The following are the most common symptoms of a brain tumor; however, each person may experience symptoms differently. Symptoms vary depending on the size and location of tumor, and many symptoms are related to an increase in pressure in or around the brain because there is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue or fluid can cause pressure on the brain and lead to increased intracranial pressure. In particular, increased intracranial pressure can be caused by a tumor blocking one or more of the ventricles that drain cerebrospinal fluid, leading to hydrocephalus.

Increased intracranial pressure may lead to headache, vomiting, nausea, personality changes, irritability, drowsiness, depression and decreased cardiac and respiratory function, which can eventually lead to coma if not treated.

One of the most common symptoms of brain tumors is headache, but the majority of headaches are not caused by brain tumors. Headaches caused by brain tumors tend to worsen when lying down or upon first waking; they tend to recur, eventually becoming constant.

Symptoms are usually specific to where a brain tumor is located and its size.

Symptoms of brain tumors in the cerebrum may include:

• Increased intracranial pressure
• Seizures
• Visual changes, such as vision loss
• Slurred speech
• Aphasia
• Loss of ability to write
• Impaired sense of smell
• Drowsiness
• Personality changes
• Impaired judgment
• Difficulty remembering and memory loss
• Hemiparesis or hemiplegia
• Gait disturbances
  

Symptoms of brain tumors in the brainstem may include:

• Increased intracranial pressure
• Seizures
• Endocrine problems
• Visual changes or diplopia
• Headaches
• Hemiparesis or hemiplegia
• Respiratory changes
• Clumsy, uncoordinated gait
• Hearing loss
• Personality changes
  

Symptoms of brain tumors in the cerebellum may include:

• Increased intracranial pressure
• Vomiting
• Headache
• Uncoordinated muscle movements
• Nystagmus
• Ataxia

The symptoms of a brain tumor may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

The exact cause of most brain tumors is unclear.

For many tumors, genetic mutations or chromosomal abnormalities are known to be associated with tumor occurence.

Most brain tumors are sporadic, but some are linked to certain genetic conditions, such as neurofibromatosis type I and II, von Hippel-Lindau disease, Li-Fraumeni syndrome, Turcot syndrome, tuberous sclerosis and nevoid basal cell carcinoma syndrome.

Individuals who have received radiation therapy to the head as part of prior treatment for other malignancies have an increased risk for new brain tumors.

Brain tumors can occur at any age but are most common during early or middle adulthood. Both men and women can have brain tumors but men have a slightly higher risk.

In addition to a complete medical history and physical examination, a neurological examination is usually conducted to identify symptoms and any problems. This exam consists of evaluating eye movements, hearing, sensation, motor function, swallowing, sense of smell, balance and coordination.

The primary component of diagnosing brain tumors is imaging studies. The preferred imaging test is most often a magnetic resonance imaging (MRI) scan because it provides superior tumor detail, but a computed tomography (CT) scan is a good alternative. MRI or CT scans may be performed with or without contrast enhancement.

Depending on the suspected tumor type, additional procedures may be performed that include:

• A cerebral angiogram, a minimally invasive procedure, can be performed to image the blood vessels in the tumor, particularly for highly vascular tumors.

• An X-ray of the chest may be performed to identify where in the body the tumor started before it metastasized to the brain.
• A bone scan can be used to detect tumors and bone abnormalities.

• A myelogram may be done to detect tumor metastasis.
• Spinal tap, a procedure in which a special needle is placed into the spinal canal, may be done to obtain a small amount of cerebrospinal fluid for testing to identify cancer cells or determine if there is an infection or other problems.
• A blood draw may be done to check for tumor markers that indicate a particular tumor type.
• Positron emission tomography (PET) scan, which involves injecting radioactive glucose so that it can be traced in the body, can be used to detect malignant tumor cells, which are more active and therefore take up more glucose than normal cells do.
• Magnetic resonance spectroscopy (MRS) is a procedure that detects the chemical composition of the tumor as a means to identifying the tumor type.

To confirm a diagnosis, a biopsy is typically performed before or during surgery.

At Columbia, our neurosurgeons use the latest surgical techniques to successfully treat brain tumors, providing the best possible outcome for each patient. Specific treatment for brain tumors depends on several factors, such as type, location and size of the tumor in addition to an individual’s age, overall health and medical history.

For most brain tumors, the first step of treatment is usually surgery, the goal of which is to remove as much of the tumor as possible while maintaining neurological function. If complete resection is achieved, the tumor may be cured; however, for some tumors, only subtotal resection is possible because otherwise normal brain tissue could risk damage. Our highly skilled neurosurgeons are careful to excise as much tumor as possible while preserving brain tissue and overall function.

Brain tumor surgery can be performed by craniotomy or transsphenoidal surgery to remove the tumor, depending on what is best for the patient and tumor type. If hydrocephalus is present, a ventriculoperitoneal shunt will need to be surgically placed into the blocked ventricle before or during surgery. The other end of the tube is placed into the abdomen to help drain excess fluid that can otherwise build up in the brain and cause an increase in pressure inside the skull.

If residual tumor remains, adjuvant therapy along with radiation therapy, chemotherapy or both may be needed.

One of the newer therapies that may be used to treat brain cancer is stereotactic radiosurgery. This technique focuses high doses of radiation at the tumor site, while sparing the surrounding normal tissue, with the use of photon beams from a linear accelerator or cobalt X-rays.

Dr. Richard Anderson (Pediatric), Dr. Jeffrey Bruce,  Dr. Sean Lavine, Dr. Grace Mandigo, Dr. Guy McKhann, Dr. Marc Otten, Dr. Sameer Sheth and Dr. Michael Sisti are experts in diagnosing and surgically treating brain tumors. They can also provide a second opinion.