Question 1

I recently saw a 17-year-old boy with symptoms of a brain tumour, including headaches whenever he studies for a while and an unpleasant noise in the head. Could you go back over the characteristic features so I can decide on a referral?

Dr. Sonal Gupta · Accepted Answer

On CT and MRI, together with MR spectroscopy, you can tell with about 90% accuracy whether a tumour is benign or malignant, but only a biopsy confirms whether it is benign or malignant and what grade it is. Symptoms usually cannot differentiate a benign from a malignant tumour; they only tell you that there may be a brain tumour. All the symptoms you describe definitely merit an MRI. Do the MRI to see whether there is a tumour and where it is, and share the images or the report with me so I can get back to you.

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. Epilepsy can occur with or without a lesion, and only intractable epilepsy or lesional epilepsy needs surgery. To make surgery more accessible, we can run an online epilepsy clinic where I see what medication the patient is being treated with and whether the epilepsy is intractable. If it is intractable, the patient can come to India for an epilepsy surgery workup. I think that is the best way to go.

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

An infiltrating malignant tumour such as a glioma can never be removed completely; microscopic cells are always left behind. Because these tumours cause significant surrounding brain swelling, the void gets filled up in no time, so the void itself is not a concern.

Question 10

A 7-year-old girl presented with headache and vomiting over two weeks that progressed over the last three days. MRI showed a well-defined left frontal mass with mild midline shift; the differential is metastasis versus high-grade glioma, and the treating doctors favour high-grade glioma and recommend a frontal lobectomy. What would you recommend?

Dr. Sonal Gupta · Accepted Answer

It is not a frontal lobectomy any more. What we do is neuronavigation-guided surgery targeted at the tumour alone, and with a surgical robotic system you can achieve near-complete removal of these high-grade tumours, which improves the patient's survival.

Question 11

What about the outcomes and complications?

Dr. Sonal Gupta · Accepted Answer

Complications are less than 5%, so we are not too worried about them here. The outcome will depend on the biopsy report and on the genetic study we do. A high-end approach to these tumours helps give extra survival, but let me be very clear: I am not saying that high-grade tumours can be completely cured.

Question 12

Will chemotherapy be used as adjuvant therapy?

Dr. Sonal Gupta · Accepted Answer

Yes. Stereotactic radiosurgery will help, followed by chemotherapy or immunotherapy depending on the biopsy. A genetic study of the tumour is now part of the diagnosis, and we do one to give an advanced approach to these brain tumours.

Question 13

Is immunotherapy actually used in the treatment of brain tumours?

Dr. Sonal Gupta · Accepted Answer

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

Live Discussion with Dr. Sonal Gupta