Cancer in the brain develops like cancer in any other tissue. Organs are made up of tissues and tissues are made up of cells. Cancer starts inside cells. Cells grow and multiply when they need to. When they get old, they die and are replaced by new cells.
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Sometimes this process starts to work abnormally. New cells start to form when the body doesn’t need them and old cells don’t die when they should. This causes more cells to accumulate in that tissue than necessary. This is called a tumor. Brain tumors can be benign or malignant. Benign brain tumors do not contain cancer cells.
Benign brain tumors can usually be surgically removed and do not usually reoccur. They do not spread into the surrounding brain tissue. However, they can cause various and sometimes very serious health problems in the related organ by compressing with mass effect. Unlike benign tumors in other organs, benign brain tumors can sometimes cause life-threatening conditions. Very rarely, a benign brain tumor can develop into a malignant brain tumor.
Malignant brain tumors contain cancer cells. They grow rapidly and infiltrate the healthy tissue around them. Very rarely, they can sometimes spread to the spinal cord or even to other organs of the body. This is called metastasis.
Cancer in another part of the body can also cause a brain tumor. This type of cancer is called a secondary or metastatic brain tumor. Secondary brain tumors are much more common than primary brain tumors. These tumors take on the characteristics of the original cancerous tissue and have the same name. For example, lung and breast cancers are among the cancers that metastasize to the brain. Brain metastasis means that a cancer that develops in tissues and organs outside the brain spreads to the brain tissue and forms a tumor there. This type of tumor is also called secondary tumor. These types of tumors are the most common tumors in the brain. It is the leading cause of death in cancer patients.
PITUITARY TUMORS
A pituitary tumor or pituitary adenoma is a benign tumor formation that usually occurs in the front of the pituitary gland. Pituitary tumors account for approximately 15% of primary brain tumors. The pituitary gland is a bean-sized gland located at the base of the brain, just behind the root of the nose, in a bony structure called the sella tursica. This gland secretes prolactin, growth hormone and adrenocorticotropic hormones. These hormones help many important functions in the body, such as sexual development, bone growth, muscle building, coping with stress and disease prevention. Pituitary tumors disrupt this normal hormonal functioning. Some pituitary tumors do not secrete hormones.
Tumors formed from the support cells in the brain, the glia, are called gliomas. Ependymoma is a glioma. Ependymomas originate from ependyma cells lining the ventricles, the spaces inside the brain. Ependymomas are soft, grayish or red tumors. Sometimes they may contain fluid-filled cysts or calcifications.
BRAIN ANEURYSM
A brain aneurysm is a ballooning of one of the brain vessels due to weakness of the muscle layer inside the vessel. This ballooning causes thinning and weakening of the vessel wall. Subarachnoid hemorrhage is an intracerebral hemorrhage that occurs when the vessel ruptures in this weakened area. Such bleeding can cause stroke, coma or death.
The exact cause of brain aneurysms is unknown. However, some factors are recognized to contribute to the formation of brain aneurysms.
These factors are:
- High blood pressure
- Cigarette smoking
- Genetic predisposition
- Damage to blood vessels
- Some infections
Not all aneurysms in the brain bleed. Sometimes aneurysms bleed from a small vessel tear. Then there is a very small amount of bleeding into the brain. Sometimes the tear is very large, which can lead to more serious symptoms and even death.
Currently available treatment options are divided into three categories: medical, surgical and endovascular.
MEDICAL TREATMENT OPTIONS
The only treatment for an unruptured brain aneurysm is medical treatment. The medical treatment approach is also based on smoking cessation and blood pressure control strategies. These are the factors that have been shown to influence the formation, growth and rupture of aneurysms. In addition to quitting smoking, starting a diet and exercise program to control blood pressure and, if necessary, using drugs that lower blood pressure are effective methods to prevent ruptures in aneurysms. In addition, regular radiographic examinations (MRI, CT or angiography) are important to monitor the size of the aneurysm and whether it is growing.
SURGICAL TREATMENT OPTIONS
The first “clip” application in surgical treatment of brain aneurysms was made in 1937. In the 1960s, the increase in clip types and the introduction of microsurgical methods in neurosurgery made surgical treatment of brain aneurysms the gold standard. Despite this, surgical clipping operations are classified as major and difficult surgeries. Clipping is done through a craniotomy (removal of part of the skull). The brain and brain vessels are accessed through a craniotomy and the aneurysm is found. The aneurysm is then carefully separated from the surrounding brain tissue. At this stage, a small metal (usually titanium) clip is applied to the neck (base) of the aneurysm. These clips have a spring mechanism and, when inserted, cut off the blood flow into the aneurysm.
