Is the brain tumor a verdict or not?
Tell us about the classification of a brain tumor?
There are several classifications of brain tumors. First of all, we distinguish between primary and secondary tumors. Primary tumors arise directly in the brain, secondary tumors are distant metastases of other tumors of the human body. Most often in the brain metastasize lung cancer, breast cancer, skin melanoma. Among primary tumors, intracerebral tumors and extra-cerebral tumors are distinguished, which arise from the envelopes of the brain and cranial nerves. Primary brain tumors are also distinguished by the degree of malignancy. There are four degrees of malignancy: I - benign, II - atypical, III - anaplastic, IV degree - malignant tumors. The type, location and degree of malignancy of the tumor depends on the type, amount of surgical intervention, the need for radiotherapy and chemotherapy.
What are the main causes of brain tumors?
First of all, it is believed that the cause of the appearance of brain tumors, like other tumors, are gene mutations. These changes arise under the influence of various environmental factors, such as radiation, chemical factors, as well as other factors of the environment and the internal environment of the organism that contribute to cell mutation. The cell differs from the normal cells of the body, but because the immune system of the organism does not distinguish its cell, it allows the foreign cells, divides, grows uncontrollably. For some benign tumors, there is a genetic predisposition, so there are tumors that can be transmitted by inheritance. The emergence and growth of other brain tumors contribute to hormonal changes in the body. We very rarely can establish the true cause of the disease, most often we are already having an existing brain tumor.
What are the symptoms and complaints that occur with brain tumors?
There are general cerebral symptoms, which you need to pay attention to. This is, above all, a headache. Headache intensity is usually stronger than usual, occurs at night, intensifies in the second half of the night, in the morning. Headache can be accompanied by nausea, indomitable vomiting.
These symptoms say that a person has an increase in intracranial pressure. There are also focal symptoms, which indicate a certain localization of the tumor in the brain. These include speech disorders, limb movements in the limbs, hearing and vision impairment, dizziness, mental disorders, memory, attention, as well as epileptic seizures. Seizures can be generalized with loss of consciousness, and focal without loss of consciousness or with their subsequent generalization. In any case - the appearance of one of the above symptoms - this is an occasion to immediately consult a doctor.
Tell us about your department of neurosurgery. What equipment is represented in the department?
If we talk about the separation of neurosurgery on the basis of the regional clinical hospital. I.I. Mechnikov, we have all the conditions for providing neuro-oncological care at the modern level. There are several important prerequisites for this: 1) Availability of necessary equipment. Thanks to the regional state administration and personal participation of the chief doctor of the hospital, prof. S.A. Ryzhenko we have the happiness and the opportunity to work on a modern operating microscope, during the operation to use the neuronavigation system, endoscopic rack, the system of intraoperative multimodal neurophysiological monitoring, high-frequency electrocoagulation, ultrasonic dissector-aspirator, electric traps, operational micro-tools of leading foreign manufacturers. At our disposal are modern equipment for artificial ventilation and modern tracking equipment: cardiac monitors, pulse oximeters, both in the operating room and in intensive care units. We have a whole set of high-tech methods of treatment and equipment that allow not only to remove a tumor of any complexity category (from I to V) completely (totally), while maintaining the high quality of life of the patient.
2) The second mandatory condition for success is, of course, training and experience. All the doctors of the department passed internships in leading clinics in Europe, first of all: Germany (Cologne), Finland (Helsinki), this is England (London), Italy (Rome), Czech Republic (Prague). And now, we have our own achievements, to which we have received patents and which we show, share our own experience. We are invited as guest lecturers with reports to Turkey (Istanbul, 2017), India (New Delhi, 2016) and to us they go to study from all over Ukraine (Kiev, Kherson, Vinnitsa, Kropivnitsky, Odessa, etc.) and other countries (Transnistria, Turkmenistan). To us, also come the patient from near and far abroad (Russia, Uzbekistan, Turkmenistan), there, unfortunately, some tumors of IV-V category of complexity are not possible to be fully removed. Every year, 1640-1700 patients are examined and treated in our department, more than
250 of the most complicated operations are performed with brain tumors and even more than 450 operations with other pathologies. In the department, all doctors have the highest qualification category, including 1 doctor of medical sciences and 1 candidate of medical sciences.
