Today is Glioblastoma Awareness Day. The day is observed with the aim to raise awareness about the importance of finding a cure for Glioblastoma, the most aggressive form of brain cancer. It is also a way to honor patients, families and caregivers, as well as the clinicians and researchers who are committed to helping those with glioblastoma.
As the world observes Glioblastoma Awareness Day 2022, Dr Rahul Gupta -Director, Neurosurgery, Fortis Hospital, Noida – shares some insights on developments that have taken place over the last 5 years in terms of treatment of glioblastoma.
The wide availability of CT and MRI leads to early detection so that patients can be operated at an early stage hence better results.
New sequences of MRI like spectroscopy, functional imaging, perfusion studies, and tractography help to localize tumors in a better way. This also helps in planning the trajectory of surgery and the location of craniotomy (minimally invasive technique). Pre-operative DSA and embolization can help in the surgery of certain vascular skull base tumors.
1. Operating microscope – This high-end gadget is essential for the surgery of all brain tumors. It magnifies the tumor many times and helps in the safe and complete removal of brain tumors.
2. Intraoperative fluorescence for localization of Malignant brain tumors is an essential tool to distinguish between a normal brain and tumor cells in real-time. This is done using a special dye and filters (lens) through a software in the operating microscope.
3. Awake craniotomy is done in patients with tumors located in eloquent areas of the brain, especially on the dominant side (left side in a right-handed person). The patient is sedated, and craniotomy is made under scalp block (local anesthesia). Pt is asked to speak and move limbs on command while the tumor is being removed. This prevents post-operative deficits and improves post-operative outcomes.
4. Neuro monitoring- this checks the electrical activity of the brain to localize various functional areas of the brain. This prevents any injury to functionally important areas of the brain. This needs an electro-physiologist inside the operation theatre.
5. Special gadgets like CUSA machine, electric diathermy, graduated suction machine, specialized operating table with head clamps, and high-speed bone cutting drill and saw.
6. Neuroanaesthesia- A good Neuro-anesthetist as a part of the brain tumor surgery team is imperative nowadays. He looks after the patient pre-operatively, during the surgery, and post-operatively. He gives good anesthesia to keep the brain lax and wakes up the patient after surgery without complications. He also looks after the patient in Neuro-ICU after surgery. Good anesthesia machines, medicines, and techniques have helped in the successful excision of difficult brain tumors.
7. Newer technology and techniques have eased out the surgeries for difficult brain tumors which were labeled inoperable in the past.
1. Good post-operative care in Neuro ICU helps in the safe and good recovery of brain tumor patients. The patient is made pain-free, monitored closely, and calmed done with medications. Some patients may need post-operative ventilation in ICU.
2. Good quality radiotherapy and chemotherapy after surgery for Malignant brain tumors help to give long disease-free survival to the patient. Various new techniques like stereotactic radiotherapy, Intraoperative radiotherapy, and new chemotherapy agents are available and constant research is going on.