ENDOVASCULAR TREATMENT OPTION
The use of endovascular techniques in the treatment of brain aneurysms began in the 1970s. However, with the development of the material in the 1980s and its subsequent approval in the US in 1995, the technique became more widely used. The aim of endovascular spring application is to destroy the aneurysm, as in surgical clips. The long-term indication that this treatment is successful is that the aneurysm does not reappear. Re-opening of the blood pathway inside the aneurysm or regrowth of the aneurysm after treatment is considered a treatment failure. A soft spring made of platinum is used for the procedure. This spring is carefully advanced through one of the large arteries in the groin to the brain and inserted into the aneurysm inside the brain. The spring placed inside the aneurysm disrupts the blood flow. As a result of the slowed blood flow, a large blood clot forms here. The aneurysm is blocked by the clot and cannot rupture and bleed. The long-term durability of endovascular arch application, which is a more preferred method compared to neurosurgery in terms of intervention, is not yet known. Also, not all aneurysms are suitable for spring application.
WHAT ARE THE PROBLEMS THAT MAY ARISE?
The most dangerous situation that can occur during both clipping and spring application is rupture of the aneurysm and bleeding into the brain. The exact incidence of this phenomenon is not known, but it is estimated to be 2-3% for both procedures. When the aneurysm ruptures, bleeding into the brain occurs. This can lead to stroke, coma or death. Intervention for aneurysm rupture, which can occur during both procedures, can be performed more easily during open brain surgery. Because during this procedure, the bleeding site can be seen more easily and intervened more easily to control bleeding. Strokes due to decreased blood flow and thus decreased oxygenation can also occur during clipping or spring application, which is another dangerous situation. The prevalence and distribution of this stroke depends on the location of the aneurysm. How long the procedure takes, the risks involved, and how long it takes to return to normal life depend on the location of the aneurysm, the size of the bleeding and the patient’s medical condition. Therefore, each person’s situation should be considered individually and discussed with their physician.
WHO IS MORE LIKELY TO HAVE SUBARACHNOID HEMORRHAGE?
This type of bleeding usually occurs 1 in 10,000. Approximately 5-10% of all strokes are due to subarachnoid hemorrhage. It is mostly seen in the 20-60 age group. It occurs slightly more often in women than in men. A small proportion of subarachnoid hemorrhages do not involve a ruptured artery. Such hemorrhages are spontaneous and usually occur in the perimesencephalic spaces of the brain. This type of subarachnoid hemorrhage has a very high chance of recovery. This type of bleeding is thought to be from veins or thin capillaries. The most common symptom of subarachnoid hemorrhage is sudden onset headache. This headache is often referred to as “the worst pain experience ever”. The pain may have been preceded by a sensation of an explosion in the head. Pain in the whole head is usually more severe in the back. Nausea and vomiting may also accompany headache. In addition, there may be blurred consciousness, decreased attention and disturbances of consciousness that can progressively lead to coma. Visual disturbances, double vision, blind spots or sudden loss of vision in one eye can also occur. The neck is painful and stiff. Light can irritate the eyes. There may be neck and back pain. The person may have a seizure. An area of the body may not be able to move or sensation in that area may be lost. Personality disorders, confusion, irritability may occur.
Vascular Diseases
Brain Hemorrhage
Cerebral hemorrhage means bleeding into the brain due to a rupture of one of the arteries in the brain. When bleeding occurs, the brain inside the skull, which is an inflexible structure, is pressurized and crushed by the fluid that fills it, resulting in various symptoms. There are two types of cerebral hemorrhage: bleeding into the brain (intracerebral) and bleeding under the meninges (subarachnoid), i.e. around the brain.
WHAT HAPPENS IN INTRACEREBRAL BLEEDING?
This type of bleeding involves a rupture of one of the small arteries in the brain. In this case, there is pressure on the brain tissue in the area of the bleeding and dysfunction in the part of the body controlled by that part of the brain. The most common cause of bleeding into the brain is high blood pressure. Years of high blood pressure have an effect on the small vessels, weakening them and making them prone to rupture. The most effective way to prevent this type of brain hemorrhage is to keep blood pressure within normal limits.
WHAT HAPPENS IN SUBARACHNOID HEMORRHAGE?
In this type of bleeding, there is a rupture in one of the large arteries at the base of the brain. In this case, the blood flow spreads all around the brain and into the cerebrospinal fluid. Most subarachnoid hemorrhages are caused by the rupture of an aneurysm in the brain. The walls of these aneurysms are thin and therefore prone to rupture. Some people have these aneurysms, others do not. The reason for this is unknown. Some people are born with aneurysms, but they do not rupture for life. But the consequences of an aneurysm rupture are often very serious. About half of patients with bleeding aneurysms die. Another cause other than aneurysm is arteriovenous malformations.
WHO IS MORE LIKELY TO HAVE SUBARACHNOID HEMORRHAGE?
This type of bleeding usually occurs 1 in 10,000. Approximately 5-10% of all strokes are due to subarachnoid hemorrhage. It is mostly seen in the 20-60 age group. It is slightly more common in women than in men.
WHAT ARE THE SIGNS AND SYMPTOMS OF SUBARACHNOID HEMORRHAGE?
