Some people with metastatic brain tumors don't show any symptoms... : MRI Guided Brain Tumor Surgery in India

What Is It?

A metastatic brain tumor is cancer that has spread (metastasized) from another part of the body to the brain. It is also called a secondary tumor, lesion or brain metastasis (plural: metastases). In contrast, a primary brain tumor starts in the brain, not in another part of the body.

A tumor is an abnormal mass of tissue. It occurs when cells divide more than they should or don't die when they should.

Cancers that spread to the brain can originate in any part of the body. The original tumor is called the primary tumor. Metastatic brain tumors most commonly originate in the lung, breast, skin, colon, and kidney. A very aggressive form of skin cancer called melanoma often spreads to the brain.

Brain metastases occur when cancer cells break away from a primary tumor. They travel to the brain, usually through the bloodstream. These cancer cells may settle in the brain and continue growing. Sometimes only one secondary brain tumor occurs. But in many cases there are multiple lesions.

The brain is a complex organ enclosed in the skull. Among other things, it serves as the body's center of

• thought
• memory
• emotion
• speech
• vision
• hearing
• movement.

Symptoms

The signs and symptoms of secondary brain tumors depend on their size and location. This is because different parts of the brain control different functions.

As a tumor grows, it can press against or destroy normal brain tissue. It can also increase pressure inside the skull.

Signs and symptoms of brain metastases include

• headaches
• seizures
• visual changes, such as double vision
• lack of energy and/or sleepiness
• vomiting
• changes in mood, behavior, or personality
• weakness in parts of the body
• trouble speaking or hearing
• problems with memory or mental ability
• loss of balance or coordination.

These symptoms are not necessarily signs of brain metastases. But it is important to contact your doctor if you experience any of them.

Some people with metastatic brain tumors don't show any symptoms. However, over time, the brain metastases will continue to grow, eventually causing symptoms.

Diagnosis

The first step in diagnosis is usually a physical exam. Your doctor will check for general signs of disease. He or she will also ask about your health habits and past illnesses and treatments.

The following tests and procedures may be used to determine whether you have cancer that has spread to your brain.

Neurological and visual exams. These tests assess the your mental and physical abilities, including

• alertness
• muscle strength
• coordination
• reflexes
• response to pain
• eyesight

Tumor marker test. A sample of blood, urine, or tissue is taken. Levels of certain substances that may indicate the presence of cancer are measured.

Imaging tests:

• Computed tomography (CT) scan. An x-ray camera rotates around the body. It makes detailed, cross-sectional images of the brain.
• Magnetic resonance imaging (MRI). Radio waves and strong magnets produce detailed pictures of the brain. MRI is better than CT at finding metastatic brain tumors.
• Positron emission tomography (PET) scan. Radioactive glucose (sugar) is injected into the patient's vein. A rotating scanner highlights areas where cells are consuming the glucose. (Cancer cells use more glucose than normal cells.) PET scans may be used before or after treatment.

Lumbar puncture (spinal tap). Assuming it can be done safely, the doctor may want to remove cerebral spinal fluid from the lower back with a needle in some cases. The fluid is then checked for cancer cells.

Angiogram. A contrast dye is injected into the bloodstream and x-rays are taken. This allows the doctor to examine blood vessels and blood flow in the brain. It may identify blockages such as tumors. However, this procedure is less common than in the past because MRI can often provide the same information.

Biopsy. A small piece of tumor tissue is removed for examination. The tumor tissue may be tested for certain substances that provoke an immune response. It will also be analyzed for changes in the cells and their genetic material.

Biopsy can be done using a needle inserted through a hole in the skull. Or it may be done during surgery to remove a tumor.

Sometimes a biopsy can't be done safely because of the tumor location. In this case, the doctor uses imaging and other tests to make the diagnosis.

Sometimes the primary cancer is discovered after the patient is diagnosed with metastatic brain tumors. If brain lesions are the first sign of cancer, various imaging tests may be done to search for the primary tumor

MRI Guided Brain Tumor Surgery in India

MRI Guided Brain Tumor Surgery is an advanced imaging treatment technique developed to enable neurosurgeons with intra-operative MRI to aid in the removal of complex and difficult-to-access brain tumors during surgery. The technique involves use of a powerful computer system that precisely helps neurosurgeon locate a lesion, plan each step of the procedure on computer screen and find out the ideal access to the tumor before performing the operation.

The technique is particularly helpful in treating a tumor that has difficult accessibility such as it is located deep inside the brain. During the procedure, the instrument movement is tracked very precisely by the computer providing surgeon with total control inside the brain with the help of real-time imaging. The technique also helps the surgeon to check if the tumor has been removed.

The Brain Suite has two main parts. There is a high-intensity MRI scanner integrated with an image-guided surgical system. The MRI scanner has a wide-bore opening allowing a patient to lie on his or her side. Previously, tumors that could only be accessed from the side of the skull were not easy to scan. This special MRI system lets doctors repeat scans during the operation to get more accurate information on the location, shape and size of the tumor. This minimizes problems associated with brain tumors shifting during excision.

