Brain tumours are thankfully rare, but there are many different types of tumour and therefore the  signs and symptoms can be very varied. The early signs can easily be missed, or misdiagnosed as another condition. Sometimes, the symptoms may be very subtle or there may even be no symptoms at all.

However, early detection will lead to the most effective brain tumour treatment pathway, and result in the best patient outcome. Therefore, it’s important to recognise potential warning signs, and always seek medical advice if you have any concerns.

Here’s a look at some of the most common brain tumour symptoms, and when to consult a doctor. As we have mentioned, these symptoms can be varied depending on the type, size and location of the brain tumour. They can also be sudden and intense, or subtle and develop gradually over time.

Persistent headaches

Almost everyone gets headaches sometimes, and they can have numerous causes. Most of the time, a headache won’t be caused by a tumour. Common causes include stress, migraines, dehydration, infections, hangovers, eye strain or bad posture.

However, according to the Brain Tumour Charity, about 60 per cent of people living with a brain tumour do experience headaches at some stage, which are caused by a build up of pressure on the nerves and blood vessels within the brain.

Potential signs to look out for:

• If your headaches feel different to usual, such as a dull or throbbing ache that gets worse over time, or occurs intermittently
• If your headaches are worse first thing in the morning or whenever you wake from sleep, and recede when you assume an upright position
• If your headaches do not respond to conventional painkillers that were previously effective, such as paracetamol or ibuprofen
• If your headaches are triggered or worsened by coughing, bending, shouting or straining
• If your headaches are accompanied by other symptoms, such as vomiting, seizures, muscle weakness, vision disturbance, or cognitive changes

Vision changes

If the tumour is pressing on an optic nerve or causing a swelling of the optic nerve in the back of the eye, it may lead to changes in vision. This may include:

• Blurred or double vision
• Episodes of sudden vision loss, often after standing up
• Losing part of the field of your vision, such as peripheral vision

If you have any concerns about your vision, book an appointment with an optician for an eyesight test, or see your doctor.

Seizures

Seizures (commonly referred to as fits) are one of the most common first symptoms of a brain tumour in adults. All incidents of seizure should be reported to a doctor, as they can have several potentially serious causes. However, it does not necessarily mean that there is a problem.

Seizures can be relatively minor, such as a temporary jerking of the limbs, or involve convulsions and loss of consciousness. A seizure that is related to a brain tumour is more likely to cause moments of confusion, visual disturbances, or hallucinations than a full loss of consciousness.

Nausea and vomiting

A brain tumour can cause persistent feelings of nausea or vomiting, which are often accompanied by dizziness. It’s important to remember that these are usually not a sign of a tumour and can be caused by many different reasons, including: food poisoning, gastrointestinal viruses, pregnancy, and over indulgence in food or alcohol.

Nausea on its own is more likely to be caused by one of the above reasons. However, if it’s worse in the mornings and improves during the day, it gets worse if you suddenly change position, have persisted for over a week with no other obvious explanation, or are accompanied by other potential brain tumour symptoms, seek medical advice.

Persistent tiredness

Tiredness and fatigue can affect anyone, and they do not affect all brain tumour patients. The fatigue could be mild, such as sometimes feeling sluggish and slow, or almost totally debilitating, preventing an individual from carrying out their usual duties.

The fatigue might manifest as poor concentration; sleeping too much or trouble getting to sleep or staying asleep; aching muscles; anxiety and depression; feeling an exhaustion that is disproportionate to the activity carried out; lack of motivation; and a loss of interest in activities that were previously enjoyed.

When to see a doctor

The above are not a comprehensive list of potential brain tumour symptoms, and in most cases they won’t lead to a positive diagnosis of a tumour. However, if you are experiencing multiple symptoms, or symptoms that don’t improve after a few weeks and have no obvious explanation, then you should get checked out by a doctor.

If you would like to find out more about radiotherapy brain tumour treatment options, please visit our website.

A brain tumour diagnosis is a distressing time, and there is a lot of new information to take in. Naturally, you and your loved ones will be anxious to understand what your treatment options are. If you are in the UK, national guidelines recommend that brain tumour patients are treated by a group of specialists known as a multi-disciplinary team (MDT).

Here’s a closer look at who the members of an MDT are, and how they shape a brain tumour treatment pathway.

What does an MDT team do?

An MDT consists of healthcare professionals with different specialties who work together to form the best treatment plan for each patient. This ensures that individuals receive personalised care that is uniquely tailored to their needs and wishes, and the treatment plan is formed after input from multiple viewpoints with different areas of expertise.

The MDT will continue to manage your care throughout your treatment and follow up journey. This will ensure a consistent approach, and your progress will be regularly monitored and discussed with the relevant team members, and adjustments will be made if and when they are deemed necessary.

Who are the members of an MDT?

