Common neuro-oncological tumours

Common neuro-oncological tumours

In order to be able to plan an optimal treatment path, it is important to obtain the most accurate information possible about the tumour.

We treat all tumours in the area of the brain, meninges, skull bones and cranial nerves. The most common neuro-oncological tumours are described in detail below.

 

The so-called "brain tumours" have their origin in the supporting cells of the brain. Complete removal is usually not possible. This is mainly due to the infiltrating growth into the surrounding and partly functionally important brain tissue. With the exception of the very slowly growing WHO grade I tumours, gliomas are therefore still considered incurable. However, the combination of surgical therapy and subsequent targeted drug (chemotherapy) and radiotherapy measures often results in long-term tumour control.

Until recently, gliomas were classified into four different tumour grades (WHO I to IV) according to the WHO classification. Here, specific tissue characteristics of the tumour were mainly taken into account (cellular origin, cell composition, growth behaviour). In 2016, the WHO criteria were updated and expanded to include the aspect of molecular genetic changes, as these play an increasingly important role in diagnostics, therapy planning and prognosis.

A new modern form of therapy for the treatment of very aggressive gliomas is the use of so-called tumour therapy fields (TTF). Here, alternating electrical fields are continuously applied via ceramic gel pads that are glued to the scalp. In addition to the established radiation and chemotherapy, this has proven to be an effective method to reduce the division of tumour cells.

Meningiomas are usually slow - and non-invasive - tumours that grow from one of the three layers of the brain (arachnoidea). Problems are usually caused by the displacement of healthy brain tissue or nerves. Larger or more aggressive tumours also grow into the brain tissue. Because of their regularly slow growth, meningiomas can reach a considerable size before they produce symptoms.

The therapy of choice is usually the removal of the tumour as completely as possible. Only in a few cases  additional radiotherapy treatment is necessary. In the case of very small tumours or a high surgical risk, imaging follow-up or targeted radiation (e.g. Gamma Knife) are recommended as an alternative to surgery.

This is a mostly benign tumour originating from the nerve sheath of the eighth cranial nerve (n. vestibulocholearis). One part of this nerve is responsible for the sense of balance, the other for hearing. The seventh cranial nerve (nervus facialis), which is responsible for the movement of the facial muscles, accompanies the vestibulocholear nerve. The close proximity to these nerves on the one hand, and the proximity to the brain stem on the other, explain the complaints that can be caused by the tumour and justify the high demands on surgical therapy. Individually, a treatment strategy must be considered in view of the exact location, size and symptomatology of the tumour. In addition to tumour resection, targeted radiotherapy is also an option. In some cases, therapy can be dispensed with undergoing imaging follow-ups.

The pituitary gland (hypophysis) is one of the most important organs for the production and control of hormones. The most common type of tumour in this area is the mostly benign pituitary adenoma. From a certain size of the tumour, in addition to hormonal disturbances, vision can also be affected, at which point at the latest the tumour should be treated.

Some pituitary adenomas, e.g. the so-called prolactinoma, can be treated with medication. In most cases, however, an operation is the therapy of choice. Because of the location of the pituitary gland on the bottom of the brain and its proximity to the paranasal sinuses, removal of the tumour through the noseusing endoscopic or microsurgical techniques is usually possible . Only in rare exceptional cases, e.g. in the case of very large tumours, does microsurgical removal through an opening in the skull have to be performed. If an operation is not possible and there is no possibility of drug treatment, targeted radiation of the pituitary adenoma can be considered. Radiation therapy can also be used in the case of a recurrent tumour or if important vessels or nerves are invaded and surrounded by the tumour.

About 20 to 40 percent of all patients with cancer develop one or more metastases in the brain during the course of their disease. During treatment, it is particularly important to consider not only the local findings but also the overall health condition and the status of the tumour outside the brain. This means that an interdisciplinary approach should always be taken. In addition to the possibility of surgical removal of cerebral metastases, there are various alternative or complementary radiotherapeutic approaches available. In rare cases, drug therapy is also possible.

Tumours of the spinal cord (e.g. gliomas, ependymomas), the membranes of the spinal cord (meningiomas) and the outgoing nerves (e.g. neurinomas, swannomas) are complex diseases that we treat surgically in our clinic.

The latest surgical microscopes including fluorescence microscopy and angiography, micro Doppler, intraoperative neuromonitoring (IONM), ultrasound and minimally invasive approaches are used.

If access through the mouth, chest or abdomen is necessary, we work closely with the experts at the clinics for ENT, visceral surgery and vascular surgery.

Metastases from other organs can affect the spine and lead to compression or instability of the spinal cord or nerves. Here, a combination of stabilising surgery and (partial) removal of the metastases is often necessary.

Stabilising operations include kyphoplasty or vertebroplasty, in which we stabilise the unstable vertebral bodies by injecting cement.

Should radiotherapy or chemotherapy be necessary after the operation, we plan the best possible follow-up therapy in the interdisciplinary tumour board together with oncologists and radiotherapists.

Our treatment offer

The interdisciplinary tumour board develops an individual treatment concept for each patient, taking into account the recognised guidelines and international standards. Alternatives to surgery, such as radiosurgery, are also always taken into account in the decision-making and consultation process.