Brain tumors are a common clinical condition in any neurosurgical clinical practice. Patients and relatives have many misconceptions and concerns regarding the surgical treatment for this condition. Very often, this results in delay in significant delays in treatment. A delay in treatment results in progressive neurological decline and poor outcomes. One of the reasons for lack of confidence regarding treatment for brain tumors is the absence of optimal facilities for performing brain tumor surgeries.
There are various aids available to improve the results and reduce the complications. These include pre-operative imaging as MRI scans and its applications as functional MRI, diffusion tensor imaging, MR spectroscopy, MR perfusion. Intra-operative aids include microscopes, endoscopes, navigation, stereotaxy, CUSA, neurosurgical drills and anaesthesia techniques.
Dr Nitin Garg uses these modalities effectively for optimal results and outcomes. He has special interest in "Image guided Neurosurgery". Navigation guidance is used to plan the approach, avoid critical and eloquent nerual structures.
Various unique methods used as per the location of the tumor include navigation assisted craniotomy, awake craniotomy for transcranial approaches, skull base approaches for tumors as orbitozygomatic osteotomy, preglabellar approach, far lateral approach, endonasal endoscopic approaches, Endoscopic transcranial approach for intraventricular / paraventricular lesions and stereotaxy (frameless and frame based) for biopsy of deep seated lesions. Various tumors treated include:
1. Gliomas -- benign and malignant.
2. Meningiomas
3. Metastatic brain disease.
4. Pediatric brain tumors as medulloblastoma, ependymoma.
5. Intraventricular tumors as Colloid cyst, neurocytoma, choroid plexus papillomas.
6. Posterior fossa tumors as acoustic schwanomma, epidermoid, meningioma, hemangioblastoma.
7. Brain stem gliomas.
8. Benign tumors as DNET causing epilepsy.
9. Orbital tumors as meningioma, hemangioma, lacrimal gland tumors. neurofibromas.
10. Miscellaneous tumors Post-operatively, emphasis is placed on detailed histopathological analysis. This includes immuno-histochemistry and molecular analysis in some patients. There is detailed discussions in the hospital tumor board for some of the cases wherein discussions are held between various specialists as radiation oncologists, medical oncologists, pathologists, radiologists and the neurosurgeons. Patients are counselled extensively prior to discharge regarding the the nature of the tumor, the various treatment options and the need for constant follow up. This is essential for the family to gain a perspective into the course of the disease.