|
|
/Home//Brain Tumors: Surgery
It is generally accepted that complete or nearly complete surgical removal of a brain tumor is beneficial for a patient. The neurosurgeon's challenge is to remove as much tumor as possible – without injuring brain tissue important to the patient's neurological function (such as the ability to speak, walk, etc.). Traditionally, neurosurgeons open the skull through a craniotomy, to insure that they can fully access the tumor and remove as much of it as possible.
Another procedure that is commonly done, sometimes before a craniotomy, is called a stereotactic biopsy. This is a smaller operation used to obtain tissue, so that an accurate diagnosis can be made. Usually, a frame is attached to the patient's head, a scan is obtained, and then the patient is taken to the operating area where a small hole is drilled in the skull to allow access to the abnormal area. A small sample is obtained, for examination under the microscope.
In the early 1990s, computerized devices called surgical navigation systems were first devised which eliminated the need for exploration. These systems assisted the neurosurgeon with guidance, localization and orientation. This information reduced the risks and improved the extent of tumor removal. In many cases, this allowed previously inoperable tumors to be excised with acceptable risks. Some of these systems can also be used for biopsies, without having to attach a frame to the skull. One limitation of these systems is that they utilize a scan (CT or MRI) obtained prior to surgery to guide the neurosurgeon. Thus, they cannot account for movements of the brain that may occur intraoperatively. Investigators are developing techniques using ultrasound, and performing surgery in MRI scanners, to help update the navigation system data during surgery.
Intraoperative language mapping is considered by some as a critically important technique for patients with tumors affecting language function, such as large, dominant-hemisphere gliomas. This procedure involves operating on an awake patient and mapping the anatomy of their language function during the operation, prior to deciding which portions of the tumor are safe to resect. Recent studies have determined that cortical language mapping may be used as a safe and efficient adjunct to optimize glioma resection while preserving essential language sites.
Ventriculo-peritoneal shunting may be required for some patients with brain tumors. Everyone has cerebrospinal fluid (CSF) within the brain (and spine) that is slowly circulating or flowing all the time. If this flow becomes blocked, the sacs that contain the fluid, the ventricles, can become enlarged, creating increased pressure within the head, called hydrocephalus. If left untreated, hydrocephalus can cause brain damage and even death. The neurosurgeon may decide to use a shunt to divert the spinal fluid away from the brain, and therefore reduce the pressure. The body cavity in which the CSF is diverted is usually the peritoneal cavity (the area surrounding the abdominal organs). The shunt is usually permanent. If it becomes blocked, the symptoms are similar to that of the original condition of hydrocephalus, and may include headaches, vomiting, visual problems, and/or confusion or lethargy, among others.
HealthCare in New York , Nursing Home Library
|
|
Martha's Helping Angels projec
