Glioblastomas(GBM) are the most aggressive tumours of the brain. Just imagine a brain tumour that grows 1-1.5% every day and can double up in less than two months. Surgical resection is the first step in the treatment for such tumours.
Why is surgery so important in glioblastomas?
Can i avoid brain surgery?
Can brain tumour be cured without surgery?
These are the obvious questions that come to mind of a patient whenever the diagnosis of a likely malignant brain tumour is considered. Here are some of the important factors that should convince you against such thoughts, and make your decision towards surgery easier.
Safe maximal resection
One factor which has definitely been linked to increase survival in malignant brain tumours is maximal surgical resection. It is well established that resection of tumours with good margins is standard of care with best cure rates for most tumours occurring outside the brain. This is however not always possible in malignant brain tumours as the resection is limited by involvement of brain areas that are functionally important, like the area that controls speech or movement. That is why word ‘safe’ is always added to surgery for brain tumours.
Surgery helps in establishing diagnosis
Establishment of diagnosis is another important objective of surgery in brain cancers. After surgery tumour tissue is sent to laboratory for examination. It confirms the type of tumour, and grade of tumour. It also tells us about the aggressiveness of tumour and certain tests can tell us whether certain chemotherapy will work or not after the surgery.
Surgery decreases intracranial pressure
Malignant or cancerous brain tumours are associated with significant swelling in adjacent brain areas. As the brain is surrounded by a rigid skull, this increase in swelling leads to a rapid rise in pressure inside the cranial cavity. This increased pressure causes worsening headaches, vomiting, and increased sleepiness. Increased intracranial pressure will cause death if left untreated by causing pressure on the critical area of the brain, the Brainstem, which is responsible for basic functions like respiration. There are medicines like steroids to reduce such swelling, but they only work temporarily.
Surgery helps in decreasing swelling inside the brain by removal of brain affected by the tumour.
Surgery decreases the tumour burden, which makes chemotherapy and radiotherapy more effective
Tumour burden refers to the number of cancer cells. By removing larger parts of tumour in a bulk fashion, surgery reduces the tumour burden. And hence radiotherapy and chemotherapy become more efficient after surgery in controlling the remaining tumour.
What are the complications of brain tumour surgery?
Surgical advances over the last decades have significantly improved the outcomes for brain surgeries. Certain complications that can occur with these surgeries include infection, hepatoma or blood clot at the surgical site, or neurological deterioration. Neurological deterioration means worsening of function after the surgery, which depends on the location of tumour and its proximity to the critical areas of the brain. To give an example, surgery for a tumour close to the motor areas of the brain may lead to weakness or paralysis of one side of body. These deficits may or may not improve with time.
The benefits of surgery far outweigh the risks associated.
Disclaimer- This article is for the general awareness of the patients and cannot replace expert medical advice. Patient treatments need to be individualised and that can be decided based on clinical examination and evaluation by a trained physician.