Neurology

Brain Tumor Surgery
by Prof. Türker Kılıç, M.D.

Broadly speaking a brain tumor is an abnormal growth of tissue in the brain or central spine that can disrupt proper brain function. Doctors refer to a tumor based on where the tumor cells originated, and whether they are cancerous (malignant) or not (benign).

turker-kilic

Prof. Türker Kılıç, M.D.

Neurosurgery

Primary brain tumors begin when normal cells acquire errors (mutations) in their DNA. These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor.

Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain. These tumors most often occur in people who have a history of cancer. But in rare cases, a metastatic brain tumor may be the first sign of cancer that began elsewhere in your body.

Symptoms & Diagnosis

Brain tumor symptoms can vary according to tumor type and location. There are times a person may have no symptoms when their brain tumor is discovered, however symptoms can be:

  • Recurrent headaches
  • Issues with vision
  • Seizures
  • Changes in personality
  • Short-term memory loss
  • Poor coordination
  • Difficulty speaking or comprehending

Diagnosing a brain tumor can be a complicated process and involve a number of specialists, depending on many factors. A brain scan, most often an MRI, is the first step. A biopsy may be necessary, so a pathologist can be brought in to help identify the brain tumor type.

Treatment options vary:  Surgery, Radiation Therapy, Chemotherapy and Targeted Therapy and combination of those.

Surgery

If the brain tumor is located in a place that makes it accessible for an operation, your surgeon will try to remove as much of the brain tumor as possible. In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible. In other cases, tumors can’t be separated from surrounding tissue or they’re located close to sensitive regions in your brain, making surgery risky. In these conditions, your doctor will remove as much of the tumor as it is safe. Even removing the brain tumor partially may help reduce your symptoms and with the help of complementary treatments, cancer can be handled completely.

Surgery to remove a brain tumor carries risks, such as infection and bleeding. Other risks may depend on the part of your brain where your tumor is located. For instance, surgery on a tumor near nerves that connect to your eyes may carry a risk of vision loss. These risks can be reduced by an experienced surgeon and medical staff, performing in a well-established facility.

Radiation Therapy

Radiation therapy uses high-energy beams, such as X-rays or protons, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or in very rare cases, radiation can be placed inside your body, close to your brain tumor (brachytherapy).

External beam radiation can focus just on the area of your brain where the tumor is located, or it can be applied to your entire brain (whole-brain radiation). Whole-brain radiation is most often used to treat cancer that spreads to the brain from some other part of the body and forms multiple tumors in the brain.

Side effects of radiation therapy depend on the type and dose of radiation you receive. Common side effects during or immediately following radiation include fatigue, headaches, memory loss and scalp irritation.

Radiosurgery

Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. Each beam of radiation isn’t particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.

There are different types of technology used in radiosurgery to deliver radiation to treat brain tumors, such as a Gamma Knife or LINAC, Linear Accelerator.

Chemotherapy

Chemotherapy uses pharmaceuticals to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously). The chemotherapy drug used most often to treat brain tumors is temozolomide (Temodar), which is taken as a pill. Many other chemotherapy drugs are available and may be used depending on the type of cancer.

Tests of your brain tumor cells can determine whether chemotherapy will be helpful for you and also to determine the type of pharmaceuticals to be used.  Side effects depend on the type and dose of drugs you receive.

Targeted Therapy

Targeted treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Targeted therapy drugs are available for only certain types of brain tumors yet, but many more are being studied in clinical trials,  many different forms of targeted therapy are being developed.

One of the most common surgeries: Glioma Surgery

Glioma is a type of tumor that occurs in the brain and spinal cord. Gliomas begin in the gluey supportive cells (glial cells) that surround nerve cells and help them function. A glioma can affect your brain function and be life-threatening depending on its location and rate of growth.

Symtomps

Most common symptoms:

  • Headaches
  • Seizures
  • Personality changes
  • Weakness in the arms, face or legs
  • Numbness
  • Problems with speech

Other symptoms include:

  • Nausea and vomiting
  • Vision loss
  • Dizziness

Glioblastoma symptoms and other symptoms of glioma appear slowly and may be subtle at first. Some gliomas do not cause any symptoms and might only be diagnosed when you visit a doctor because of another health problem.

Surgical Procedure

Surgery is the most common treatment for gliomas and requires craniotomy (opening of the skull). It is sometimes performed via intraoperative MRI or intraoperative brain mapping if the tumor is close by sensitive areas of the brain.

The biopsy sample is taken during/ before surgery that provides tissue samples to the pathologist. The pathologist will then be able to make an accurate diagnosis of the tumor’s composition and characteristics so your neurosurgeon can decide on the course of the following treatment.

Prof. Türker Kılıç, M.D.

Neurosurgery
  • Medical School, Hacettepe University, Faculty of Medicine
  • Specialty, Marmara University, Department of Neurosurgery
  • Sub-specialization, Harvard Medical School Department of Brain and Nerve Surgery and ‘Dana-Farber’ Cancer Institute Neuro-oncology
  • Double Major, Marmara University, Department of Anatomy
  • Professor since 2009
  • H-index 34
  • Since 2012, Bahçeşehir University (BAU), Founding Dean of Faculty of Medicine
  • Member of European Academy of Sciences and Arts, 2015 Salzburg
  • Works in BAU Göztepe Hospital, İstanbul

Known as one of the best Neurosurgeons in the world Prof. Türker Kılıç, focused his practice on Tumor Surgery, Vascular Neurosurgery, Glioma Surgery, Meningioma Surgery, Aneurysm, and AVM. He operated on more than 15.000 brain tumor cases in his career.

Professor underlines the variety of conditions classified under Neuro-oncology, beginning from Benign conditions till Malignant brain tumors known as Glioblastoma. He refers proudly to his clinic that treats more than 1.000 brain tumor cases annually. Other than Glioma Surgery, the second surgery type that Prof. Kılıç performs most is Meningiomas and he has reached more than 3.000 case in 25 years.  At the third level, comes vestibular Schwannomas and AVMs. By both volume and variety, Prof. Türker Kılıç’s clinic can undoubtfully be listed amongst the excellence centers of Neuro-Oncology in MENA and Europe.

“In every 22 months, knowledge in Neuro-surgery doubles. This changes almost everything, especially in the field of pituitary adenomas”.

Prof. Türker underlines that in this field of treatment they are actively using micro-surgery & endoscopic neurosurgery and adds that Intraoperative MRI (MRI scans during the surgical procedure) helps them determine when to go forward safely and when to stop and leave the rest of the tumor to Gamma Knife. Adding brain mapping & speech mapping onto these, he is able to use the most advance technologies, complementary to each other in his center.

Prof. Türker Kılıç highlights the importance of Turkey as ‘a hub for healthcare services’ because of two main reasons. The first is the quality of education in the field of medicine which historically proved to produce competent physicians. The second reason is technological advancements that Turkey has considering the last 15 years.

As being the Founding Dean of Turkey’s biggest private university Bahçeşehir University, Prof. Türker Kılıç tackles the debate over academic titles & performance, which a frequently asked question; Does high h-index also show high quality of surgical skill? He states even though academic performance does not always reflect good technical skills, it’s better to look first at highly qualified academic physicians to find physicians with superior skills. He holds an h-index of 34 and at the same time performed over 15.000 tumor surgery cases, that makes him a perfect example to prove academic and surgical quality go hand in hand.

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