Walker

Endoscopic Resection of Colloid Cyst of the 3rd Ventricle

This 50y female had been followed in our practice since 2009, when she presented with an incidental finding of a small colloid cyst of the 3rd ventricle. At the time it was not causing any hydrocephalus and a watch and wait policy was adopted. Here is an axial T2 MRI showing the cyst (small dark lesion at foramen of Monro). Over the years she had remained stable but in recent […]

Recurrent Glioma – an agonizing choice of approach

A 48 year old man had been followed in our clinic for approximately 5 years. He had previously been treated at another institution after being diagnosed with a malignant glioma after suffering from seizures. After his initial presentation with seizures, he had surgical resection of a small tumour of the right frontal region, and then this was followed with radiotherapy and chemotherapy. He made a reasonable recovery from this. On […]

Giant Olfactory Groove Meningioma

This 74 year old lady presented with progressive depression. She had been treated medically for months but her symptoms did not improve. She then developed headaches and cognitive deficits such as poor short term memory became increasingly obvious. An MRI scan of the brain was eventually done, revealing a very large lesion of the anterior cranial fossa. Fig 1. Preoperative MRI T1+GAD. A. Axial, B. Sagittal, C. Coronal Surgery proceeded […]

Haemangioblastoma

This 43 male presented with progressive headaches and neck pain over many months. He also described some visual obscuration over that time. He had a CT scan without contrast and was referred for assessment. An MRI scan was performed, showing a large, highly vascular left sided posterior fossa tumour, with obstructive hydrocephalus (figs 1 and 2). Urgent treatment of the hydrocephalus was needed so he proceeded to an endoscopic 3rd […]

The Role of Surgery for Malignant Glioma – Is it all good?

Surgery has an important role in the diagnosis and treatment of patients with most brain tumours, including glioma patients with a suspected brain tumour are usually referred straight to a neurosurgeon for that reason. Traditionally, brain tumour surgery has been a core activity and skill for neurosurgeons, but better outcomes for almost all patients with brain tumours (especially gliomas/GBM/malignant glioma) are achieved when the patient is managed by a neurosurgeon […]

Why doesn’t the immune system work against Brain Cancer?

That is a VERY good question. Why would the body allow tumour cells to grow and destroy the normal brain? Isn’t the immune system supposed to rid us of foreign and destructive material? The immune system certainly is supposed to do this. It a highly evolved and finely tuned system that in general works extremely well. There are checks and balances built into this system which can go wrong – […]

CMV and brain tumours

Cytomegalovirus (CMV) is a common virus in our community. Most adults will show serological evidence of of previous exposure. CMV can cause severe disease, but generally this is only in newborns or in immunosuppressed patients, such as those people having had a transplant. In the last few years, it has become clear that CMV can be identified in brain tumour tissue – both in primary gliomas (glioblastoma, astrocytoma, GBM) and […]

Tumour Treating Fields – A new treatment for Glioblastoma

Malignant gliomas (glioblastoma, GBM) are difficult to treat. Our current methods of treatment –  surgery, radiotherapy and chemotherapy – all help but are ultimately not curative. New treatments are desperately needed. In recent years, a new form of treatment has been developed which may have a role in the future – Tumour Treating Fields (TTFields). TTFields are low intensity, intermediate frequency electric fields that slow cell division therefore inhibit tumour […]

Dexamethasone – the potential downside

Brain tumours often cause swelling in the brain and this swelling makes the pressure effect of the brain tumour worse. Symptoms therefore can be exacerbated – headaches may be worse, or patients can be drowsy or the neurological deficits such as arm and leg weakness are exaggerated. For many years, corticosteroids (typically dexamethasone) have been used to reduce the swelling around brain tumours. Starting dexamethasone can be very effective in controlling […]

Spinal Case – Keyhole lumbar laminectomy

Patients with spinal stenosis usually present with symptoms of neurogenic cluadication, with bilateral leg pain with walking and standing. A CT or MRI will often make the diagnosis. Surgery is the appropriate treatment and the traditional operation is a decompressive lumbar laminectomy at the affected levels. The commonest level to be affected is at L4/5, and a normal surgical approach would usually require a midline incision of 10-15 centimetres. Patients would […]

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