Surgery is the primary method of treating brain tumors in Israel . Not always possible to remove the tumor in relation to the localization or the risk of organ damage. In such cases, they turn to other treatment methods.
Surgical intervention to remove a brain tumor in clinic Assuta is performed in the following situations:
- For carrying out the biopsy and extract a sample of tumor tissue.
- To completely remove the tumor.
- In order to resection the maximum number of tumors. Many studies show that this operation slows disease progression and improves survival.
- To reduce pressure in the brain.
- To carry out chemotherapy - implant placement.
Assuta Hospital is a leading private medical center in Israel, to the main activities of which include surgery, including neurosurgery. The patient can receive medical care from the best specialists of the country, with the use of modern medical and diagnostic equipment, in the most comfortable conditions for him.
Advances in medical technology allow doctors to do a biopsy in almost any area of the brain. New methods provide for the removal of certain types of tumors with fewer side effects, and also operate in tiny areas without disturbing surrounding healthy areas.
Even though the process of improving the methods and means of treatment, there are neoplasms, which can not be surgically removed. These options include the following tumors:
- Those that are located in areas of the brain responsible for speech, vision and movement. Resection of tumors in these areas will cause serious, long-term consequences.
- Spread to other brain fate.
- Localized in the brainstem.
- Arising in the pineal or thalamic areas, deep in the center of the body.
Attempts to remove the marked tumor may be too dangerous, or do not improve prognosis.
During a biopsy a small piece of tumors removed for examination under a microscope. This test gives doctors information about the type of cells from which the cancer develops. His goal - to identify the type of tumor. Occasionally biopsy performed directly during the removal of a brain tumor .
In order to identify the localization of tumors conducted MRI or CT. Then, the small puncture in the skull and a needle was removed using a thin sample of the tumor.
When the formation is located deep inside the brain, it can be performed stereotactic needle biopsy using stereotactic frame, which helps guide the needle to the tumor, or by neuronavigation system. The results of an MRI or CT scan is transferred to the navigation system. The image becomes three-dimensional and is seen in various projections, allowing modeled future surgery for brain tumors . Sets the entry point, the trajectory of the needle and the area for biopsy.
Symptomatic treatment before surgery
Brain tumors often cause swelling of surrounding healthy tissue. Such call peritumoral edema. It occurs due to accumulation of fluid in the tissues around the tumors, may increase intracranial pressure or worsen neurological symptoms - headache, nausea, vomiting and weakness. To reduce the edematous state physicians often prescribe corticosteroids preoperatively use dexamethasone and prednisone.
Tumors can also lead to disruption of the electrical signals in the brain that will provoke convulsions. This is a common and common symptom. Experts recommend anticonvulsants or antiepileptic drugs prior to surgery in brain tumors to control seizure activity. After surgery, the reception may continue to stop seizures, and not interfere with the healing process.
Children with brain tumors may develop hydrocephalus. This accumulation of cerebrospinal fluid (CSF) due to blockage of the flow around the brain. Fluid accumulates in the ventricles, which increases the intracranial pressure.
- In infants with hydrocephalus swells fontanelle, increased head size or growth rate, there is vomiting, lethargy, convulsions and high-pitched crying.
- In older children, say headache, vomiting, irritability and seizures.
To facilitate the state can put a shunt.
Preparing to remove a brain tumor in Assuta
Surgery is preceded by diagnostics to make sure that the patient is able to move the surgery. She performed a few days before surgery for brain tumors. It can be heart and lung examination.
If the patient smokes, you should try to quit or reduce smoking. This will reduce the risk of complications (infection in the lungs), and will also contribute to the healing of wounds.
It may be assigned a course of steroids to reduce the swelling of the brain caused by the tumor. It is important to take them exactly prescribed by a doctor.
The patient is usually admitted to the hospital the day before or the morning of surgery. Nurses give elastic stockings to wear during and after surgery to help prevent blood clots in the legs. Patient consults a member of the surgical team, anesthesiologist.
Craniotomy - surgery to remove a brain tumor in Assuta
To remove a tumor needs an operation called craniotomy or craniotomy. The neurosurgeon removes the area of bone (bone flap) from the skull to reach the brain tissue. After resection of part or all of the tumor is set in place the bone segment using sutures or staples to close.
Removal of the brain tumor is usually performed under general anesthesia. During a craniotomy, the surgeon uses specialized tools and a powerful microscope to examine body tissue. Thus, the abnormal tissue is removed and is not affecting the health. At the end of the physician decides whether to replace the bone flap. If it is put in place, the operation is called a craniotomy, when replaced - craniotomy.
