Question 1

For a 17-year-old patient showing several of these symptoms, what characteristics should guide a referral for further workup?

Dr. Sonal Gupta · Accepted Answer

Symptoms alone do not distinguish a benign tumour from a malignant one; both can present the same way. A CT scan and MRI together can predict whether a tumour is benign or malignant with about 90% accuracy, though only a biopsy can confirm the diagnosis and grade. Any patient with these symptoms should be sent for an MRI.

Question 2

How can epilepsy surgery be made practical and accessible for African patients?

Dr. Sonal Gupta · Accepted Answer

Not every epilepsy patient needs surgery - only intractable epilepsy (uncontrolled despite adequate medication) or epilepsy caused by a visible lesion on MRI warrants it. To make this accessible, an online epilepsy clinic can review a patient's medication history and MRI findings remotely, and only call the patient to India for a surgical workup once epilepsy is confirmed to be intractable.

Question 3

If an adult has a first-time seizure, is it correct to suspect a brain tumour as the cause?

Dr. Sonal Gupta · Accepted Answer

Every patient presenting with a seizure should have an MRI under the epilepsy protocol with contrast, since a CT scan can miss small lesions responsible for epilepsy. However, not all seizure disorders are caused by a brain tumour.

Question 4

How are childhood brain tumours identified and managed differently from adult ones?

Dr. Sonal Gupta · Accepted Answer

Identification is the same as in adults. The surgical approach is also the same, but radiotherapy and chemotherapy protocols must be modified according to the child's age.

Question 5

Can a brain tumour be detected in a newborn?

Dr. Sonal Gupta · Accepted Answer

Yes. An ultrasound of the skull can be used as a screening test to check for excess fluid or a tumour, but an MRI is required for a definitive diagnosis even in a newborn.

Question 6

What are the post-operative complications of brain tumour surgery?

Dr. Sonal Gupta · Accepted Answer

Complications have come down to under 5% of cases. They include epilepsy, a haematoma (clot) at the surgical site, infection from open surgery, and, if the tumour is very large, the possibility that a portion has to be left behind.

Question 7

Will children benefit from epilepsy surgery at an early age?

Dr. Sonal Gupta · Accepted Answer

Yes. If a child is dependent on multiple anti-epileptic medications, surgery helps by reducing both the number of medications needed and their side effects.

Question 8

A 19-year-old has been on epilepsy follow-up and medication for 10 years. The MRI is negative, but the EEG shows a slow-wave background. What is the next step?

Dr. Sonal Gupta · Accepted Answer

This patient should be referred for a dedicated epilepsy workup.

Question 9

After a complete resection of a cancerous mass, there is a void left in the brain. How does this void evolve during healing, and are there always neurological sequelae?

Dr. Sonal Gupta · Accepted Answer

A cancer tumour can never be removed completely; microscopic cells are always left behind. Because these tumours cause significant surrounding brain swelling, the surgical cavity fills in quickly on its own, so the void itself is not a concern.

Question 10

A 7-year-old girl presented with a two-week history of headache and vomiting that progressed over the last three days. MRI showed a well-defined left frontal lobe mass with a differential of metastasis versus high-grade glioma, and local doctors are recommending a frontal lobectomy. What would you recommend, and what are the likely outcomes?

Dr. Sonal Gupta · Accepted Answer

Rather than an open frontal lobectomy, neuronavigation-guided keyhole tumour surgery using a surgical robotic system allows near-complete removal of high-grade tumours, improving survival, though high-grade tumours cannot be described as fully curable. This is typically followed by stereotactic radiosurgery and chemotherapy or immunotherapy depending on the biopsy, guided by genetic study of the tumour, which few centres worldwide perform routinely.

Question 11

Is immunotherapy actually used in the treatment of brain tumours?

Dr. Sonal Gupta · Accepted Answer

Yes. Genetic-based targeted immunotherapy is the latest advancement in brain tumour treatment.

Diagnosis and Management of Brain Tumour

Questions Doctors Asked Dr. Sonal Gupta