The members of an MDT will typically consist of the following:

Neurologist

A neurologist is a specialist in medical non-surgical abnormalities in the brain and spinal cord, and is often involved in the initial assessment of brain tumour patients, and the ongoing management of tumour-related seizures.

Neurosurgeon

A neurosurgeon will be involved if the tumour is operable, to remove part or all of the tumour.

Oncologist

A clinical or neuro oncologist specialises in the non-surgical management of brain tumours, such as radiotherapy or chemotherapy. A medical oncologist may be part of the MDT to deliver chemotherapy, immunotherapy, or other types of drug treatments.

Radiographer

A diagnostic radiologist uses imaging technology to create images of the brain that are used to accurately show the size, shape and location of the tumour. A therapeutic radiographer is involved in administering the radiation treatment.

Specialist nurses

A specialist nurse will be appointed to the team to offer support and advice, and will usually be your first point of contact.

Healthcare professionals you may meet post-treatment

Alongside your brain tumour treatment, your GP will remain involved in your day to day care and will be your first point of contact for health issues that aren’t or do not appear to be related to your brain tumour or treatment.

Depending on the type and severity of your symptoms, and the way they have affected your wellbeing and daily life, you may also work with the following medical staff as part of your treatment:

Neuropsychologist

A neuropsychologist specialises in the rehabilitation of patients with traumatic brain injuries, including damage that may have been caused by a brain tumour or the treatment. They may carry out assessments such as language tests that are designed to identify any difficulties, and work with you to help you manage the changes.

You may also be referred to a psychologist or a clinical psychiatrist to help you deal with mental or emotional problems that have developed as a result of your brain tumour, such as anxiety disorders or depression.

Therapists

You may be referred to various therapists as part of your rehabilitation process. These include an occupational therapist, who can help you to manage daily activities and if relevant, help you prepare for a return to work. A physiotherapist may be involved with your rehabilitation if you have difficulties with balance or muscle weakness.

If the area of your brain impacted by the tumour has affected your language and speaking skills, or if you have difficulty chewing and swallowing food, then you may be referred to a speech and language therapist. You may also be referred to a dietitian to ensure that your nutritional needs are being met.

How brain tumour patients benefit from an MDT approach

The direct involvement of a diverse range of specialists means that better-informed decisions can be made when creating your treatment plan. The team will meet to discuss your diagnosis and treatment options, which leads to better coordination and continuity of care, and higher quality patient outcomes.

Overall, the treatment plan will not just take into account the clinical aspects of your brain tumour, but will take a holistic approach that involves you as a person. You will always have the final say in the type of treatment that you receive, and your team will have your best interests at heart.

If you are interested in finding out more about radiotherapy for brain tumour treatment, please visit our website today.

April 8 is World Neurosurgeons Day, when the achievements of surgeons who carry out highly complex and precise procedures on the brain are celebrated. Leading edge technology such as Gamma Knife surgery has enabled the development of brain surgery that is less invasive, safer, and more effective than ever before.

However, these advancements may not have been possible without the dedicated efforts of Harvey Williams Cushing, the man widely regarded as the father of modern neurosurgery.  World Neurosurgeons Day marks the date of his birth on 8 April 1869. Here’s a look at his achievements, and how neurosurgery has evolved since his death in 1939.

The legacy of Harvey Cushing

Harvey Cushing was born in Cleveland, Ohio, and graduated from Yale College in 1891. He went on to study at Harvard Medical School in Boston, and received his medical degree in 1895.

From here, he completed an internship at Massachusetts General Hospital, where he successfully developed new anesthesia practices and was among the first medics to recognise the potential of X-rays as a diagnostic tool.

In 1896, Cushing started work at the Johns Hopkins Hospital in Baltimore, where he was mentored by the distinguished surgeon William Halsted, and was also strongly influenced by the professor of medicine Sir William Osler. He also spent a year studying with some of the finest surgeons in Europe.

By this time, Cushing had decided to focus his career on neuroscience, and he developed a reputation as one of the most meticulous brain surgeons of his generation. Previously, neurosurgery was considered a last resort with a low success rate: many procedures resulted in fatal bleeding or infections, or permanent brain damage.

Cushing introduced a range of innovations that resulted in a much higher success rate, particularly for the treatment of brain tumours. He developed a classification system for different types of tumours, and used X-rays to accurately locate the position of the tumour in the brain.

He also developed new methods for controlling bleeding and better anaesthesia techniques. One of his most significant legacies was the identification of Cushing’s syndrome, a disorder caused by excess cortisol production due to a pituitary gland tumour.

Cushing was also a prolific writer and talented draughtsman, and he made detailed notes and illustrations of all his work, and these, alongside his many publications that made original contributions to the field of neurosurgery, have educated and inspired future generations of medical professionals.

