What is a glioma?
Primary brain tumours are called gliomas. They are tumours of brain cells.
When is a brain tumour suspected?
Gliomas may present with:
- new seizures or fits
- worsening neurological symptoms such as limb weakness, speech problems or visual disturbance
- symptoms from raised intracranial pressure such as severe headache
- an incidental finding on a brain scan done for another reason
What investigations will I need?
Imaging of gliomas will be with an MRI scan unless you are unable to have this type of scan due to a medical condition.
Some patients with glioma will undergo special physiological MRI or CT scans at Salford Royal using cerebral perfusion or spectroscopy techniques. This will be discussed with you in detail on an individual basis.
If you are having surgery, then a further image-guidance MRI scan may need to be performed at Salford Royal.
How is a glioma treated?
Often at diagnosis, steroids in the form of dexamethasone tablets will be started to reduce brain swelling. Brain swelling or oedema often occurs in normal brain adjacent to a tumour. If you presented with a seizure then you will also be started on anti-seizure medication called anti-convulsants.
Your case will be discussed at Salford Royal, the neuroscience centre for Manchester.
Gliomas are managed by a multi-disciplinary team comprising neurosurgeons, oncologists, radiologists, pathologists and nurse specialists. This group of brain tumour experts forms the Neuro-oncology MDT at Salford Royal and we meet every Tuesday morning, covering the population of Greater Manchester and beyond.
Gliomas need to be managed rather than completely eradicated. Gliomas tend to send microscopic extensions into surrounding normal brain tissue so complete surgical resection is usually not possible. A multi-disciplinary approach is needed. Often this means a combined treatment with surgery followed by radiotherapy and/or chemotherapy.
Surgery for gliomas
Surgical options for gliomas include biopsy only, sub-total debulking surgery or maximum debulking surgery. An operation for debulking of the tumour is called a craniotomy.
Which surgical option is appropriate for your tumour will be discussed in detail with you. There is increasing evidence that maximum debulking surgery, when safe to consider, improves outcomes.
Most surgery is performed under general anaesthesia with the use of latest image guidance technology. Some glioma resections are also assisted by fluoroscein-guided resection methods. Some low-grade tumours may be appropriate for the asleep-awake craniotomy program.
Occasionally surveillance with scans rather than surgery is the preferred option.
The risks of surgery for glioma will be discussed with you in detail on an individual basis. As a general rule there is a small risk of infection, bleeding, fluid leak or seizures. The specific risks of neurological problems such as stroke vary from case to case. The risk to life is less than 1%.
What happens after surgery?
After surgery patients receive pain relief for headache and are mobilised within 24-48 hours. Most patients are able to go home on day 3 or 4. You will have sutures or staples in the wound, which will be removed by your local district nurse service.
Patents are called back for an office appointment to discuss the pathology results after the brain tumour MDT have reviewed your case. This will be 1-2 weeks after surgery.
What type of glioma do I have?
Gliomas are classified according to:
- cell type
- grade (how aggressive they are)
- genetic analysis
The commonest cell types are astrocytes or oligodendrocytes and tumours may be mixed.
The WHO system grades tumours into 4 subtypes, I to IV, with IV being the most aggressive form.
Further useful prognostic information can be given after pathological and genetic analysis of tumour tissue in the lab.
Your Brain & Spine Clinic neurosurgeon will discuss this with you in detail.
Do I need radiotherapy and chemotherapy?
Gliomas, even low grade ones, often require multi-modal treatment and it is likely that you will be reviewed by one of our neuro-oncologists.
Oncology treatment may be with radiotherapy, chemotherapy tablets or both.
Throughout your treatment you will have a named specialist nurse, be given written information and have plenty of opportunity to discuss your treatment in detail with your surgeon or oncologist.