Brain Tumors

How common are brain tumors?

About 7 out of 100,000 residents in the general population suffer from some form of brain tumor, while malignant ones make up about 2% of all malignant tumors in the human body.

What causes brain tumors and are there ways to prevent them?

Current scientific data supports that brain tumors develop after accumulated genetic mutations, which lead the nerve cell to proliferate uncontrollably. These mutations can be caused either by genetic predisposition or by environmental factors.

Data so far show some association with high doses of radiation therapy or long-term exposure to certain chemical agents. Early diagnosis and proper treatment are the keys to the optimal outcome of a patient with a brain tumor.

Are all brain tumors malignant?

Tumors arising from the covering of the brain (meninges) are usually benign, and are called meningiomas. In contrast, tumors arising from brain cells (intracerebral tumors) are usually malignant.

The most common malignant brain tumors are gliomas. Depending on the degree of malignancy of a glioma and the speed of its reproduction, it can be classified into four stages (Grade 1-4). Grade 1 and 2 gliomas are considered low-grade, while grades 3 and 4 are high-grade.

What symptoms would worry a patient enough to go to the doctor?

Brain tumors can give some atypical general symptoms, such as headache, nausea, dizziness, or when they press on a functional center lead to weakness in an arm or leg or difficulty speaking. Also, in many cases a tumor first manifests itself with a seizure or changes in a patient's behavior.

How is a brain tumor diagnosed?

The test of choice for the diagnosis of a brain tumor is the Magnetic Tomography. Many times, of course, the first diagnosis can also be made with a CT scan. While there are other more specialized imaging tests that help in surgical planning, such as functional magnetic resonance imaging and desmidography, in which the neurosurgeon assesses how close to the movement or speech centers the tumor is. Also, magnetic spectroscopy provides information on the type and composition of the tumor preoperatively.

What are the ways of treatment?

In almost all cases where a brain tumor is diagnosed, surgical removal of material for histological confirmation (biopsy) is required. In most cases, surgical removal of as much of the tumor as possible is recommended.

Multicenter studies have shown that removal of >90% of a malignant brain tumor is associated with a better outcome compared to patients who only underwent biopsy or partial removal of the tumor. Post-operatively for all highly malignant gliomas (Stage 3 or 4) the combination of chemo- and radiotherapy is required.

What are the newest developments in the surgical treatment of brain tumors?

The truth is that in recent years we have added new weapons to our surgical quiver for treating brain tumors. For example, the use of robotic neuro-navigation to guide the neurosurgeon with millimeter precision exactly in the area where the pathology exists is something that is now internationally considered a must in every brain surgery.

I was also fortunate to specialize in more advanced surgical techniques at Weill Cornell/New York Presbyterian in the US, such as using endoscopic neurosurgery to remove specific tumors through the patient's nose, with virtually no external incisions or destruction of the normal brain.

We also apply the use of a special pigment that colors the malignant tumor and makes it more visible during the surgery, so that it can be safely removed as much as possible. Finally, when the tumor is located close to centers of movement or speech, there is now the possibility for the patient to maintain his senses (awake craniotomy) during the surgery and to control his functions in real time, in order to eliminate the possibility of causing any neurological damage during tumor removal.

What is the reality today for our country and what expectations should we have?

Returning to our country in 2018 after many years in Germany and the USA, my vision was that the patient could receive a similar quality service in the field of Neurosurgery here in our country, to that received by the average patient in the countries that I worked.

The truth is that now, both at Athens Medical Center and at Apollonion Hospital in Nicosia, where I operate, the technological support and know-how that exists is comparable to the most advanced centers abroad. In any case for individual complex cases we keep open channels of communication with the centers in Germany and the USA where I worked, so that they can be supported accordingly if deemed necessary.

We must all understand that there is no longer a "one man show" in medicine and the cooperation between doctors and centers is always for the benefit of the patient.

What new weapons should patients expect in the near future regarding their treatment?

In addition to surgical developments, significant advances have been made in the field of molecular staging of brain tumors, so that each patient receives a more personalized treatment (targeted personalized treatment). Also, in the field of chemotherapy and radiation therapy, special protocols and techniques are now applied that significantly increase the survival time and quality of life of these patients.

What is the survival of patients with brain tumors?

The truth is that I almost always hear this question from my patients and their relatives and I never give a specific number. The reason is not that I am avoiding the answer, but the survival that exists in the studies is simply an average.

Of course there is a range that all parties should be aware of, but each patient is unique and has an individualized treatment and no one can speak with specific numbers and figures. We all have patients who have defied the statistics and this gives strength and courage to all of us.