Post-Cushing advancements in neurosurgery

Neurosurgeons built on the foundations laid by Cushing to develop further groundbreaking techniques that have resulted in more precise and less invasive brain tumour treatment that has a lower risk of side effects.

For example, modern imaging techniques such MRI scans and CT scans have enabled neurosurgeons to more accurately locate the position of tumours. Recently, this process has become even more precise due to the introduction of AI technology, which can be used to automate the process of tumour delineation.

This enables tumours without clearly defined boundaries to be located in a more precise and consistent manner, reducing the risk of human error and variables in interpretation. AI assisted delineation is much quicker compared to a fully manual process of segmenting tumour contours. This speeds up the treatment process and improves patient outcomes.

For open surgery to remove brain tumours, modern procedures are designed to be less invasive with smaller incisions. Many neurosurgeons make use of robotic and AI-driven systems for more accurate and controlled guidance during procedures.

Radiosurgery and stereotactic radiosurgery

Radiosurgery was first developed to treat brain tumours by the Swedish neurosurgeon Lars Leksell. stereotactic radiosurgery involves delivering localised irradiation in one session to a precisely targeted area of the brain, in order to kill the abnormal tumour cells while having minimal impact on the surrounding healthy brain tissue.

Stereotactic radiosurgery was introduced for the treatment of inoperable arteriovenous malformations, acoustic neuromas, and brain metastasis.

Gamma Knife surgery

One of the most effective and low-risk forms of stereotactic radiosurgery is Gamma Knife surgery. This makes use of multiple radiation beams with a level of accuracy greater than 0.5mm.

The individual beams are too weak to damage normal brain tissue as they are directed onto the target area, but the beams intersect on the target area to provide effective impact on the abnormal cells.

This minimally invasive procedure has a much lower risk of side effects compared to other forms of brain surgery, and most patients can return home on the same day and will require just one session of treatment.

If you would like to find out more information about Gamma Knife surgery, please get in touch with a member of our team today.

Neurosurgery is a famously difficult and risky procedure. However, thanks to pioneering medical researchers and highly skilled surgeons over the years, there are now some very safe, effective and less invasive ways to operate on the brain. For example, one of the most precise and innovative ways to treat brain tumours is Gamma Knife surgery.

Gamma Knife is not traditional open surgery, so it eliminates the high level of risk and complications involved with making incisions into the skull. Instead, it uses precisely focused gamma rays to target the tumour cells via an external machine. The exact location of the tumour is determined by advanced AI-assisted imaging techniques.

However, such technologically advanced procedures are a very long way from the earliest experimentations with brain surgery. Here’s an overview of how this most challenging yet potentially life-saving procedure has evolved over the years.

The earliest forms of brain surgery

Archeologists and historians have unearthed evidence that a primitive form of brain surgery known as ‘trepanation’ was performed as early as 7,000 BCE in pre-Incan civilisation in Peru, and also in Ancient Greece and Egypt, and some areas of south east Asia.

Trepanning involves detaching the scalp and drilling a hole in the skull, and was thought to relieve headaches or the pressure caused by a large tumour. It may also have been carried out to treat mental illnesses, epilepsy and head trauma.

Skulls that have undergone trepanation have been found with evidence of new bone growth, suggesting that some patients survived the procedure. However, it is difficult to assess how effective it was at relieving their symptoms. Early practitioners had a very limited knowledge and understanding of the brain, so any treatments would be very rudimentary.

The field of knowledge was advanced by Hioppcrates (470 BC-360 BC), the Ancient Greek polymath who is considered to be the founding father of modern medical ethics. He left detailed texts containing accurate descriptions of clinical head injuries, spasms, and seizures.

Cornelius Celsus lived in ancient Rome in the first century AD, and there is evidence that he carried out skillful surgery on depressed brain fractures. The Islamic school of brain surgery that flourished between 800 and 1200AD is also considered to be influential on later generations of neurosurgeons.

Despite these advancements, brain surgery was likely to have been a last resort and only carried out in rare circumstances. Before modern anaesthetics and antibiotics were invented, it was an extremely dangerous and painful procedure, and the risk of bleeding and infections probably outweighed the benefits in most cases.

The first successful brain tumour procedure

The world’s first successful brain tumour was carried out by a Glaswegian surgeon named William Macewen in 1879. The patient was a young girl named Barbara Watson who presented with a large lump over her left eye, and was suffering from recurring seizures.

Macewen had a specialist interest in neurosurgical procedures, and had explored the safest methods of accessing the brain and infection control measures. He went on to carry out a successful operation to remove the tumour, and the patient went on to make a good recovery.

Macewen published an account of the procedure and outcome in the Glasgow Medical Journal in 1879, although his achievements weren’t widely recognised until almost ten years later in 1888.

The first primary brain tumour operation involving a direct opening of the skull was carried out by Mr. Rickman J. Godlee in 1884 in a London hospital. The 25 year old patient survived the procedure, but died of apparent complications 25 days later. However, a post-mortem revealed that all traces of the tumour had successfully been removed.