Sometimes there is a possibility of endoscopic surgery through a small hole in the skull using an instrument called Neuro, flexible and thin tube equipped with a camera and the eyepiece. Through it introduced tools to remove the tumor.
If it is impossible to completely resect the tumor, remove the top part of it. This is called partial resection. After that, the fabric is sent to a laboratory for further study by a pathologist.
Awake craniotomy - operation in brain tumors in Assuta
Craniotomy or craniotomy is sometimes carried out in the patient's state of wakefulness. The goal is to reduce the risks associated with surgery. The doctor is able to check whether such features are concerned, as speech or movement during surgery. If there are any changes, the work in this direction stops.
Before surgery, the patient is given a sedative, is introduced into the incision a local anesthetic. The patient can see and talk with the doctors.
Bypass surgery or surgery to establish the shunt hospital Assuta
If the tumor blocks the flow of cerebrospinal fluid (CSF) around the brain, it accumulates (called hydrocephalus state) and causes an increase in pressure within the body. Install a shunt on which drains excess fluid, solves the problem.
A shunt is a flexible, soft, thin tube. It is placed through a small hole in the skull into one of the ventricles, while the excess liquid is displayed in the chest. The shunt has a valve system with which the liquor is regulated and the pressure fluid is prevented from returning to the brain.
The shunt can be temporary or permanent.
Temporary external and shunts usually called outer ventricular drenazhom.Trubka placed inside the ventricle, and then is connected to the container body where the controlled volume and pressure of the cerebrospinal fluid.
There are two types of permanent shunts:
- Ventriculo-peritoneal shunt is established as follows: from the ventricle to the scalp, then passes under the skin, it is lowered down to the abdominal cavity. CSF flows into the cavity and is reabsorbed into the blood. This is the most common type of shunt.
- Ventriculo-atrial shunt like a ventriculoperitoneal with the difference that is injected into a large vein in the neck and the cerebrospinal fluid drains into one of the chambers of the heart. At the heart of cerebrospinal fluid enters the bloodstream and filtered through the liver and kidneys together with other fluids in the body. This type of shunt is rarely used.
In some cases, the shunt is not used. Instead, the surgeon makes a small opening, usually on the third ventricle, allowing cerebrospinal fluid to bypass the lock and continue to circulate. This procedure is called endoscopic third ventriculostomy.
Furthermore, there may be used a small device called an Ommaya reservoir. This tiny kupoloobrazony device that is placed under the skin of the head during the operation. A tiny tube connects the reservoir to the ventricles or tumor. The apparatus used for obtaining samples of cerebrospinal fluid, or administration of chemotherapy, which is then circulated in cerebrospinal fluid of the brain, as well as administration of cytostatic agents directly into the tumor.
After the removal of a brain tumor in Israel
After surgery, the patient is about a day in the emergency room or intensive care unit. The state closely watched by doctors and nurses. They carry out neurological tests - check reflexes, eye reaction to light. Measure the temperature and blood pressure.
Fits dropper, through which the body fluid enters the patient. It can be used a nasogastric tube extending through the nose into the stomach to remove fluid from the body. Also used a catheter to drain urine, it is removed after a few days.
On the face, around the eyes, as a rule, will be swelling and bruising. Edema will be held for two days, the bruises - a few days later. In some cases, edema in the area of the scar - a so-called meningocele - traumatic brain herniation.
After the removal of a brain tumor observed moderate pain, doctors prescribe painkillers simple.
Potential side effects of surgery include:
- Swelling around the incision.
- Wound infection.
- The accumulation or leakage of cerebrospinal fluid.
- Pain in the jaw.
- Thrombus formation.
- Vision problems.
- Strengthening of pre-existing symptoms.
Within one or two days, the patient is in bed. At this time, it is important to do the exercises for the legs and deep breathing. This helps reduce the risk of infection and thrombus formation. Physiotherapist in a clinic Assuta advise how to do the exercises. It is important for the healing process to begin as soon as possible to move.
Head wound dressing will be closed during the first few days. Nurses regularly check it to make sure it heals. After 7-10 days remove staples or stitches.
Regeneration process depends on the type of surgery for brain tumors. Some people need more help. If the following problems occur, it is important to seek medical advice: high temperature; redness or swelling around the scar; vomiting, drowsiness, weakness in the limbs, problems with speech, or seizures.
For several weeks, the patient usually feels very tired. Sometimes it lasts up to a year or more. It is important to rest and eat properly, it will promote healing. More energy will balance rest and light exercise (regular short walks).
The doctor will explain what to expect in the next few weeks, what can be done to speed up the recovery.