive parafascicular surgery (MIPS) is a key-hole surgical approach which employs minimally disruptive tools to gain a safe passage to hard-to-reach tumours. By using the brain’s natural folds and pathways to reach the tumour, it is possible to minimise cutting through and damaging normal brain tissue.
Awake surgery with intraoperative brain mapping
During parts of the procedure, electrical brain stimulation will be used to map out the areas of the brain critical for speech and movement. You will be woken up and asked to read, speak or perform certain movements. The brain maps generated from the real-time testing and feedback will help identify safe zones for the neurosurgeon and guide tumour removal. Learn more about awake craniotomy and brain mapping for tumour.
Neuromonitoring
Continuously monitoring of brain areas during surgery helps identify the functioning and non-functioning parts of the brain, and to check if the integrity of important brain structures have been affected by the surgery. One of the advantages of intraoperative neurophysiological monitoring (IONM) is that it can be done even when the patient is under general anaesthesia and as an alternative to “awake brain surgery”.
Enhanced visualization with microscope & fluorescence
Intraoperative fluorescence is the use of a special dye to demarcate tumour margins from the surrounding brain. The dye (for example 5-ALA or fluorescein) is given to the patient before or during surgery and concentrates within the abnormal brain tumour cells. When viewed through special filters under the neurosurgeon's operating microscope, the tumour becomes fluorescent and appears “glowing” compared to the surrounding normal brain. This helps the neurosurgeon to better visualise and ensure complete brain tumour removal.
Computer guided neuronavigation technology
Dedicated navigation software and hardware are used by the neurosurgeon to plan the surgical trajectory and implement it with accuracy in the operating room. Much like the GPS system that are used in cars, the neuronavigation system helps with wayfinding around the MRI brain map, to direct and guide the neurosurgeon to the exact location of the tumour.