20th century advancements

Like other forms of medicine, great advancements were made in neurosurgery during the 20th century thanks to a more detailed understanding of brain anatomy, better surgical techniques, and widespread use of anaesthetics and antibiotics. X-rays also enabled the position of tumours to be pinpointed more accurately.

The American neurosurgeon Harvey Cushing is credited with pioneering the framework for modern neurosurgery, which has significantly improved outcomes and patient survival rates.

Brain surgery in the 21st century

In the 21st century, minimally invasive techniques for treating brain tumours such as stereotactic radiotherapy have come to the forefront. One of the most advanced forms is the previously mentioned Gamma Knife, which makes use of computer assisted navigation for the most efficient and precise method of destroying tumour cells.

Such techniques avoid the significant risks of open surgery, and have a low risk of causing damage to the surrounding brain tissue.

To find out more about advanced radiotherapy and neurosurgical treatments for glioblastoma, please visit the Amethyst Radiotherapy site.

An acoustic neuroma (also called vestibular schwannoma) is a benign (non-cancerous) tumour that develops on the nerve that connects the inner ear to the brain. This nerve (which is referred to as the acoustic or vestibulocochlear nerve) is responsible for hearing and balance, and it also runs close to the main nerve that controls facial movement.

Who is affected by acoustic neuroma?

Research is ongoing into the causes of acoustic neuroma, as it is not fully understood. They most commonly affect adults between the ages of 40 and 60, although they can affect people of all ages.

In rare cases, NF2-related schwannomatosis may be diagnosed, which is a genetic condition. This tends to affect younger people, and the tumours can develop on both sides of the head.

What are the symptoms of acoustic neuroma?

Acoustic neuromas tend to grow slowly, and may not cause noticeable symptoms in the early stages, but over time they can interfere with hearing and balance. This can develop into hearing loss, usually in one ear rather than both. The most common symptoms include the following:

• Loss of hearing in one ear, which may happen gradually
• Problems with balance, frequent dizziness or a sensation of movement even when still
• Hearing a persistent ringing or buzzing noise in the ear (tinitus)

Tumours that are pressing on the nerves that control facial movement may also cause numbness, weakness, pain or a tingling sensation on one side of the face.

An acoustic neuroma that has grown to a large size may also cause persistent headaches, episodes of blurred or double vision; problems with coordination on one side of the body; and difficulty swallowing or voice changes.

How are acoustic neuromas diagnosed?

Anyone who is concerned about any of these symptoms should visit their doctor, who may refer the individual for further investigation. This might include hearing tests, and an MRI or CT scan to obtain clear images of the inside of the skull.

Although acoustic neuromas are non-cancerous, they can affect quality of life and may impact your ability to drive, carry out your job, or socialise. Larger acoustic neuromas can also lead to a potentially fatal build up of fluids on the brain. Therefore it’s essential that the tumour is diagnosed and a treatment plan is put in place.

How are acoustic neuromas treated?

The type of treatment will depend on the size and location of the tumour; how the symptoms are impacting the patient; and their age and general state of health. Smaller tumours may be actively monitored for signs of further growth rather than directly treated. This will involve having regular brain scans to build an accurate picture of the tumour over time.

The patient may also have regular hearing tests to check if the symptoms are worsening. Some tumours may never require treatment, because they do not grow any larger.

If treatment is necessary, the two main options are surgery and stereotactic radiosurgery (SRS). Larger tumours are more likely to need open brain surgery to remove the tumour. Smaller tumours or patients who are unable to undergo open surgery can be treated with SRS.

In some cases, SRS may be carried out following open surgery to treat parts of the tumour that were not able to be removed.

What are the advantages of Gamma Knife surgery for acoustic neuromas?

Gamma Knife surgery is an advanced form of SRS that uses highly focused radiation beams to target the tumour while avoiding the surrounding healthy brain tissue. This reduces the risk of side effects, and in many cases the treatment can be delivered in a single session.

The procedure typically lasts between 30 minutes to several hours, depending on the size of the area being targeted. Most patients are able to return home on the same day. Compared to traditional surgery, Gamma Knife has several advantages, including the following:

• Less invasive and much lower risk of infections or other complications
• Much quicker treatment and recovery times
• Much lower risk of damaging the facial nerves or hearing
• High success rates: in the majority of cases, tumour growth is stopped or slowed

What is the long term outlook for acoustic neuroma patients?

Most patients can be successfully treated with surgery or SRS (if required). Usually, regular MRI scans will be necessary to check if the tumour is regrowing. If symptoms such as hearing loss or tinnitus persist, these may require further treatment.

If you’re concerned about your health and want to discuss matters with one of our consultants, get in touch with Mr Neil Kitchen, who will be able to help you further.