The most common symptom is sudden onset headache. The pain may have been preceded by a sensation of an explosion in the head. Pain in the whole head is usually more severe in the back. Nausea and vomiting may also accompany headache. In addition, there may be blurred consciousness, decreased attention and disturbances of consciousness that can progressively lead to coma. Visual disturbances, double vision, blind spots or sudden loss of vision in one eye can also occur. The neck is painful and stiff. Light can irritate the eyes. There may be neck and back pain. The person may have a seizure. An area of the body may not be able to move or sensation in that area may be lost. Personality disorders, confusion, irritability may occur. A neurological examination by the physician will reveal that the patient has a condition that compresses the meninges. The presence of stiffness in the nape of the neck, neurological disorders in various parts of the body and bleeding in the fundus examination help to diagnose cerebral hemorrhage.
HOW DOES A STROKE OCCUR?
When the blood supply to the brain is interrupted in any way, brain cells do not receive the oxygen and nutrients they need. If this problem is not resolved within a very short time, permanent brain damage can occur. Once brain cells die, they cannot regenerate and the damage is permanent. Any blockage in the blood vessels in the brain or in the neck can block blood flow to the brain, depriving it of the oxygen and nutrients it needs. The problem in this case is that there is not enough blood flow. Conversely, too much blood can also cause problems. Any rupture of blood vessels in the brain can cause a cerebral hemorrhage, which often causes irreversible damage to delicate brain tissue and is more lethal.
There are two types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke is the more common type of stroke and occurs when the blood supply to the brain is cut off. Hemorrhagic stroke occurs when there is bleeding into or around the brain. The following factors increase the risk of having a stroke: smoking, having high blood pressure, having diabetes, having a history of heart disease, having high blood cholesterol levels, taking birth control pills. The signs and symptoms of stroke can be very different. However, all symptoms appear suddenly. Signs and symptoms that should suggest a stroke include: very severe headache, confusion, confusion of people, place and time, numbness in any arm, leg or face, weakness or inability to move, sudden loss of speech, loss of vision, loss of balance or inability to perform skills that require coordination. Approximately 30% of stroke patients have a history of transient ischemic attack. The signs and symptoms of transient ischemic attacks are approximately the same, but they often resolve within a few minutes. This is called a transient ischemic attack because whatever the symptoms, they all resolve within 24 hours.
HOW IS STROKE TREATED?
Various specialists work together to eliminate or minimize the sequelae left in the person after a stroke. However, it is extremely important to diagnose the stroke as early as possible and to start treatment as early as possible in order to achieve successful treatment and prevent permanent sequelae. If stroke is diagnosed early, neurosurgeons have various treatment options. These include repairing a bleeding aneurysm in the head, removing blood clots that can block the brain, or removing plaque that can break off from the carotid arteries in the neck and block the brain.
ARTERIOVENOUS MALFORMATION
An arteriovenous malformation is an abnormal connection between an artery and a vein. It is a local disorder in the structure of the circulatory system that can occur while the baby is still developing in the womb or after birth. It is most common in the central nervous system, but can occur anywhere in the body.
CAVERNOMA
Cavernoma or cavernous malformation is a vascular anomaly of the central nervous system. This disease involves a group of abnormal, bulging veins. They look similar to blackberries and are usually less than 3 centimeters in size. This is more common in some people than in others. Cavernomas occur in both men and women and with the same frequency in all races. The incidence is higher in patients with a family history of cavernoma. Rarely, one person may have more than one cavernoma. Cavernomas can occur anywhere in the brain. The prevalence in the community is around 5 per thousand. While most cavernomas do not show any signs and symptoms, some may present with symptoms such as convulsions, progressive neurological findings, cavernoma bleeding and headache. In many patients, the symptom that starts the diagnostic process may be the investigation of a headache. Sometimes patients may present with double vision, sensory disturbances and loss of strength or paralysis on one side of the body.
The findings are closely related to where the cavernoma is located in the brain. Some patients may present to the emergency room with the complaint of convulsions and when the cause of the convulsion is investigated, the underlying cavernoma may be revealed. Approximately 35% of patients with cavernoma may present with convulsions. In about 25% of patients, cavernomas appear after bleeding. This is the most serious consequence of cavernomas. If the cavernoma bleeds, it usually starts with a headache. The headache starts suddenly, followed by nausea and vomiting, and neurological problems begin to emerge as consciousness gradually shuts down. In some cases, if the bleeding is very small, it may not cause any symptoms or signs. Cavernomas can be diagnosed by CT or MRI. Both radiologic diagnostic tests can reveal where in the brain the cavernomas are located and how large they are. Cavernomas cannot be seen with brain angiography. Treatment options are considered when cavernomas present the following symptoms: Neurological dysfunction, bleeding, unbearable symptoms and uncontrollable convulsions. Treatment of cavernomas is surgical.
