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Brain tumors

Introduction to brain tumors

There is a wide variety of brain tumors, most of them with slow growth and benign behavior. However, brain tumors can originate from different structures contained in the skull, from the meninges, which is the fibrous tissue that envelops the brain and spinal cord, to the cerebellum (meningiomas)even the brain cells themselves (primary brain tumor or glioma)or originate from other parts of the body (metastasis). The origin of the tumor and its location are the main prognostic factors of the disease that will later serve to decide the most appropriate treatment. 

A detailed medical history, a physical examination, and the right imaging or neurophysiological tests (brain MRI, visual fields, evoked potentials ...), will be enough to reach a diagnosis and propose a therapeutic option.

Assessment by a specialist is essential since, in certain situations of high surgical risk and low risk of malignancy, many of these lesions can be treated conservatively, simply requiring observation by repeated brain MRI scans. On other occasions, the surgical risk is so high and the risk of malignancy so low, that it will be decided to treat the complications derived from the brain inflammation caused by the tumor (headache, facial pain, hydrocephalus, etc.), while the treatment of the tumor itself will remain in the background.

In cases where the diagnosis is in doubt and there is a risk of a malignant tumor, surgical options may be considered, including brain biopsy (closed or open) or primary tumor resection. 

The risk of oncologic brain surgery depends on several factors ,these include the patient's age, his/her general condition or neurological involvement prior to surgery, the type of tumor to be operated on (benign, intermediate grade or malignant) and finally the location of the tumor and its relationship with certain brain structures.  The ideal situation is to be able to resect the entire tumor without neurological sequelae. This is possible in many cases, but each patient must be evaluated individually. The risk of definite neurological sequelae must be carefully studied, taking into account all the factors mentioned above. In some cases, the risk of these sequelae after surgery is related to the aggressiveness of the surgery itself (resecting the entire tumor or leaving a remnant that is close to important brain structures). 

The ideal situation is to be able to remove the entire tumor without neurological sequelae. This is possible in many occasions, however each patient must be assessed individually and the risk of definitive neurological sequelae must be carefully studied, taking into account all the aforementioned factors.

Benign brain tumors

Tumors originating from the meninges (meningiomas) are the most common in this group. The management of these tumors ranges from radiological observation (repeated MRIs) to surgical treatment. One or another attitude will depend on size of the tumor’s size, its growth rate, its location in the brain and relationship with important brain structures or the neurological symptoms that it is causing. Large meningiomas rapidly growing and causing neurological symptoms are usually amenable to surgical treatment.

These are usually safe surgeries, and the patient progresses satisfactorily. 

After histological analysis of the tumor, some of them will require other oncology treatments después de la cirugía como la radioterapia.


Malignant brain tumors

The most common malignant brain tumor is the brain metastasis. Systemic tumors that frequently cause brain metastases are the melanoma, the lung cancer, the breast cancer, or the prostate cancer.

The main prognostic factor of this situation is related to the oncological status of the primary tumor: if this tumor is under controlled and there are no metastases widely disseminated throughout the rest of the body, the prognosis of the brain metastasis is usually favorable.

The second kind of malignant brain tumors is less common and originates from the brain cells themselves. There are many types of these tumors, which are generally known as gliomas or primary brain tumors. Some of them are more aggressive, while others show an intermediate behavior between benign and malignant tumors. A detailed evaluation of the clinical history, the neurological examination and the brain MRI will help the neurosurgeon to advise the most appropriate option in each case, ensuring the greatest resection of the tumor with no neurological sequelae.

Cranial base tumors and pituitary tumors

The skull base is the anatomical region between the skull and the structures of the facial and otorhinolaryngological massif (nasal roof, rhinopharynx and middle ear). For this reason, this region is characterized by great anatomical complexity, which is further complicated by the large number of arteries, nerves, and bone structures found within.

Brain tumors located in this region are usually benign and slow growing, however, given the proximity of the tumor to these important structures, the appearance of neurological symptoms is usually frequent despite their small size. A particular type of tumors in this region are tumors derived from the pituitary gland (pituitary adenomas being the most frequent).

Dada la complejidad de estas cirugías, el especialista deberá evaluar la situación del/la paciente y consensuar con él/ella el tratamiento, discutiendo tanto los beneficios como los riesgos derivados.


Introducción (origen del dolor, tipos de trastornos de columna, prevención, diagnóstico, tratamiento médico, fisioterapia, terapia física avanzada, técnicas mínimamente invasivas).

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