Improvement in treatment for brain tumors in Pakistan

World Brain Tumor Day is observed on June 8 each year across the globe. It is meant to develop awareness about brain tumors among the general public. In Pakistan on this day we let our citizens know what new diagnostic and treatment expertise we have brought in for poor people in the public sector.

Brain tumors are uncommon and incidence rate for primary malignant and non-malignant brain tumors in USA is 22 cases per 100,000 population. Out of these one third are malignant and two thirds are non-malignant.

We do not have exact incidence of these tumors in Pakistan as we do not have central tumor registry for our population. It is not exactly known what causes these tumors. However there is increased risk in certain rare genetic syndromes and childhood exposure to radiation. Certainly if father or a brother has brain tumor, there is no increased risk in children or rest of family members.

Brain tumors can present with headaches, problem with vision, epilepsy, stroke, personality changes and drowsiness. If not diagnosed early, may lead to comatose condition. Nowadays it is very easy to diagnose these tumors with a contrast CT scan of brain which is widely available. Sometimes we have to do MRI scan of brain which gives better details of tumor size, location and its exact relation with blood vessels and eloquent parts of brain like speech, arm, face, leg areas.

The first 3 Tesla MRI in the public sector of Pakistan is functional at PINS Lahore General Hospital with functional and DTI imaging which has given new dimension to eleqarea tumor surgery.

There are 100 different types of brain tumors and not every tumor is cancerous. Different types of brain tumors present in different age groups from childhood to old age. Tumors can either arise from brain primarily or spread to it from the rest of the body. However tumors arising from brain do not spread to other parts of body. A neurosurgeon should operate in a way as to steal away tumor from brain during surgery, meaning that rest of brain should remain undisturbed and there should be no/ minimal external evidence of surgery!

Recently there has been great improvement in treatment for brain tumors in Pakistan which is at a par with international standards. Today a neurosurgeon does minimally invasive surgery which means small area of head shave, small incision hidden in hair line with better visibility and direct and safe access to tumor with neuronavigation and operating microscope.

Tumors at base of brain like pituitary tumors, skull base meningiomas etc. can be accessed through nose with endoscope without any external evidence of brain surgery.

The magnified image along with crushing and suction of tumor with Cavitron ultrasonic surgical aspirator (CUSA) makes surgery very safe. All these diagnostic and operative facilities are available at Lahore General Hospital. We have also started painless but awake brain tumor surgery at PINS so that surgeon stops removing a tumor as soon as there is early weakness in arm on difficulty with speech.

Generally in expert hands operative mortality of most of brain tumors is less than 5%. Moreover improvement in anaesthesia techniques, ICU facilities, postoperative radiotherapy, gamma knife, chemotherapy (temezolamide) and gliadel wafers has improved patient survival with brain tumors. However there is a dire need for research grants and interdisciplinary approach to further improve survival of these patients in Pakistan.

The writer is Professor of Neurosurgery PGMI/AMC/ Punjab Institute of Neurosciences, Lahore General Hospital.