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Surgical Management of Brain Tumors

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SURGICAL MANAGEMENT OF BRAIN TUMORS JASSIN M. JOURIA, MD DR. JASSIN M. JOURIA IS A MEDICAL DOCTOR, PROFESSOR OF ACADEMIC MEDICINE, AND MEDICAL AUTHOR. HE GRADUATED FROM ROSS UNIVERSITY SCHOOL OF MEDICINE AND HAS COMPLETED HIS CLINICAL CLERKSHIP TRAINING IN VARIOUS TEACHING HOSPITALS THROUGHOUT NEW YORK, INCLUDING KING’S COUNTY HOSPITAL CENTER AND BROOKDALE MEDICAL CENTER, AMONG OTHERS. DR. JOURIA HAS PASSED ALL USMLE MEDICAL BOARD EXAMS, AND HAS SERVED AS A TEST PREP TUTOR AND INSTRUCTOR FOR KAPLAN. HE HAS DEVELOPED SEVERAL MEDICAL COURSES AND CURRICULA FOR A VARIETY OF EDUCATIONAL INSTITUTIONS. DR. JOURIA HAS ALSO SERVED ON MULTIPLE LEVELS IN THE ACADEMIC FIELD INCLUDING FACULTY MEMBER AND DEPARTMENT CHAIR. DR. JOURIA CONTINUES TO SERVES AS A SUBJECT MATTER EXPERT FOR SEVERAL CONTINUING EDUCATION ORGANIZATIONS COVERING MULTIPLE BASIC MEDICAL SCIENCES. HE HAS ALSO DEVELOPED SEVERAL CONTINUING MEDICAL EDUCATION COURSES COVERING VARIOUS TOPICS IN CLINICAL MEDICINE. RECENTLY, DR. JOURIA HAS BEEN CONTRACTED BY THE UNIVERSITY OF MIAMI/JACKSON MEMORIAL HOSPITAL’S DEPARTMENT OF SURGERY TO DEVELOP AN E- MODULE TRAINING SERIES FOR TRAUMA PATIENT MANAGEMENT. DR. JOURIA IS CURRENTLY AUTHORING AN ACADEMIC TEXTBOOK ON HUMAN ANATOMY & PHYSIOLOGY. Abstract The field of brain tumor research, diagnosis, and treatment is rapidly evolving. Over 120 types of brain tumors have been identified to date, and that number continues to increase. As the information available about brain tumors grows, so does the ability to target screening and therapies to provide patients with optimal outcomes. It is critical that health clinicians understand the surgical and treatment options in order to educate patients and to develop a care plan that has a positive outcome while respecting the patient's needs and desires. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 4.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need Health clinicians need to be able to differentiate between malignant and benign tumors and to understand the commonly used classification system identifying tumor types. Once the type of tumor and its prognosis are identified, the important responsibility of explaining treatment options to the patient will help to guide the patient and their family to make informed choices that is right for them. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Course Purpose To provide health clinicians with knowledge of brain tumor types and surgical interventions in order to educate patients and their families, as well as to better collaborate with all members of the health team on the best course of care. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. Benign brain tumors a. are typically fast-growing. b. rarely spread to other areas of the body. c. often metastasize to other parts of the body. d. are never malignant. 2. Metastatic brain tumors a. are less common than primary brain tumors. b. originate in the brain. c. are also known as secondary brain tumors. d. are more common than secondary brain tumors. 3. True or False: The meninges are three membranes that completely cover the brain and spinal cord. a. True b. False 4. _____________ are the core components of the brain, spinal cord, and peripheral nerves, and the human brain has approximately 100 billion of them. a. Neurons b. Cranial nerves c. Synapses d. Glial cells 5. Malignant brain tumors a. tend to grow faster. b. share all of the characteristics of cancers generally. c. is characterized by its ability to spread to other organs. d. are rarely life-threatening. 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction The field of brain tumor research, diagnosis, and treatment is rapidly evolving. Over 120 types of brain tumors have been identified to date, and that number continues to increase. Physicians diagnose brain tumors by conducting a neurologic exam and tests including an MRI, CT scan, and biopsy. Treatment options include watchful waiting, surgery, radiation therapy, chemotherapy, and targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells. Many people typically receive a combination of treatments. As the information available about brain tumors grows, so does the ability to target screening and therapies to provide patients with optimal outcomes. It is critical that health clinicians understand surgery and treatment options in order to communicate it to their patients and develop a care plan that has a positive outcome while respecting the patient's needs and desires. Anatomy Of The Brain This section will first review the normal anatomy of the brain before continuing forward with a discussion of the common types of brain tumors and treatment in children. The brain and spinal cord together form the central nervous system (CNS). The CNS controls personality, thoughts, memory, intelligence, speech and understanding, emotions, senses, and basic body functions, as well as how individuals function in their environment. Many factors influence how a child will experience and report symptoms associated with a brain tumor, such as the age and ability of the child to communicate symptoms. Clinicians may have to depend on the observation of parents or teachers to determine how 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com the child diagnosed with a brain tumor may be affected. Brain Structure The brain is made up of three main components: the forebrain, midbrain, and hindbrain. The forebrain is comprised of the cerebrum, thalamus, and hypothalamus, which is part of a complex system of nerves and networks in the brain called the limbic system. The midbrain consists of the tectum and tegmentum. The cerebellum, pons and medulla are in the area of the brain known as the hindbrain. Cerebrum The largest area of the brain is the cerebrum, which consists of the left and right cerebral hemispheres. Generally speaking, the right cerebral hemisphere controls the left side of the body and the left cerebral hemisphere controls the right side of the body. Research has shown that the right cerebral hemisphere is responsible for such functions as innovation, intuition, and creativity. The left cerebral hemisphere is associated with analytic thought, logic, and language.1 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com The cerebrum is comprised of four main lobes: frontal, parietal, temporal, and occipital. Each lobe controls a specific group of activities.2 • Frontal — Movement, intelligence, reasoning, behavior, memory, personality, planning, decision making, judgment, initiative, inhibition, mood. • Parietal — Intelligence, reasoning, telling right from left, language, reading, and sensation. • Temporal — Speech, behavior, memory, hearing, vision, smell, and emotions. • Occipital — Vision. Cerebellum The cerebellum is the second largest area of the brain. It is made up of two hemispheres, or halves, as well as a middle section. The cerebellum is connected to the brain stem. Corpus Callosum The corpus callosum is made of nerve fibers, deep in the brain, that connect the two halves of the cerebral hemispheres. Brain Stem The brain stem is the bottom-most portion of the brain, connecting the cerebrum with the spinal cord. The midbrain, pons, medulla oblongata, and reticular formation are all part of the brain stem. 7 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Midbrain The midbrain is the short portion of the brain stem between the pons and the cerebral hemispheres. The top of the midbrain is called the tectum. The third and fourth cranial nerves originate in the midbrain. Pons The pons, a part of the brain stem, contains the origins of the fifth, sixth, seventh, and eighth cranial nerves. Medulla Oblongata The medulla oblongata, a part of the brain stem, connects the brain with the spinal cord. It contains the origins of the ninth, tenth, eleventh, and twelfth cranial nerves. Reticular Formation The reticular formation is the central core of the brain stem. It connects with all parts of the brain and brain stem. Ventricles The ventricles (passageways in the brain) are connected cavities; which are the lateral, third,
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