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By RAVI GANDHI, MD

There are nearly 700,000 Americans living with brain tumors. There will be another 200,000 people diagnosed with a brain tumor each year. The most common symptoms are:

• Headaches, often in the morning
• Nausea and vomiting
• Changes in your ability to talk, hear, or see
• Problems with balance or walking Headaches, often in the morning
• Nausea and vomiting
• Changes in your ability to talk, hear, or see
• Problems with balance or walking
• Problems with thinking or memory
• Feeling weak or sleepy
• Changes in your mood or behavior
• Seizure

Brain tumors are divided into primary, arising from cells within the skull, or secondary, metastatic tumors that have extended from elsewhere in the body. Approximately, 86,000 of the brain tumors are primary, of which 30 percent are malignant. More than any other cancer, brain tumors can interfere with a patient's quality of life even at early stages.

Despite the morbidity associated with brain tumors and the number of cases, there have been only four new FDA approved drugs and one new device in the last 30 years. For many of the tumor subtypes, surgery and radiation still remain the first options. Many tumors do not require any treatment other than careful observation. A treatment plan is usually developed by a multidisciplinary tumor team consisting of neuro-oncologists, radiologists, radiation oncologists, and neurosurgeons who specialize in brain tumors.

Once an informed decision has been made to proceed with surgery, there are many tools in the neurosurgeons' armamentarium that facilitate safer, more precise, and less invasive surgery.

These tools such as image guidance and fluorescent help to identify the tumor during surgery. By allowing for precise localization, tumors can be removed through smaller openings and less contact with normal tissue. Fluorescent technology requires a special IV drug to be given and a special microscope during surgery. This helps facilitate differentiation of malignant tumors from normal brain tissue actively.

Intraoperative MRI during surgery helps to identify any residual tumor before the patient leaves the operating room. This is important in many tumors in which a gross total resection can improve survival.

For tumors in eloquent locations, neurosurgeons with the appropriate experience can remove tumors with patients awake. This allows for careful mapping of brain function such as language or motor areas. The brain does not have any pain fibers therefore patients tolerate this type of surgery very well.

For tumors in deep locations that are not easily accessible, some tumors can be treated with Laser Interstitial Thermal Therapy (LITT). A laser is directed to a defined area within the tumor, using a thin fiber that is guided to the tumor tissue. This fiber is inserted through a small hole in the skull and guided to the tumor using intraoperative MRI and a robotic assisted drive. The laser transmits energy and as a result, heats up the tissue surrounding the tip of the laser fiber. High temperatures can cause rapid, irreversible tissue damage - in this case, to the brain tumor.

The endoscope is a tool that allows surgeons to visualize by placing the light and a camera into a small space. This tool allows surgeons to remove complex tumors through access via the nose. This tool gives surgeons the ability to look around corners with exquisite detail often facilitating removal of tumors through very small openings.

Other therapies include, implantable chemotherapy or radiation wafers.

The diagnoses of any type of brain tumor is certainly life altering. The most important first part is a consultation with a neurosurgeon who works in a team of doctors who are all focused on treating brain tumors. A number of tumors can be observed or treated with radiation. When surgery is necessary, the above advances in technology make the operation safer, more precise, and less invasive surgery improving the chances of a great outcome.

Dr. Ravi Gandhi joined Orlando Neurosurgery following a cerebrovascular and skull base neurosurgery fellowship at Goodman Campbell Brain and Spine in Indianapolis, Ind. and a neuroendovascular fellowship at Albany Medical Center in New York. A neurosurgeon with nearly a decade of experience and a wide variety of peer-reviewed articles and oral presentations he has a special interest in the detection and treatment of complex brain and spinal tumors, blood vessel disease of the head and neck, and emergency treatment of neurological trauma and stroke. Visit www.orlandoneurosurgery.com