Brain & Spine Tumors
Dr. Prem Pillay, Singapore
Introduction
Brain and spine tumors refers to tumors that grow in or around the brain and the spinal cord and can cause severe disability and even death if undetected and untreated by damaging the central nervous system. According to Dr Prem Pillay, a Senior Neurosurgeon in Singapore, the number of people affected by these tumors is increasing because of better detection and also our aging population. These tumors can also affect children.
There are two categories of brain and spine tumors. There are those that are benign and often slow growing such as Meningiomas, pituitary tumors and acoustic neuromas. These are often seen in adults and can sometimes reach a large size by the time symptoms appear and are recognized. Dr Prem Pillay advocates early detection in order to increase the chance of a smaller tumor size at diagnosis. This could make treatment more effective and safer . The second category of tumors are those that are more malignant. They either start in the brain or spinal cord or come from elsewhere to that location. Someone who has breast or lung cancer can have spread of this cancer to the brain or spinal location. Malignant tumors that start in the brain or spinal cord are often Gliomas including astrocytomas.
Diagnosis
Brain tumors can cause headaches, seizures, weakness of a limb or limbs, loss of sensation, and loss of one the senses (smell, taste,vision,hearing, balance). However, Dr. Prem Pillay cautions that headaches are common and are more often from tension and migraines than a brain tumor. However, the presence of the other problems mentioned should lead one to a doctor for a neurological and spinal examination. Spine tumors can present with back pain, neck pain and loss of strength or feeling in the arms or legs or sometimes both. However, again Dr. Pillay observes that neck and back pain is often from slipped discs or spine degeneration rather than a spine tumor. Evaluation of the problem by a qualified specialist can help in arriving at a diagnosis and the proper use of tests including MRI and CT (computed tomography).
In order to confirm the diagnosis, useful tests include MRI of the brain and the spine. The MRI does not use radiation but a magnetic field to arrive at images that can clearly show the nervous system of the brain and the spine and any tumors. The size and location of tumors can be precisely determined. A Biopsy is often needed to know the tumor type. This can either be done during the operation for tumor removal or using a needle. The needle type biopsies are now often computer and image guided meaning that MRI or CT technology is used for navigation and precision.
Modern Treatments
In the past the treatment modalities for brain and spinal tumors in adults and children was often limited to the use of surgery alone often with attempts at radical removal with large openings. Modern surgery includes the use of high end neuro microscopes, Computer Guidance linked to MRI and CT scans, and finer tools for tumor removal. Parts of the tumor that are difficult or risky to remove can be treated later by other modalities such as Radiosugery. According to Dr Prem Pillay, radiosurgery has become a major and useful tool in the treatment of both brain and spine tumors. Radiosurgery uses precision and guided energy beams that penetrate painlessly and invisibly to the tumor site without needing an open operation. In the past there was the Gamma knife but now there are a wider range of radiosugery platforms including Tomotherapy, LINAC (linear accelerator) systems with micro-multileaf collimators for high precision and the ability to treat the brain and the spine. There are tumors that can be treated with radiosurgery alone without open surgery as the first step. Malignant tumors may need several modalities of treatment including surgery, radiation and chemotherapy.
Conclusions
Although brain and spine tumors can be dangerous and devastating in adults and children ,Dr Prem Pillay believes that earlier diagnosis and the use of technologically advanced tools including microsurgery, robotics and radiosurgery is playing a role in saving many lives throughout the world including Singapore.
