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What are the steps involved in treating brain tumours?




1. The first step is diagnosis. A brain tumour diagnosis is generally made with a brain scan, usually a CT scan initially and followed by an MRI scan which provides much more detail about the brain and the tumour than a CT scan does. Most people have symptoms that prompt their GP to order a CT scan, such as headaches, behaviour change, limb weakness, speech disturbance, or even seizures.

2. Following diagnosis you will need a referral to see a Neurosurgeon. Once the diagnosis of a brain tumour has been made your GP will refer you to a Neurosurgeon, or sometimes a patient will be instructed to present to their local hospital Emergency Department. This is considered a high priority referral, and should not be delayed; if you have been diagnosed with a brain tumour and need an urgent appointment to see a Neurosurgeon please contact us on (08) 7127 2359.

3. Next you will have your initial consultation. Your Neurosurgeon will take a history, perform a physical examination and go through your scan results with you. They will then explain if you need surgery or not and also what type of surgery is appropriate, taking into consideration risks specific to your scenario including the anatomical location where your tumour is.

4. Surgery is arranged without delay. You will be admitted to hospital and have a planning MRI scan the day before your operation. You must fast for at least 6 hours before surgery, and all blood thinning medications need to be discontinued for up to a week prior. After surgery you will be taken to a Critical Care Unit for observation. You will most likely feel exhausted and sometimes very nauseous but with surprisingly little pain.

5. You will spend up to a week in hospital recovering from surgery. You will have an MRI brain scan the day after your surgery. Physiotherapists will help you gently mobilise over the coming days. After you have recovered you will be discharged home, usually around 3-5 days after surgery but sometimes up to a week. Most surgery patients are prescribed a short course of the steroid medication Dexamethasone to help with brain swelling and this is gradually weaned after the operation. You may also be prescribed a medication to reduce the risk of you having a seizure, this is called an anticonvulsant.

6. When you are ready you will be discharged home. You should take things quite easy for the first few weeks, including no work or study. Your sutures are dissolvable and will fall out by themselves as your wound heals. You cannot drive a motor vehicle after brain tumour surgery for a period of time of at least 3 months but potentially up to a year, often depending on whether or not you have had a seizure or black out. If you feel well enough you may go back to work or study after your initial rest period. Once your results are available your surgeon will contact you to explain them and to advise necessary next steps.

7. If appropriate your surgeon will refer you to an oncology service. If your tumour is unfortunately of an aggressive type then you will almost certainly benefit from additional therapy, including chemotherapy and radiation therapy. In most instances chemotherapy can be administered as a tablet and can be taken at home without the need for hospitalisation, however radiation therapy must be performed in a specialist setting and treatment generally occurs daily for between 2 and 6 weeks. Your Neurosurgeon will refer you to both oncology specialists as part of the multidisciplinary approach to your care.

8. You will need ongoing follow up. Almost all resected brain tumours require follow up, with face-to-face consultations and MRI scans. The frequency and duration of follow up varies between patients and tumour types, however as a rule of thumb it would be reasonable to perform 3-monthly scans for the first year after surgery, and assuming no concerning features identified on the MRI scan performed 12 months after surgery the interval between these scans can be stretched out. Your multidisciplinary team will advise on the best follow up plan for your individual scenario.

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