Very large tumours causing severe brain compression require surgical treatment. Smaller tumours can be treated by radiation.
This is carried out by the neurosurgeon, and sometimes in conjunction with the ear, nose and throat (ENT) surgeon using microsurgical technique.
There are basically three surgical approaches: Retrosigmoid, Tranlabyrinthine, and Middle Fossa. Combinations of these approaches may be used for very large tumours. The choice of the approach will depend on the size and location of the tumour, whether the patient still has good hearing and the medical fitness of the patient.
Fat or muscle may also be harvested from the abdomen or thigh during surgery to assist with the closure.
Post-operatively, the patient will usually spend one to several days in the intensive care unit for close monitoring and treatment.
Radiation treatment is carried out using the Novalis Shaped-Beam machine located at the NNI-Khoo Teck Puat Radiosurgery Suite at Singapore General Hospital (SGH) Level B1, Block 2. This delivers narrow beams of strong radiation aimed precisely at the tumour from many different directions. Normal brain tissue therefore receives only a fraction of the total radiation dose received by the tumour. Exact knowledge of the tumour location is necessary, and this is achieved by securing the head firmly but painless in a custom made mask system and doing a CT scan of the head with the mask system in place. For treatment planning a MRI scan of the head is also required.
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