Hi,

I have gone through the dropbox files. Before answering the questions, I am confused there are blood reports of a 60 year old female and MRI report of a 61 year old female, both sharing the same surnames. Also, the MRI report says the lesion is in the frontal lobe and not the temporal lobe. Further, I am unable to see the MRI images. Would it be possible for you to send me jpeg files?

I can however try and answer a few generic questions you have posed.

The lesions look more like primary brain tumours and not secondaries. For operating on these tumours you need a unit with Neuronavigation equipment and an operating microscope. I am afraid that in India you have no objective means of assessing a surgeon's technical merit, as reporting surgical outcomes based on pre-op risk stratifications is not mandatory. Even across the world, except in Cardiothoracic surgery in the UK, this is not generally followed. So, what typically works in India is "word of mouth" and this is not necessarily accurate. Once thing that is good is if there is a team of experienced Neurosurgeon's available (like the centre I work in Chennai)

It is not possible to guess the grade exactly, but in a 60 year old the chances are that the lesion is likely to be one of higher grade 1.e, grade 3 or 4. But medicine is not an exact science, and unexpected outcomes are pretty common.

As for typical outcomes and risks and complications of surgery in this location- I can answer when you clarify if the location is frontal or temporal. Any brain surgery carries the risk of infection and bleeding, risk of stroke, paralysis, speech disturbances, CSF leak etc and risk to life. The risk of major complications including risk to life are in the order of less than 3-5%, and the other risk' probability varies according to the location.

The "prognosis" i.e what happens after treatment, survival etc depends on how much of the tumour has been removed, if any radiotherapy or chemotherapy has been given etc. Some locations make it possible for full removal, while others cannot be removed without paralysing the patient. If the tumour is Grade 4, the median survival is about 11 months which is extended to about 16 months after full treatment. If it is grade 2, then 5 and 10 year survival is possible, again depending on the factors mentioned above. Grade 3 behaves in the middle range.

I think there is nothing specific that needs to be done, except good family support and not letting your anxieties make the patient more worried than she is already. normal diet, plenty of rest helps.

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Hi XXXXXXX

Thank you for the screencast. I have gone through the images. While this could be any grade form 2-4, I would hazard a guess at it being either grade 3 or 2. The tumour looks like it can be removed radically. However, the only worrying factor is that it may be close to the motor cortex - the part of the brain controlling the movement of the opposite side of the body. Therefore, an FMRI of the brain with motor paradigm is one test I would personally get. Though I may be wrong, if the motor cortex is away from the tumour, then I can attempt to be as radical as possible.

Once the tumour is removed, depending on the pathology, radio +/- chemo is a distinct possibility.

I don't know much about the set-ups of major neuro centers in Delhi, but I am sure there are centers with neuronavigation equipment and the latest microscopes and microinstruments. I can only say that in the team I work in, we are a team of 5 consultant's working on a team under Dr XXXXXXX Ghosh- who you can look up online as he has his own website. We work as one team with shared responsibilities to give continuity of care. We have the South Asia's first installation of the Brainlab Curve neruonavigation equipment along with the latest XXXXXXX Ziess Opmi Pentero microscope + all the micro-instruments. I am not looking for you to travel to Chennai from Delhi, but if any one I know needs to have a brain op, I would look for a similar team of professionals.

Hope this helps.

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Hi XXXXXXX

Thank you for the reply. Both myself and Dr XXXXXXX ( WWW.WWWW.WW have performed awake surgeries. i have done mine when I was working in the UK. Ours is a new and one of its kind team (for India-in the private sector), much like the teams in the US. Ours is also a team that is only 6 month's old and we haven't done any awake surgery yet. Before putting your mother-in-law through an awake craniotomy, which can be a challenge, we can consider it only if absolutely indicated as per fMRI results. A patient need not present with weakness, but if the tumour is very close to the motor cortex, the surgeon can damage the motor cortex when aggressively trying to remove the tumour. Therefore it helps the surgeon get his bearings right if fMRI data, neuronavigation, tractography etc are all available.

We do all our craniotomies at SRM with neuronavigation guidance and have recently also started integrating the neuronavigation with the microscope.....i.e when looking through the microscope, the outline of where the tumour is on the MRI is projected. I would say that it is pretty state of the art! That makes it more convenient for the surgeon and lessens operating time.

I hope all goes well with your mother-in-law and please do let me know if you have any further queries. Please give your feedback if you close the question.

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