Ranjeev Bhangoo

Back pain is very common, affecting most people at some time in their life. In most people it is short lived but in some the pain can last for longer periods of time. Most patients are able to manage their pain with painkillers. Other treatments that may be helpful include manipulation therapy such as physiotherapy, osteopathy or chiropractors. Acupuncture and TENS are sometimes useful. If these simple measures do not bring relief it is appropriate to consider surgical treatments. Your specialist will arrange an MRI to look for specific abnormalities which may be helped by surgery. If particular wear is seen within the facet joints then they may recommend an injection of steroid into the joints to help with your symptoms. If the discs appear to be the worn then they may recommend further investigations including discography to identify whether surgery such as spinal fusion may be of benefit.

This is neurosurgery in children, and requires dedicated paediatric neurosurgeons with experience of operating on the developing nervous system working in close collaboration with paediatricians to achieve the best outcome for each child.  The London Neurosurgery Partnership has assembled just such a group.

Although brain tumours are rare in childhood, they are now the commonest solid cancer seen in children in the UK. There are 300 new cases in the UK every year and thanks to ongoing research, advances in both survival and quality of life continue.

The role of surgery may be diagnostic or therapeutic. Some patients may not be suitable for surgery.The location and extent of a tumour may make it unsuitable for a removal, in which case a biopsy may be performed to confirm the diagnosis. A biopsy removes a small piece of the tumour so it may be examined under the microscope.  When performing a biopsy we always use image guidance or a stereotactic frame as it is undoubtedly the safest way to perform a brain biopsyIf the tumour is in a relatively "silent" part of the brain or if it so large that it is causing symptoms or raised pressure in the brain, it may be debulked. The aim is to safely reduce the volume of the tumour. A craniotomy is performed with image guidance or with the help of the stereotactic frame. For primary malignant tumours of the brain we are able to use the latest tumour fluorescent labelling techniques (Gliadel©) to ensure the most effective possible tumour removal and instil intratumoural chemotherapy (Gliadel Wafers©) at the time of surgery if possible.

Brain Tumours can be divided into primary brain tumours (those that arise from the brain itself) and secondary (those that spread from a cancer somewhere else in the body).  The latter are more common.  Primary Brain Tumours almost never spread out from the central nervous system.

There are between 5-15 primary brain tumours per 100,000 population. This accounts for 5%-10% of all cancers in all age groups and probably 30%-40% of tumours in children.

It is now well recognised that patients with brain tumours (and their family) do best if managed by a group of doctors both medical and surgical who have a particular interest in the management of brain tumours.  This is known as Tumour Multidisciplinary Team (MDT).  As a group of neurosurgeons committed to the best outcome for their patients, we at the London Neurosurgery Partnership have come together with the doctors at Leaders in Oncology Care to provide just such a group.  As a result all patients with brain tumours receive highly individualised care that delivers not only the best treatment possible for the patient but treatment that is appropriate to the patient’s and family’s psychological and emotional needs.

Symptoms of Brain Tumours

Tumours usually present in one of three ways: headaches (54%), progressive neurological deficit (68%) or seizures (26%).

The headaches are related to raised pressure inside the brain. The classical description is one of early morning headaches, often over the forehead, which is present when the person wakes up. The headache usually settles by afternoon. Many patients also complain of nausea or vomiting.

Any neurological deficit will depend on the site of the tumour. The commonest deficit seen is a weakness (frontal tumour); some patients may have numbness (parietal tumour), problems with speech (dominant temporal tumour), visual problems (temporal, parietal or occipital tumour) or a change in personality (frontal tumour). Certain tumours present in a very specific fashion, i.e. endocrine problems with a pituitary tumour.

Seizures (epileptic fits) occurring for the first time in an adult must be investigated with an urgent scan. The types of fits seen in patients with tumours varies from classical grand mal seizures where the patient loses consciousness, shakes, may be incontinent and tongue bites, to focal seizures which may cause a temporary loss of function. In patients with a tumour in the movement area they may lose movement in one arm for a short period of time which then spontaneously recovers.