Brain tumour – symptoms, treatment, surgery and rehabilitation (a complete guide)

A brain tumour is an abnormal mass of cells growing within the brain or the structures surrounding it. It may be benign or malignant, but every tumour, even a benign one, is serious because of the limited space inside the skull. For many patients and their families, a diagnosis of a brain tumour brings an avalanche of questions: what are the symptoms, what does the operation involve, what deficits may appear after the procedure and what does rehabilitation look like.

This article sets out the most important information step by step: from the definition and symptoms, through diagnosis and treatment, to neurological rehabilitation and arranging care after returning home. It is written for patients and their loved ones and is intended to help them better understand the treatment process and the real prospects of recovery.

After brain tumour surgery, the key is to start a well-planned course of rehabilitation after brain tumour surgery quickly. If paresis, speech, balance or independence problems have appeared after the procedure, what matters most is therapy matched to the patient’s real neurological deficits as part of comprehensive neurological rehabilitation programmes.

Key points

• A brain tumour can cause headaches, seizures, and disturbances of speech, movement, vision, memory and behaviour, but the symptoms depend above all on the location of the lesion.
• Diagnosis is based on brain imaging, most often computed tomography and magnetic resonance imaging, while the final diagnosis is provided by histopathological examination.
• Treatment can involve several stages and may include neurosurgery, radiotherapy, chemotherapy and other forms of supplementary treatment.
• Temporary or permanent neurological deficits may occur after surgery, which is why specialist rehabilitation is important from the very first days after the procedure.
• The best results come from early, individually tailored neurological rehabilitation and from continuity of therapy after discharge from hospital.

What is a brain tumour?

A brain tumour is a growth located in the brain tissue or in its immediate surroundings. The tumour cells divide in an uncontrolled way, forming a mass that presses on healthy brain structures and disrupts their work.

Brain tumours are divided into primary tumours, which originate from brain tissue or nearby structures, and secondary tumours, that is metastases of cancers from other organs. They may be benign and grow more slowly, or malignant and highly aggressive. Even a benign tumour, however, can pose a real threat because of the rise in intracranial pressure and the damage it causes to surrounding tissue.

Every brain tumour is different. The symptoms, prognosis and choice of treatment depend on the histological type, the size of the lesion, its location, the rate of growth and the patient’s general condition. The final diagnosis is most often established on the basis of a histopathological examination of tissue taken during a biopsy or surgery.

Brain tumour symptoms and diagnosis

The symptoms of a brain tumour vary and depend on the location of the tumour, its size and the rate of growth. In some patients they appear suddenly; in others they build up gradually and for a long time may be mistaken for other neurological conditions.

• Headaches that worsen over time, often becoming more severe in the morning or when changing body position, not infrequently accompanied by nausea and vomiting.
• Seizures, which may be the first sign of a brain tumour, even in an adult with no previous history of epilepsy.
• Focal symptoms, such as paresis, sensory disturbances, and problems with speech, vision, hearing or balance.
• Psychological and cognitive changes: problems with memory and concentration, disorientation, apathy, irritability or a marked change in personality.
• Other symptoms depending on the location of the tumour, for example hormonal disturbances, difficulty swallowing, chronic fatigue or loss of appetite.

Many of these symptoms can also occur in other, less serious conditions. If, however, they appear for the first time, worsen or follow an unusual course, an urgent medical consultation and neurological work-up are needed.

Diagnosis

The basic stage of diagnosis is brain imaging. Most often, computed tomography or magnetic resonance imaging with contrast is performed, showing the location, size and nature of the lesion. MRI usually provides a more detailed picture and helps to assess the relationship of the tumour to key brain structures.

This is supplemented by a neurological examination and additional tests, for example an assessment of the visual field, hormone tests or a fundoscopic examination. Final confirmation of the diagnosis and of the type of tumour is provided by a histopathological examination of tissue taken during surgery or a stereotactic biopsy.

Treatment of brain tumours

Treatment is chosen individually, depending on the type of tumour, its malignancy, location, size and the patient’s general condition. The treatment plan is prepared by a team of specialists, most often a neurosurgeon, a neurologist, an oncologist, a radiotherapist and a rehabilitation physician.

