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Brain Tumors

Metastatic

Metastasis implies the tumor originated from somewhere other than the brain. These tumors are frequently encountered in the neurosurgical practice. They oftentimes involve the brain parenchyma, but can involve the skull as well. The presenting symptoms are related to the location, size and the amount of brain swelling. Symptoms can include, but are not limited to headaches, speech or visual impediments, seizures and weakness.

The options to treat these tumors include medications, chemotherapy, radiation and surgery. The neurosurgeon will work closely with other specialists including your oncologist to optimize the care delivered.

Primary

There are several types of brain tumors. Basically, they are regarded as being either benign or malignant. These tumors can involve the brain substance itself or the skull. This determination can oftentimes be made by using imaging characteristics and pathologic analyses. They are typically graded depending on cell type and on a scale using the World Health Organization classification of I-IV. These tumors can cause symptoms such as headaches, seizures, bleeding and weakness. Depending on the location, size and symptoms, your doctor will determine what treatment options would be utilized. The current options include surgery, radiation, chemotherapy. Dr. Stevens’ training includes treating patients using radiosurgical options – CyberKnife and Gamma Knife and implantable chemotherapy. He uses microsurgical techniques using the operating microscope and performs computer assisted, image-guided brain surgery.

Some specific CNS tumor types include:

Gliomas

Astrocytomas are the most common type of brain tumors which arise from within the brain substance. These tumors have varying behaviors and prognosis depending on the cell type.

Symptoms vary depending on location of the tumor and size.

Choroid Plexus Papillomas

Account for less than 1% of brain tumors.  These are typically benign tumors in younger patients, but can occur in adults as well. Patients can present with headaches, nausea, vomiting and other neurologic issues.

Craniopharyngioma

Are located near the pituitary gland and are usually benign tumors.  Their location, however, make their management difficult.

Ependymomas

Arise from cells which line the spinal fluid storage chambers in the brain, ventricles. They can be located both in the brain and spinal column. Because of this, your doctor may want imaging of both your brain and spinal column if these tumors are suspected.

Meningiomas

Slow growing tumors that develop from one of the brain covering layers. Surgery is the recommended treatment option for symptomatic tumors. Typically are cured when completely removed surgically. The location at times can make this a difficult task to accomplish.

Lymphoma

Primary central nervous system (CNS) lymphoma occurs when cancer cells accumulate in the lymph tissue of the spinal cord and brain.  Imaging studies such as MRI or CT scans (including PET CT) can be used to determine location and extent of the tumor burden.  Patients who have compromised immune systems are at a higher risk of developing the disease. Biopsy or spinal tap are oftentimes necessary to make the definitive diagnosis.  Chemotherapy and radiation therapy are some of the available treatment options.

Hemangioblastoma

These tumors are the hallmark of patients with the genetic syndrome, Von Hippel-Lindau disease. They are benign, slow-growing, but very vascular tumors. The symptoms at presentation vary depending on the tumor location and this also determines how amenable they are to surgical cure. MRI and CT scans are used to aid in diagnosis. Treatment options remain surgery and radiation therapy. Chemotherapy agents are being investigated as well.

Hemangiopericytoma

These are rare tumors which arise from parts of blood vessels we call capillaries. Tumor location can cause headaches or weakness. CT and MRI scans are used to make the diagnosis. Surgery for biopsy or resection aids in definitive diagnosis. Chemotherapy and radiation therapy are utilized in addition to surgery.

Lipomas

These are benign tumors, but their location may make completed surgical resection difficult. Treatment is usually observation or surgical resection.

Vestibular Schwannoma

This tumor arises from the vestibulocochlear nerve that aids in hearing and balance. They can be associated with Neurofibromatosis II. Depending on the size, critical surrounding structures can be affected. They are not usually regarded as malignant; however, they can compromise facial sensation, other muscles or hearing. Your doctor will sometimes perform additional tests to determine which treatment option is the best for the specific tumor.

These tumors can be treated with radiation, surgery or observation.

Pineal region tumors

The pineal gland has varied functions and is believed to secrete melatonin, serotonin and other peptides. It is involved in the regulation of circadian rhythms and environmental changes. There are over 17 pathologic lesions that can be found in this area. They represent about 1% of brain tumors. Symptoms can include headaches and vision and endocrinologic abnormalities.

Treatment options include observation, chemotherapy, radiation and surgery.

Pituitary Tumors

The pituitary is known as the ‘master gland’ because of the important role it plays in the endocrine system. Tumors of the pituitary gland represent 10% of brain neoplasms. They are much more common in adults than children. The tumor size and whether or not the tumor secretes hormones oftentimes dictate the symptoms. They can include headaches, vision and endocrine abnormalities. Rarely, these tumors can hemorrhage and urgent neurosurgical care is needed.

Your doctor will need to perform blood tests and check your vision. These tumors can be treated with medications depending on the tumor type. Other treatment options include, but are not limited to radiation and surgery.