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Causes of Epilepsy in Children : Advanced Surgical Procedures for Management of Epilepsy

To understand epilepsy, you first have to understand how the brain functions. The brain controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that normally communicate with each other through electrical activity.

Epilepsy is defined as two or more seizures that occur without a specific cause. Seizures are altered behavior that occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function.

Different kinds of epilepsy are classified according to:

·         Signs and symptoms

·         The child's age when they begin to occur

·         The child’s EEG pattern

·         Neurologic findings on examination

·         Special kinds of imaging (x-ray-type) tests, including magnetic resonance imaging (MRI) and computerized tomography (CT) scans

Seizure Classifications

Focal Seizures

These seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. If the child does not lose consciousness throughout the seizure, the seizure was previously classified as simple. If the child loses consciousness or does not respond appropriately, the seizure was previously classified as complex.

Focal seizures may include one-sided jerking movements of the arms or legs, stiffening, eye deviation to one side or twisting of the body. Sometimes these symptoms follow these other signs:

·         Seeing visions

·         Hearing noises

·         Tasting and smelling things

·         Dizziness

·         A rapid heart rate

·         Dilated pupils

·         Sweating

·         Flushing

·         Stomach fullness

·         Psychic symptoms such as a sense of deja-vu, distortions, illusions and hallucinations

Generalized Seizures

These seizures involve both sides of the brain. As a result, the seizures are less variable than focal seizures.

Typically, they involve brief staring spells; sudden, quick muscle jerks; generalized and rhythmic jerking of the extremities; generalized stiffening episodes; or generalized stiffness followed by rhythmic jerking of the extremities or a sudden loss of muscle tone, resulting in a head drop or sudden fall to the ground.

Causes

Fever (febrile seizures) are caused by fever in children age three months to five years of age, with no other underlying neurologic problems present. Febrile seizures are common and occur in 2-5% of all children. Simple febrile seizures are brief (usually less than five minutes), generalized convulsions that only occur once in the course of an illness.

Metabolic or chemical imbalances in the body may also cause seizures. Conditions that prompt seizures include hypoglycemia (low blood sugar), hypo/hypernatremia (too little or too much sodium in the blood) and hypocalcemia (too little calcium). Meningitis or encephalitis (brain infections) may also induce seizures. Other acute problems that can cause seizures include toxins, trauma and strokes. In children with epilepsy, a common reason for sudden increase in seizures is that the youngsters are not taking their medications as directed.

Trauma at birth or brain abnormalities such as tumors can also be the source of seizures. A lack of adequate oxygen near the time of birth, trauma, infection and stroke can induce a seizure. Sometimes the seizures appear suddenly, although the brain abnormality may have been present for a long time.

Seizures can also develop as a result of a neurodegenerative disease. While neurodegenerative diseases are rare, they can be devastating.

Diagnosis

The best tool the doctor has to evaluate the spells is the child's history. This includes knowing what happened immediately before the seizure, the first indication that something was wrong, a complete description of the event, the level of responsiveness of the child, how long the seizure lasted, how it resolved and what the child did after the event. All or some of the following tests may be used:

·        

Blood tests

·         Electroencephalogram (EEG) – A procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.

·         MRI – A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

·         CT scan – A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) of the body, both horizontally and vertically. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.

·         Lumbar puncture (spinal tap) – A special needle is placed into the lower back into the spinal canal. This is the area around (but not into) the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problem. CSF is the fluid that bathes your child's brain and spinal cord.

Medication

Many types of medications may be used to treat seizures and epilepsy. Epilepsy medications are selected based on:

·         The seizure type

·         Child’s age

·         Side effects

·         Consistent use of the medication

Discuss your child's medication side effects with their physician. While your child is taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following:

·         Blood work: Frequent blood draws testing may be required to check the level of the medication in the body. Based on this level, the physician may increase or decrease the dose of the medication to achieve the desired level. This level is called the "therapeutic level," and is where the medication works most efficiently. Blood work may also be done to monitor the effects of medications on body organs.

·         Urine tests: These tests are performed to see how the child's body is responding to the medication.

·         EEG

You should weigh the risks and benefits of therapy versus the risks of a subsequent seizure before your child begins taking a medicine. Treatment is generally not started after the first seizure in children.

While reports vary, the recurrence risk after the first seizure, if it occurred for no apparent reason, is approximately 40%. The majority of recurrent seizures occur soon after the first event — 50% occur within six months.

The use of only one drug is preferable if possible, as approximately 70% of children become seizure-free on therapy with one medication. Another 15% of children become seizure-free on a combination of several. The final 15% have epilepsy that does not respond to medication.

Other Treatments

·         Ketogenic diet – A strict, high-fat diet useful for generalized seizures that don't respond to medication.

·         Vagal nerve stimulator – A surgically implanted wire around the vagal nerve hooked to a pacemaker device in the chest that is programmed to give intermittent stimulation to the vagal nerve. This device is FDA-approved as adjunctive therapy for partial seizures in children over age 12. However, some researchers believe it’s useful for younger children, as well as in children with intractable generalized seizures.

·         Epilepsy surgery – For some patients, particularly those with focal seizures that don't respond to medication or with identifiable lesions on head imaging studies, epilepsy surgery may be the best treatment.

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