3) The third component of success is teamwork. When treating brain tumors, we use a multidisciplinary approach in our clinic. This is a joint work with oncologists, radiologists and chemotherapists. We closely cooperate with the city oncology dispensary. We also constantly get in touch with specialists from the X-ray department, who use modern MRI scanners (1.5 TL), 64-slice spiral CT scanners, and a modern multifunctional angiographic complex. And of course these are our experienced anesthetists. Joint work with the departments of the Dnipropetrovsk Medical Academy allows conducting modern pathohistological and immunohistochemical studies of the removed tumor, in order to verify its nature and degree of malignancy, and to determine rational therapeutic tactics.
The main task in neurooncology at the present stage of development is not only to remove the tumor, but also to preserve the patient's quality of life, and in case of malignant tumors, to prolong this quality life as much as possible. If the patient came with his feet, he must also leave us with his feet, while talking, smiling, thanks to the medical staff, but without a tumor.
Are operations performed to remove the brain in the mind or under general anesthesia?
Most operations on the brain are performed under general anesthesia. In order to remove the tumor, we use a neuronavigation system that allows us to find and minimally invasive (non-traumatic) even a small tumor, even at the deepest depth in the brain. At the same time, when the tumor is located in a functionally important area, and we need to save the person speech or movement in the limbs, then the wake-up technology of anesthesia is used. This allows us to stop in time, but at the same time to remove the tumor as completely as possible. During this operation, access to the tumor (skin incision, trepanation of the skull) is performed under anesthesia, after that the patient awakens, and further the operation is performed with the full consciousness of the patient. The neuropathologist, neurophysiologist and anesthesiologist constantly communicate with the patient. And in the patient who is conscious, we remove the tumor, constantly checking the strength in the arm, leg, understanding of speech and pronunciation of words. If we see that there are first deviations from the norm, then we stop, while still retaining important parts of the brain and, accordingly, the quality of life of the patient. Whether there is a risk of carrying out of operation on excision of a tumor of a brain?
In the course of any operation there are certain risks. The result of the operation usually depends on three
main factors. I call them: the surgeon's factor (this is the experience and availability of the necessary equipment), the patient factor (the presence of severe concomitant pathology, age) and the tumor factor (its size, localization, bleeding, connection with blood vessels, nerves, vital brain structures). The degree of risk and frequency of occurrence of possible complications primarily depend on the degree of complexity of the surgical intervention and the general condition of the patient's body. In any case, together with the patient and his relatives, we discuss in detail the treatment plan, the nature and scope of the operation, alternative methods of treatment, possible risks and complications, and the possibilities for their prevention. Together with anesthetists, we carefully examine and prepare the patient for surgical intervention.
Are there postoperative complications?
When complex operations (IV-V complexity category), without this, unfortunately, it is impossible. No clinic of the world will say that they do not have postoperative complications. The frequency and nature of postoperative complications in our department is comparable to the leading clinics in Europe. In order to minimize them, we have two doctors on duty at the office around the clock - a neurosurgeon, they watch the patient how he goes off with anesthesia, how he wakes up. All patients in the first 24 hours after the operation performed a computerized CT scan of the brain. If there is a hemorrhage at the site where there was a tumor, or other problems associated with the operation, it is diagnosed and eliminated on time, which is a prerequisite for the patient's recovery. An invariable guarantee of success is experience. As in aviation, errors due to the pilot's fault are minimized after he flies more than 10 thousand flight hours. The large number of complex operations in our department allow us to have such an experience.
What can you advise our readers?
Two main tips:
First: if there are complaints, you should always contact a specialist on time. In time to pass the necessary examination, diagnose the disease at an early stage and get a comprehensive treatment. In this case, the diagnosed tumor and the correct treatment in time help save life. Acquaintance with the Internet, printed publications, scientific and popular science magazines, which is the magazine "Health", allows you to learn a lot of interesting and useful.
The second advice: patients should first of all remember that the country, or some city, does not treat, but the specialist doctor treats in a certain clinic. And when the question is solved, to which doctor will apply, it is necessary, first of all, to learn about the number of operations performed by the doctor and in this clinic, what is the degree of complexity of the operations and their results. Because good advertising, as practice shows, is not always the key to a successful operation and recovery.
Sirko Andrey Grigorievich
Doctor of Medical Sciences, Honored Doctor of Ukraine Head of the Department of Neurosurgery,
Associate Professor of the Department of Nervous Diseases and Neurosurgery
Ukraine, 49005, the city of Dnepr, pl. Sobornaya, 14
Tel. slave: (056) 713-51-13 www.m.mechnikova.com www.neurodp.com.ua