• Surgical treatment: in many cases the primary method of treatment, allowing the tumour to be removed, the mass effect to be reduced and tissue to be obtained for a histopathological diagnosis.
• Radiotherapy: used as supplementary treatment after surgery, or on its own when an operation is not possible.
• Chemotherapy: particularly important for certain malignant tumours, often combined with radiotherapy.
• Targeted therapies, immunotherapy and other modern methods: used in selected clinical situations and in line with the tumour’s profile.
• Watchful waiting or palliative care: in some cases the aim is to control the tumour’s growth and improve quality of life rather than to achieve a complete cure.

Not every tumour can be completely removed. Sometimes the limiting factor is its location near important brain structures or the patient’s general condition. That is why treatment always requires a careful weighing of the benefits and risks.

Brain tumour surgery – the procedure and possible complications

Neurosurgery most often involves opening the skull and precisely removing the lesion. The procedure is usually carried out under general anaesthetic, although in selected cases awake surgery is used, so that speech or motor functions can be monitored during the operation.

Before surgery, the procedure is planned on the basis of advanced imaging. The neurosurgeon may use neuronavigation, an operating microscope, fluorescence techniques and other tools that improve the precision and safety of removing the tumour.

Despite this high precision, brain surgery always carries a risk of complications, such as bleeding, brain swelling, infection, or the appearance or worsening of a neurological deficit. That is why, after the procedure, the patient is closely monitored, often in an intensive care unit or a special post-operative room.

Symptoms after surgery

Immediately after the procedure the patient may be drowsy, disoriented and experience headaches, nausea or general weakness. In the early post-operative period it is very important to control pain, observe the level of consciousness and gradually get the patient moving.

The hospital stay usually lasts from a few days to about a week. If the patient’s condition allows, as early as the first day the staff encourage them to sit up, stand up and get up with assistance. Early activation reduces the risk of complications and allows the patient’s true neurological state to be assessed more quickly.

After surgery, neurological symptoms may be temporarily more pronounced. Some deficits result from post-operative swelling and may improve over the following days or weeks, but others can be permanent and require long-term rehabilitation.

Neurological deficits after brain tumour surgery

Neurological deficits are lost or weakened functions of the nervous system. After brain tumour surgery they may result both from the tumour itself, which had already damaged certain areas of the brain, and from the need to operate near important structures.

Common consequences include paresis, sensory disturbances, difficulties with speech and understanding, visual disturbances, balance problems, weakened cognitive functions, increased fatigability and emotional changes. The extent of these difficulties is highly individual and depends on the location of the tumour, the extent of the surgery and the patient’s condition before treatment.

Many of these deficits can improve thanks to the brain’s neuroplasticity and appropriately chosen rehabilitation. These mechanisms are often similar to those described in relation to the symptoms of central nervous system damage. The greatest progress is usually seen in the first months after surgery, but improvement can also continue for much longer.

Deficits depending on the location of the tumour

Frontal lobe

Tumours of the frontal lobe can lead to paresis on the opposite side of the body and to problems with planning, concentration and controlling behaviour. Personality changes, apathy or disinhibition often appear. If the lesion involves the area of Broca’s region, difficulties with speaking may occur.

Parietal lobe

Tumours of the parietal lobe are sometimes associated with disturbances of sensation, spatial orientation and motor coordination. In some patients, difficulties with reading, writing and simple calculations also appear.

Temporal lobe

Lesions in the temporal lobe can cause problems with memory and understanding speech, hearing disturbances and temporal lobe seizures. If the dominant hemisphere is affected, receptive aphasia may develop, which requires focused therapy for speech disorders and aphasia.

Occipital lobe

Tumours of the occipital lobe mainly affect visual functions. They can cause visual field defects, problems with recognising faces and objects, or difficulty interpreting visual stimuli.

Cerebellum

Tumours within the cerebellum often result in balance disturbances, ataxia, an unsteady gait and difficulties in performing precise movements. They may be accompanied by nystagmus, dizziness and nausea, which is why therapy for gait and balance disorders plays an important role.

