If we ask ourselves, is it necessary to operate on a benign brain tumor the answer is not simple even if it is given by the best neurosurgeon doctor in Tarragona. A simplified working classification of brain tumors depending on their type of cell is in either benign or malignant. Characteristically benign tumors grow slower, are non- invasive (do not destroy tissue) and do not cause alterations of adjacent tissues. Malignant tumors, on the other hand, are fast-growing and more destructive.
In order to carry out a histological classification (based on cell-type) it is necessary to have a sample of a lesion, for this reason when imaging tests still leave some doubts, biopsies can be performed. Not all benign lesions are stable over time; some malignant lesions were previously benign. However, this does not happen in all cases and there are some tumor lines that are more prone to change than others. From an anatomical point of view, regardless of the malignancy of the lesion, there are tumors that must always be operated on. In the brain, where there are many symptomatically eloquent areas (the area of speech or language, the motor cortex, the cranial nerves), localized lesions, even if they are small, can cause serious injuries which entail complicated recoveries. Usually benign lesions allow more time to program an elective resection surgery.
The elective resection surgery
In general, any benign tumor with a risk of malignancy that shows signs of active growth or that is causing symptoms will be a candidate for surgical resection. In some cases, benign tumors are discovered incidentally during a study performed for some other reason. In these cases, sometimes a “watch and wait” approach is chosen with strict regular controls to detect growth, and therefore be able to act before the tumor is of significant size or causes symptoms. Sometimes the location of a tumor in a critical brain area or in contact with sensory or vascular structures means it has a high risk of affecting a necessary function or even causing a vital functional injury. Then, surgery is only mandatory if the neurological functions of the patient begin to be affected.
What happens with elderly patients
When the diagnosis is made in a person of advanced age and the risk of neurological sequelae exceeds the functional benefit or improvement of the vital prognosis, conservative management is chosen. It must be kept in mind that certain slow-growing benign tumors, such as meningiomas, may calcify over the years and spontaneously stop growing. In general, a benign tumor in a complicated location, where surgery presents a high risk of serious sequelae, is the main determining factor when deciding whether to consider surgery or not and the reason due to which sometimes it is preferable to wait for the benign tumor to show signs of activity. At Instituto Clavel we have been offering our patients the best and most advanced treatments in neurosurgery for more than 15 years. We also have the best surgeons in Spain, with a wealth of experience, which allows us to offer our patients maximum safety during surgery.