Approach

Oncology Management

The adoption of technology has improved the quality of survival as well as longevity

Dr NK Venkataramana, Founder Chairman & Director Neurosciences, Brains Hospitals, Bangalore Neuro-oncology has evolved in a big way for the last three decades. In the 1980s, the delay in diagnosis, lack of proper imaging had resulted in patients with large brain tumours causing complete visual loss, hearing loss, paralysis or unconsciousness. Those days cerebral angiography was the mainstay in diagnosis. In the 1990s advent of CT scans and MRI at the dawn of the new century has resolved many issues. Brain tumours were diagnosed early and even small tumours were detected easily.

In the 1980s the treatment options were also very limited. Neurosurgery was known as macro neurosurgery with lots of limitations, leading to only partial removal of tumours. There were associated complications like brain swelling, a significant insult to the surrounding neural tissue leading to unacceptable morbidity and mortality. The advent of micro neurosurgery made surgery precise and gross total removal of the tumours as well as preserving the surrounding nerves helped to improve the outcomes and quality of life of these patients. such as 3D Imaging, MR Tractography, image-guided surgery, computerassisted neuro-navigation, ultra-sonic surgical aspirations, radiofrequency bi-polar and tumour fluorescence helped to precisely remove the tumours completely and safely regardless of the location. This has improved the quality of survival as well as longevity and in many benign tumour cures.

Parallelly, advances in neuropathology, genetics molecular diagnosis and immune histochemistry have paved the way for tailormade therapies for select individuals with specific tumours. The delivery of radiotherapy has advanced tremendously called Stereotactic radiotherapy, stereotactic radiosurgery with image guidance has contributed to the prolonged survival of the malignant tumours.

Gene therapy, immunotherapy and targetted therapies are going to be the future for the highly selected targetoriented treatment of brain tumours. Despite all the advancements, some of the malignant brain tumours such as Glioblastoma Multi-pharma poses severe challenges to neurosurgeons even today.