1. Surgery Surgery is the initial therapy for nearly all patients with brain tumors and can cure most benign tumors, including meningiomas Goal : to remove as much of the tumor as possible while minimizing damage to healthy tissue

2. Role of Surgery in Treatment of Brain Tumors Complete tumor removal (meningiomas, grade I astrocytomas, and ependymomas) Partial tumor removal - major beneficial effect on symptoms and on the effectiveness of other treatments, such as radiation therapy and chemotherapy Pathological identification - treatments of primary brain tumor become more sophisticated and “tailored” to the individual tumor, so it is important to have adequate amounts of tissue for review by neuropathologists

3. Role of Surgery in Treatment of Brain Tumors Removal of hypoxic tissue - hypoxic tissue is remarkably resistant to other forms of therapy, particularly radiation therapy. The only way to get rid of this part of the tumor is to remove it during an operation Symptomatic improvement - brain tumors cause symptoms in part by compressing the brain and thereby interfering with its normal function. Partial removal of the tumor could relieve compression and markedly improve symptoms and the quality of life of patients

4. Surgery Risks and Side Effects Infection Blood clots: Having a brain tumor by itself increases your risk of developing a blood clot - "pulmonary thromboembi“ Temporary neurological deficits: the surgical procedure itself to increase the amount of swelling in the surrounding, normal brain lead ing to a temporary worsening of your neurologic symptoms. Improves over time, particularly with the use of steroids Permanent neurological Deficit Bleeding into the surgical site. Seizures Prolonged hospitalization

5. RADIOSURGERY

6. Stereotactic Radiosurgery Treatment options for select patients with 1⁰ brain tumors and some meatastatic brain tumors Non-surgical procedure that delivers a single high-dose of precisely-targeted radiation using highly focused gamma-ray or x-ray beams that converge on the specific area or areas of the brain where the tumor or other abnormality resides, minimizing the damage to adjacent neural structures. can be completed in a one-day session but sometimes multiple treatments are required for tumors > 1 inch in diameter fractionated stereotactic radiosurgery – when 2-5 treatments are given stereotactic radiotherapy – when > 5 treatments are given

7. Stereotactic Radiosurgery Important alternative for invasive surgery Works in the same as other forms of radiation treatment - damages the DNA of tumor cells as a result cells lose their ability to divide Lesions abutting the medulla or the spinal cord should not be treated with SRS - these structures do not tolerate the radiation dose delivered to structures within millimeters of the target - medullary or spinal cord compression can result from swelling of the lesion after the radiosurgery dose, resulting in devastating neurologic deficit Following the treatment, benign tumors usually shrink over a period of 18 months to two years while malignant and metastatic tumors may shrink more rapidly, within a couple of months

8. 2 Basic kind of Stereotactic radiosurgery equipment Gamma Knife - uses 192 or 201 beams of highly focused gamma rays all aiming at the target region - -- - ideal for treating small to medium size lesions Linear accelerator (LINAC) - deliver high-energy x-rays, also known as photons - can perform radiosurgery on larger tumors in a single session or during multiple sessions