Dr. Balsam Darwish


Brain tumours are abnormal growths inside the cranial cavity (skull). Tumours can be benign or malignant. They can arise inside the brain (intrinsic) and outside the brain within the skull (extrinsic). They can originate from intracranial structures (primary) or spread to the brain from other organs such as lung, breast, skin, bowel, kidney etc. (secondary).

Tumours can present with the following:
  • Signs of increased intracranial pressure such as headaches, nausea, vomiting and double vision
  • Seizures: involuntary movements with or without alteration in consciousness
  • Neurological deficit depending on the location of the tumour such as limb weakness, numbness, language disturbance, change in personality, visual disturbance, hearing loss, loss of smell and balance problems

The diagnosis is made by examination and confirmed by brain CT or MRI scan with injection of intravenous contrast.

The cause of brain tumours is not known and probably is multifactorial. Genetic predisposition and environmental factors act together to trigger abnormal growth of some cells that grow out of control and tend to destroy surrounding brain cells in the case of malignant brain tumours or compress and displace normal cells in the case of benign tumours.

The treatment of brain tumours is individualised and depends on the type of the tumour, its location and the general condition of the patient - in particular the age, functional status and the presence of other tumours in other organs.

The treatment of primary malignant brain tumours (glioblastoma multiforme) is multimodal and often involves surgery to remove as much of the tumour as possible without causing neurological deficit, followed by radiotherapy for 6 weeks with oral chemotherapy in the form of Temozolamide (concurrent chemotherapy) . This is followed by courses of oral chemotherapy (adjuvant chemotherapy).

The treatment of benign tumours such as meningioma (tumour arising from the brain covering) and most pituitary tumours (tumours arising from the pituitary gland which is the central endocrine gland) is surgical. Complete removal of the tumour is possible in the majority of cases and is curative. Some patients may require radiotherapy or focused radiotherapy (stereotactic radiosurgery) if some of the tumour can’t be removed because of its location near vital structures. Most patients will require annual follow up by MRI scans.

The majority of brain tumours are removed through craniotomy (opening in the skull). It involves a skin incision behind the hairline so once hair grows the scar will not be visible, removal of a piece of skull bone which is put back in place at the end of the operation and fixed by tiny metal plates and screws.

The risk of the operation is minimal and depends on the location of the tumour. In most cases the operation is done under microscope magnification with the use of a navigation system which helps to localise the tumour precisely. Most patients will go to the ward after the surgery and will be able to walk and eat the same day and be discharged home in 4-7 days. Your surgeon will explain to you in detail the nature of the operation and the potential risks and the expected recovery time. Make a list of questions when you consult your surgeon.

Patients with malignant brain tumours such as glioblastoma multiforme and secondary metastases will be seen by the radiation and medical oncologist after surgery who will explain the radiotherapy and chemotherapy options and their benefits and side effects.

Patients with brain tumours will be assessed by the physiotherapist, occupational therapist and social worker, who will ensure the safe return to the home environment, before discharge.

Patients who have had a craniotomy are not allowed to drive for 6 weeks after surgery and, in the case of epilepsy, for a year. Patients with some neurological deficits and those with malignant brain tumours will not be able to drive for a longer time and in some cases forever. Always ask your doctor when you are allowed to drive.

Most patients with benign brain tumours will be able to return to their normal activities including work and sporting activities in 4-6 weeks time.