Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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Monroe Carell Jr.
Children's Hospital
at Vanderbilt
2200 Children's Way
Nashville, TN 37232


(615) 936-1000

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Diagnosis and Treatment

 

Diagnosing a brain tumor can be challenging because early symptoms can mimic those of other, less serious conditions. However, once a brain tumor is suspected, imaging of the brain is required to confirm the suspicion.

Following examination and evaluation of signs and symptoms, MRI and CT scans are useful in determining the presence of a brain or spinal cord tumor. But a biopsy is the only reliable way to confirm a specific diagnosis.

Diagnostic tools

MRI (Magnetic Resonance Imaging): These scans combine high-frequency radio waves and a strong magnetic field to produce a picture of the inside of the brain. No X-ray radiation is involved.

CT (Computerized Tomography): These scans use a sophisticated X-ray machine combined with a computer to create a picture of the inside of the brain.

PET (Positive Emission Tomography): These scans provide a picture of brain activity. They may be used when trying to tell whether a CT or MRI scan is showing the return of a tumor or damaged tissue caused by radiation. A PET scan may be used in addition to a CT or MRI.

SPECT (Single Photon Emission Computed Tomography): This type of imaging provides information similar to the PET scan, but is more widely available.

Biopsy: A doctor removes a sample of tumor tissue to study its characteristics. The sample can be taken through an open or surgical biopsy, or a needle biopsy. If the tumor is difficult or impossible to remove safely, a doctor may perform a needle biopsy to identify the type of tumor and determine the proper treatment. If the tumor can be removed by surgery, a neuropathologist will examine it to confirm the diagnosis.

Brain and spinal cord tumors are also known as tumors of the central nervous system (CNS). CNS tumors are classified as benign or malignant based on the appearance of their cells under a microscope. In general, benign tumors grow slowly and do not spread to areas of the CNS that are distant from their original site. In some cases, they also have well-defined borders that help in their removal. However, when located in vital areas of the brain or spinal cord, a benign tumor can be life-threatening.

A malignant, or cancerous, tumor is always a threat to life. Malignant tumors invade and destroy healthy tissue. They usually grow rapidly and can send "roots" into normal tissue. Individual cells from malignant CNS tumors sometimes break free from the mass and travel to other parts of the CNS.

Treatment

Surgery
To gain access to the brain, surgeons perform a craniotomy (surgical incision) or craniectomy (surgical removal). For a craniotomy, the surgeon creates a "bone flap" in the skull that is replaced after the operation. For a craniectomy, the bone is removed in pieces and not replaced.

If the tumor blocks the flow of cerebrospinal fluid (CSF), removing the tumor will correct the problem. Sometimes, however, even when the CSF pathway is open, it doesn't function properly. The surgeon may then insert a small plastic tube called a ventriculostomy or external ventricular drain (EVD) to prevent fluid buildup. Later, a more permanent internal shunt may be inserted to keep the fluid circulating around the brain. Sometimes steroids are given to reduce swelling before, during, and after surgery.

Removal of as much of the tumor as possible is the first line of defense against a recurrence. Neurosurgeons commonly designate the extent of surgical resection (removal of the tumor) as being total, near total, subtotal, partial, or biopsied only.

Total resection means there are no visible residual tumor cells under the operating microscope or on the postoperative MRI, although some tumor cells are always left behind. Some neurosurgeons refer to this as a "gross total" resection to distinguish it from the rare instances of a true total resection, in which the tumor as well as a margin of normal tissue are removed. This is rarely a safe procedure for a brain tumor. Near total means a small amount (less than 10 percent) of residual tumor is left behind. Subtotal means 50 to 90 percent tumor removal, and partial means less than 50 percent removal.

Radiation therapy (RT)
Radiation therapy, also called radiotherapy, uses X-rays to attempt to destroy tumor cells or keep them from growing. In cases where a tumor cannot be completely resected, survival rates improve when RT is used after surgery.

Chemotherapy
Chemotherapy is the use of a single medicine or combination of medicines to attack tumor tissue. It can be taken by mouth, injection, or through an intravenous line (IV). Some therapies can be given on an outpatient basis, while others require one or more days in the hospital.

Chemotherapy can be used to destroy remaining tumor cells after surgical removal. It's often used if the patient is under age 3 and the doctor wishes to delay or avoid radiation therapy. The treatment team may also use chemotherapy when they think a second attempt at surgery may be feasible, because chemo may make the tumor easier to remove.


Last Edited: October 13, 2016
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