Brainstem

Brainstem tumours are among the most clinically challenging. They can cause disturbances of swallowing, speech, cranial nerve function and balance, and even of breathing and heart function. Even small lesions in this area can lead to serious neurological symptoms.

Rehabilitation after brain tumour surgery

Neurological rehabilitation is an integral part of treating a patient after brain tumour surgery. Its aim is to restore the greatest possible level of function and the ability to live independently, through exercises and therapies tailored to the patient’s real deficits.

An early start

Rehabilitation is started as early as possible, often within the first days after surgery, while the patient is still in hospital. Early exercises help to prevent contractures, blood clots and pressure sores, and they make the most of the brain’s greatest potential to reorganise itself after damage.

A team of specialists

Effective rehabilitation requires the work of a team of specialists: a physiotherapist, a speech and language therapist, an occupational therapist, a neuropsychologist, a psychologist or psycho-oncologist, and, if needed, a social worker. The scope of support depends on the patient’s problems and the stage of treatment.

Hard work and an individual plan

Rehabilitation after brain tumour surgery is usually a long-term process and requires consistent work. Therapy is planned differently for someone with gait disturbances than for a patient with aphasia, swallowing disorders or problems with memory and cognitive functions. The therapeutic goals should be realistic and set out in stages.

The results of rehabilitation

Intensive rehabilitation improves the functional outcomes of patients with brain tumours. Muscle strength, independence, memory, communication and quality of life may all improve. Even where a full return to previous function is not possible, rehabilitation helps patients cope better with disability.

Continuity and long-term care

Rehabilitation does not end when the patient leaves hospital. Many patients need further outpatient therapy, a residential rehabilitation stay or work at home under the guidance of specialists. Maintaining continuity of therapy is crucial for preserving and building on the results achieved.

The family’s involvement

Loved ones play a very important role in the recovery process. They learn how to provide safe support, help with exercises and give the patient emotional support. At the same time, they should not do everything for the patient, because independence is one of the goals of therapy.

Returning home and further care of the patient

Discharge from hospital after brain tumour surgery marks the start of the next stage of treatment. The patient returns home with instructions on medication, wound care, further investigations, follow-up appointments and continuing rehabilitation.

Wound care

The surgical wound should be kept clean and monitored for redness, discharge or fever. If there are signs of infection, urgent contact with a doctor is needed.

Medication and continuing treatment

After surgery the patient often takes steroids, anti-epileptic medication, painkillers and other preparations recommended by the doctor. They should not be stopped or have their dosage changed without consulting a doctor.

Warning signs

• a worsening, severe headache after a period of improvement
• drowsiness, confusion or a clear deterioration in responsiveness
• fever and signs of infection of the surgical wound
• seizures or a sudden neurological deterioration, for example new paresis or new speech disturbances
• a rapid worsening of balance, vision or swallowing

Ongoing rehabilitation

After discharge it is worth ensuring continuity of rehabilitation on an outpatient basis, at home or during a specialist neurological rehabilitation stay. Regular exercise makes it possible to consolidate and build on the results achieved in the early stage of treatment.

Adapting the home

Depending on the patient’s condition, the home sometimes needs to be adapted: removing thresholds and slippery rugs, fitting handrails, preparing a rehabilitation bed or providing the patient with a walking frame, a stick or a wheelchair.

Psychosocial support

The period after returning home can be psychologically difficult, both for the patient and for their carers. It is worth making use of the help of a psychologist, a psycho-oncologist, support groups and various forms of community care, where these are available.

Continuing oncological treatment and prognosis

After surgery, many patients need further oncological care, radiotherapy, chemotherapy or regular follow-up imaging. The prognosis varies greatly and depends on the type of tumour, its biology, the extent of treatment and the body’s response to therapy and rehabilitation.

Summary

A brain tumour is an enormous challenge for the patient and their family. What matters most is prompt diagnosis, properly planned treatment, specialist neurological rehabilitation and psychological and practical support at every stage of the return to function.

Every case is different, but appropriately chosen therapy and consistent rehabilitation can significantly improve functioning and quality of life. Recovery is a process that takes time, patience and cooperation between the whole team of specialists and the patient’s family.

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