Brain Tumor

The origin and molecular properties of the cells are important for the classification of brain tumors. Does the tumor consist of the brain's own cells? Then it is a primary brain tumor that originated directly in the brain. If the tumor cells come from another organ, it is a secondary brain tumor, a so-called brain metastasis.

Depending on the brain region affected, brain tumors can cause very different symptoms. Early detection is therefore often difficult. A brain tumor can manifest itself dramatically in an epileptic seizure or cause only very unspecific symptoms, which also frequently occur in harmless diseases. The localization of the tumor in the brain is decisive for the symptoms. Possible symptoms of brain tumors are:

• Seizures
  Epileptic activity, i.e. hyperexcitability of the healthy tissue at the edge of the tumor.
• Failures or malfunctions
  Impairment of speech, motor skills, sensation, vision, calculation, thinking, memory, balance, orientation, mood, behavior, alertness, drive, social behavior, etc. due to the pressure of the tumor on the surrounding tissue or the ingrowth into the adjacent brain.
• Headache, nausea, vomiting
  An advanced tumor leads to an increase in intracranial pressure.
• Psychological changes
  If the tumor grows in functionally silent (non-eloquent) parts of the brain, it may go unnoticed for some time until nonspecific symptoms such as change of character, fatigue, forgetfulness, disorientation and confusion appear. In most cases, the symptoms last from a few weeks to a few months at the time of diagnosis.

A brain tumor is diagnosed with the help of magnetic resonance imaging (MRI). It provides images of brain tissue. Using different filters (sequences), the various features of the tumor can be visualized. Depending on the type of tumor, findings range from an almost certain diagnosis, where surgery is usually the next step, to a vague suspected diagnosis that first requires a biopsy (tissue examination) to obtain a definitive diagnosis. Unfortunately, early detection through a blood test or screening examination does not yet exist.

The operation has two goals:

1. If possible, the brain tumor should be completely removed down to the last cell.
2. The normal functions of the brain should not be affected.

A benign brain tumor is cured after complete removal. In the case of a malignant brain tumor, such as a glioblastoma, complete tumor removal results in a better prognosis and survival time. At Inselspital, we use the latest methods in navigation, ultrasound, intraoperative MRI and fluorescence techniques, as well as state-of-the-art equipment to detect the tumor boundary during surgery.

However, the absolute priority before complete tumor removal is the preservation of brain functions to allow the patient to continue living a normal life in good quality. In both benign and malignant brain tumors, we would rather accept a tumor remnant than permanently damage an important brain function. In the case of benign tumors, this tumor remnant is often observed for years or is followed up and stopped by radiosurgery. In the case of malignant brain tumors that grow infiltratively and for which no complete cure is possible by surgery, radiation and chemotherapy will attack the residual tumor.

Most brain tumor patients can be discharged home 5–7 days after their surgery. An appointment may be made in the following week to discuss the laboratory results (histology of the removed tumor tissue).

If neurological deficits such as speech or movement disorders occur postoperatively, inpatient neurological rehabilitation can be helpful. For this purpose, there are numerous specialized rehabilitation clinics in the region of Bern and the surrounding area. An application is made by the attending physicians at Inselspital, taking into account the individual patient's wishes.

If the patient suffers only from mild impairments or if inpatient rehabilitation is not desired, there are numerous outpatient therapy options to facilitate the return to familiar everyday life. These include outpatient physiotherapy, occupational therapy, speech therapy, psychosocial support, etc.

For benign and some intermediate tumors that do not require follow-up treatment, regular follow-up visits and MRI examinations are performed in the Neurosurgical Outpatient Clinic. The intervals for these check-ups depend on the type of tumor as well as the recommendation of our interdisciplinary tumor board.

For brain tumors that require complementary radiotherapy and/or chemotherapy, regular follow-up examinations are performed by the post-treatment oncologists and radiation oncologists.

In order to prevent the recurrence of a tumor after complete surgical removal or the growth of a tumor remnant, it may be useful to administer supplementary or supportive (adjuvant) chemotherapy, depending on the molecular characteristics and grading of the tumor. Chemotherapeutic agents are substances that exert a DNA-damaging effect in the tumor cells. For high-grade brain tumors (gliomas), postoperative chemotherapy with Temodal (temozolomide) is usually given in combination with radiation treatment. Temodal can usually be taken as a capsule and is actually well tolerated by patients.

Radiotherapy

Radiation therapy or radiotherapy is another important adjuvant (supportive) treatment after brain tumor surgery of higher-grade tumors. The aim is to stop the growth of remaining tumor cells. In this process, physically high-energy X-rays are produced by a linear accelerator and applied with high precision to the region of the brain tumor. The anatomical structures and surrounding brain territories are taken into account. As with chemotherapy, radiation therapy can disrupt the cell division process of tumor cells, leading to cancer cell death. To achieve the highest possible effect with the fewest possible side effects at the same time, hypofractionated (low-dose) radiotherapy is usually administered over several sessions. For high-grade gliomas, this corresponds to 30 sessions of 2 Gy each, or a total dose of 60 Gy.

Radiosurgery

Radiosurgery is a highly focused, high-dose, one- to five-times radiation treatment offered as a treatment alternative to open surgery for small, well-defined tumors. At Inselspital, a device of the latest generation, the so-called CyberKnife, is used for this purpose. With the help of a computer-controlled robotic arm, the high dose of radiation is administered with razor-sharp precision.