Glioblastoma brain cancer (Grade 4 Glioma)- Minimally invasive neurosurgery- Dr Anil kothiwala
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Glioblastoma brain cancer (Grade 4 Glioma)- Minimally invasive neurosurgery- Dr Anil kothiwala |
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This Video Uploaded At 16-12-2020 06:00:19 |
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patient was old age with multiple co-morbidity, therefore minimally invasive appraoch (#minicraniotomy #keyhole_craniotomy)was with aim of maximum safe resection.
#braincancer
#glioblastoma
#glioma
#braintumorsymptoms
Glioblastoma (GBM- grade IV astrocytoma), is a fast-growing and aggressive brain tumor. Glioblastoma is the most common malignant brain tumor accounting for 47.7% of all cases. Glioblastoma has an incidence of 3.21 per 100,000 population.
GBMs can arise in the brain de novo or evolve from lower-grade astrocytoma. In adults, GBM occurs most often in the cerebral hemispheres, especially in the frontal and temporal lobes of the brain. GBM is a devastating brain cancer that can result in death in six months or less, if untreated; hence, it is imperative to seek expert neurosurgical care immediately, as this can impact overall survival.
Symptoms
Symptoms vary depending on the location of the brain tumor, but may include any of the following:
Persistent headaches
Double or blurred vision
Vomiting
Loss of appetite
Changes in mood and personality
Changes in ability to think and learn
New onset of seizures
Speech difficulty of gradual onset
Diagnosis
Sophisticated imaging techniques can accurately pinpoint the location of brain tumors. Diagnostic tools include computed tomography (CT or CAT scan) and magnetic resonance imaging (MRI). Magnetic resonance spectroscopy (MRS) is used to examine the tumor's chemical profile.
Treatment Options
The mainstay of treatment for GBMs is surgery, followed by radiation and chemotherapy. The primary objective of surgery is to remove as much of the tumor as possible without injuring the surrounding normal brain tissue needed for normal neurological function. However, GBMs are surrounded by a zone of migrating, infiltrating tumor cells that invade surrounding tissues, making it impossible to ever remove the tumor entirely. Surgery provides the ability to reduce the amount of solid tumor tissue within the brain, remove those cells in the center of the tumor that may be resistant to radiation and/or chemotherapy and reduce intracranial pressure. Surgery, by providing a debulking of the tumor, carries the ability to prolong the lives of some patients and improve the quality of remaining life.
In most cases, surgeons perform a craniotomy, opening the skull to reach the tumor site. This is done frequently with computer-assisted image-guidance and at times using intra-operative mapping techniques to determine the locations of the motor, sensory and speech/language cortex. Intraoperative mapping often involves operating on a patient while they are awake and mapping the anatomy of their language function during the operation. The doctor then decides which portions of the tumor are safe to resect.
After surgery, when the wound is healed, radiation therapy can begin. The goal of radiation therapy is to selectively kill the remaining tumor cells that have infiltrated the surrounding normal brain tissue. In standard external beam radiation therapy, multiple sessions of standard-dose "fractions" of radiation are delivered to the tumor site as well as a margin in order to treat the zone of infiltrating tumor cells. Each treatment induces damage to both healthy and normal tissue.
By the time the next treatment is given, most of the normal cells have repaired the damage, but the tumor tissue has not. This process is repeated for a total of 10 to 30 treatments, usually given once a day, five days a week; depending on the type of tumor. The use of radiation therapy provides most patients with improved outcomes and longer survival rates compared to surgery alone or the best supportive care.
Patients undergoing chemotherapy are administered special drugs designed to kill tumor cells. Chemotherapy with the drug temozolomide is the current standard of treatment for GBM. The drug is generally administered every day during radiation therapy and then for six cycles after radiation during the maintenance phase. Each cycle lasts for 28 days, with temozolomide given the first five days of each cycle, followed by 23 days of rest. Tumor treating fields is a different modality of treatment that is introduced during the maintenance phase of treatment. |
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