Developments in the neurosurgical field have enabled safer and less intrusive treatments for brain tumours.
WHEN someone is faced with the possibility of brain surgery, the first emotion we tend to experience is instinctual unease.
This is a natural reaction as our personalities, thoughts and other aspects that define us are inextricably linked to brain function. The thought of having our identities being permanently altered can be unsettling.
Fortunately, it is a big misconception that neurosurgical intervention causes sudden personality shifts.
The reality is that these drastic changes are more often associated with brain tumours. If left untreated, it carries more severe risks and consequences compared to the relatively low risk of surgery.
Moreover, the field of neurosurgery in Malaysia has made significant advancements in both surgical technique and medical technology, further reducing risk associated with neurosurgical procedures, while enabling more precise and effective treatment.
It is important for Malaysians to develop better understanding of brain tumours and available treatments to help them make more informed decisions and protect the health of both themselves and their loved ones.
Who is at risk?
Brain tumours can affect anyone regardless of age or lifestyle and its effects can range from being relatively benign to potentially life-threatening depending on its size, location and development.
The cause for primary tumour growths that originate from the brain is still unknown.
It is generally advisable that individuals undergo an MRI scan if they experience clinical symptoms as described in this article, although this can vary depending on the patient’s condition and situation.
Patients with cancer are also more likely to develop secondary brain tumours (caused by the spread of cancer cells from other body organs). An oncologist will recommend these patients undergo serial MRI screenings once every three to six months.
Common symptoms
One of the tell-tale signs of a brain tumour is persistent and severe headaches, especially if the headaches get progressively worse over time.
A sudden change in headache intensity and pattern could also be indicative of a brain tumour but not all headaches are indicative of a tumour.
Other symptoms of brain tumours include an unsteady gait, blurred vision and vomiting.
Unfortunately, these symptoms can sometimes be overlooked and mistakenly attributed to other comorbidities, causing brain tumours to remain undiagnosed for many years.
Interventional pain specialist, neurosurgery and spine surgery expert at Sunway Medical Centre, Sunway City, Dr Toh Charng Jeng emphasises the subtle nature of brain tumours and the potential difficulties in identifying them.
“It is common for older patients, for example, to miss signs of brain tumours. They generally have their attention slowed down and maybe talk less than before. Some may think this is just a part of dementia,” says Dr Toh.
“Patients must always consult a neurosurgeon before jumping to conclusions. You shouldn’t assume psychiatric illness until you rule out red-flag conditions like tumours, especially if their symptoms do not present themselves as typical dementia signs, for example, as it would need to be investigated further.”
Given the difficulty of noticing personal behavioural changes in oneself, we must rely on our loved ones to notice unusual or persistent changes in our attitudes and recommend medical consultations.
Advancement in technology
Thanks to many advancements in the field of neurosurgery over the decades, surgical procedures on brains have become exceedingly safe.
The integration of image guidance, imaging dyes and microscope enhancements are great examples of assistive technology and play a key role in enabling surgeons to perform surgeries with improved precision and consistency.
Dr Toh says: “Patients must always consult a neurosurgeon before jumping to conclusions.”
Dr Toh adds, “The advancement of technology is to assist neurosurgeons in treatment. Thanks to assistive machinery, a surgeon’s work has become more consistent.
“For example, technology has enabled neurosurgeons to take advantage of intraoperative neurophysiology monitoring, which allows surgeons to monitor nerves while performing surgery. This helps with avoiding injury to the nerve as the machine can warn us earlier.”
Other techniques and technology include the ultrasonic aspirator that breaks brain tumours into smaller pieces to be extracted even with small craniotomy opening (keyhole neurosurgery) and the awake craniotomy that keeps the patient awake during surgery to give real-time essential feedback which further reduce the risk of surgery.
There is also the gamma knife (GK), a very powerful, precise and least collateral radiosurgery machine used today and developed by neurosurgeon Lars Leksell in 1967 specifically for cranial pathology.
Advancements in cancer treatment have improved survival rates in cancer patients with increased incidences of brain metastasis; but with the GK, cancer tumours can be controlled or reduced dramatically, translating to more improved survivals for patients with stage four brain metastasis.
It is also useful when surgical risk is too high for a small tumour situated deep in the brain.
Given the individualistic nature of the human brain as well as tumour development, neurosurgical interventions are typically tailor-made for each patient.
Patients can rest easy as doctors guide them through all available treatment options and recommended procedures, empowering them to make a decision that is most suited for their condition.
Overall, the notion that brain surgery is dangerous is largely misconstrued as rapid improvement in neurosurgical techniques and technology alongside the dedication of neurosurgeons, surgery risk has been drastically reduced, enabling former brain tumour patients to continue living long and fulfilling lives.
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