Legacy: "Atlast of Neurosurgery" / L.Karaguiosov, A. Ramadan, K.Karaguiosov / Kiwait/ 1998
Read NEXT: 3. TUMORS - Chapter 2
3.TUMORS
Surgery for cranial and intracranial neo-plastic lesions aims at the achievement of several goals. The first is to reduce or abolish the effects of the lesion as a mass, with its focal and general efects on the intracranial contents and the second is to eradicate the neoplastic tissue to control systemic affections due to tumour cell function and prevent recurrence. Additionally, there can be cosmetic problems to solve with skull tumours or general diagnostic problems in biopsy of a systemic disease with intracranial involvement. However, all goals are attained by a certain amount of removal, always with the goal of radicality at minimal or no functional cost for the patient.
The type of surgery is always related to the type of neoplastic affection. The grade of malignancy, the stage of development and the general and neurological condition of the patient with an intracranial neoplasm influence the decision to undertake surgical treatment. Surgery should be approached with a well preplanned technique, reserving emergency treatment for the cases with already uncontrollable precipitous progression of deterioration. In the latter case, results are definitely worse. Therefore, surgical treatment of intracranial tumours should be undertaken as early as possible, but not as an emergency. Emergency surgery is reserved for the cases of increased intracranial pressure or optic nerve compression. those presenting with imminent brain shifts and herniation or significant progressing visual damage or neurological deficit.
Surgical planning in intracranial tumour surgery should include imaging and functional studies to define the precise location of the lesion and its relation to adjacent normal structures. The analysis of this information permits planning of the approach and the expected extent of surgery. Decision making involves considering whether the lesion is a primary or secondary one, deciding on the expected grade of malignancy, and finally determining how skull and thecal layers may interfere with the approach. Secondary lesions are considered with respect to possible multiplicity. Malignancies are treated in the full context of the need of possible adjuvant treatment according to histopathology, and therefore frozen sections intra operatively are of great value. Surgical planning in tumours with skull base involvement should preview the possible need of combined approaches with maxillofacial or ENT techniques. All intracranial work is best accomplished with the aid of the surgical microscope and, if avail-able, of an ultrasonic aspirator.
During the application of surgical techniques in different types of tumours the above-mentioned general rules are always taken into consideration. All methods for particular types of tumors are in full accordance with them.