Mediscene

Brain tumours: The not so bad ones

By Dr. Ruvini Abeygunaratne Karunaratne

When you are told the devastating news that your brain scan has revealed a tumour, it is normal that your world comes crashing down. An abnormality noted in the brain especially one that looks like a tumour traditionally paints a bleak picture and this is true for some tumours (a broad term used for any abnormal growth). But the good news is that these are rare. It is more likely that the tumour is a harmless tumour called a meningioma.

People between the ages of 40 and seventy are more prone to developing meningiomas. They are more common in women. Children rarely get them. These tumours, if multiple can also occur in members of the same family.

These tumours arise from the lining surrounding the brain. The lining covers the brain completely extending into the indentations of the brain and as it can extend into the under surface of the brain as well, the tumours may develop in deeper regions of the brain. They don't infiltrate into the brain tissue itself which is a characteristic of non-aggressive tumours. Therefore if the tumour is in an accessible place it can be completely removed, and cured.

Meningiomas are slow growing and sometimes grow extremely large before they cause pressure effects that cause signs and symptoms that can enable a diagnosis.

Even though benign in nature, in some instances by growing in places that a surgeon cannot easily get to without causing damage, they can behave like malignant tumours.

Symptoms

An 80-year-old lady had spent the last 20 years of her life in a psychiatric unit, labelled as being 'mad'. The family had noticed behavioural changes about 20 years ago in their mother. 'Odd' behaviour was noted. She had stripped naked twice in public and had lost her sense of inhibition which was totally out of character for her. She had been incontinent on several occasions.

The situation had got worse when she had started to drift in and out of much altered moods, on some occasions so euphoric that she was found watering plants in the rain.

Seen by a psychiatrist she was diagnosed with a personality disorder and warded in a psychiatric unit. Most of the time she was dosed with medication to curb her unusual behaviour and there she was till the appointment of a new doctor to the unit. On his assessment and due to his neurological findings, he arranged a CT scan which revealed a large tumour arising and taking space in front of her brain. A meningioma.

She underwent surgery to remove the tumour; recovered well and was discharged home to her family.
This illustrates the fact that these tumours may present with behavioural changes. Some may also complain of headaches due to the pressure inside the head increasing, or initially with fits or collapse. The tumours may also be found incidentally when brain scans are carried out for other reasons.

Signs

Depending on where the tumour is, the patient may have weakness in the limbs and problems with their vision and hearing. They may have lost their sense of smell and may also lose the ability to swallow. They may have noticed a lump on their scalp, when combing their hair, which was growing bigger. These tumours are also known to increase in size during pregnancy, due to the changes in the hormonal status of the mother.

Management

A good history and examination are the key to the right diagnosis. This guides us to the investigations that need to be performed. The main scan that is requested is a CT scan or a CAT scan. This maybe followed by a MRI scan which gives more detail regarding the tumour. These two scans on occasion are followed up by carrying out a detailed study of the blood vessels surrounding the tumour. These investigations are essential to plan surgery as well as to carry out safe surgery.

If they are small, not causing any problems and have been found incidentally, then we leave them alone. Monitoring of the meningioma is carried out by doing periodic brain scans.

If the tumours are big and causing problems and in a place where they can be removed without causing any harm to the patient they are taken out. The complexity of the operation depends on many factors - where the tumour is, the patient's general condition and age.

The main aim of the operation is to remove it completely but safely. Sometimes the decision is taken to leave some of the tumour behind; this is if it is difficult to remove completely due to intraoperative problems or because just removing some would cure the symptoms and signs. If some is left behind, the patient is followed up regularly to make sure the tumour doesn't grow back, because they eventually will but as they are so slow growing it may take many years.

Some patients with some remnant tumour may also be treated with radiotherapy: this is x-ray treatment to the tumour and slows down growth again.

So remember it isn't always the end of the world if you are diagnosed with a brain tumour, just as long as it is a benign tumour, like a meningioma.

 
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