BLOGS BY DOCTORS

May 2019

A Brief Overview on Technological Journey and Transformation of Cath-lab and Equipments

  • nayati_main
  • May 14, 2019
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Dr H.S. Somanath, Chairman – Cardiology at Nayati Healthcare

  • Cath lab imaging technology has now evolved from the Analogue-based Image Intensifiers to fully Digital Flat-Panel technology with high resolution that leads a long way in serving healthcare to its fullest extremity. There are enormous advancement in combining various features like inclusion of Hybrid Systems, Intravascular Ultrasound (IVUS), Rotablation Atherectomy Device, 3D Rotational Angiogram, Fractional Flow Reserve (FFR), Stent Boost and many more.
  • Although there has been an evolution of care in the cath lab, the core technology of Angiographic Imaging, Wires, Catheters, and Balloon Interventions has not changed dramatically over the years. Some of the incremental advancements that have changed the way cardiac care is delivered.
  • Nowadays, we can automatically, without radiation exposure, collimate an image by using the previous images to collimate on, which reduces direct and scatter radiation exposures to our patients and to clinical team as well. In addition, we have lowered up frame rates from 60 frames/second to 7.5 to 30 frames/second.
  • In the beginning phase Cath-Lab, X-ray images were of very high-dose, images from low-quality image intensifiers, were recorded on 16-mm or 35-mm film with Aero techno film magazines and video reel-to-reel tapes for playback. The Jamison or Combulator processor in the darkroom could engage a person’s entire day’s work. The transformation has been through C-arms to Aerotechnic cameras, mounted overhead as image intensifiers, form intensifiers to flat-panel technology, pulsed fluoroscopy, digital enhancing of images, subtracted images and bolus-chasing, 3D visualization tools that are enabling cath labs to perform as a highly specialized research center and multipurpose facilities. The 3D rotational angiogram allows for a single dye injection and rotational images, the ability to view all coronaries/cerebral arteries with one shot, lets the clinicians use less dye which reduces the risk of any future side-effects.
  • We have also witnessed the advancement in PACS archival technology that transmits images via the web viewing the patient’s films which have gone from a noisy Tagarno film-snagging projector to a completely digital based PACS system that constantly needed our diligent attention and up-gradation.
  • The introduction of stents significantly altered the care landscape. The evolution of stent technology from the bare-metal stent to the approval and adoption of drug-eluting stents (DES), had a major impact on improving clinical outcomes. Stent Boost subtraction feature shows the enhanced stent image in relation to the vessel wall to support precise pre and post stent deployment.
  • Access techniques have migrated over the years from Judkins percutaneous approach through the femoral artery to more recently Radial Artery Approach, which can significantly decrease the risk of post-procedure bleeding (Hematomas) and reduce the post-procedure length of stay (LOS), thus influencing the care delivery model to a significant level.
  • Valvuloplasty, the widening of stenotic aortic valve was introduced into the cath lab procedure armamentarium. The endovascular approach for the valvular disease has developed significantly over the years, with the advent of Transcatheter Aortic Valve Replacement (TAVR) procedures.
  • Vascular Closure Device has been widely accepted over manual compression that includes patient comfort, early mobilization, and discharge, avoidance of local compression and its sequel and less time constraint on staff.
  • The cardiac cath lab of the future projects the functionality as a hybrid suite, supporting cardiac and vascular catheter-based interventions and associated complex staged/combined interventional and open surgical procedures under the same roof.
  • In order to conclude, we may say cath labs have come a long way, but we also need to think upon, what is next on the horizon? Will cath labs as they exist today, become obsolete with CT and MRI technological advances? Or, will robot-assisted procedures in the cath lab become common practice in all hospital set up? These are few of the contemporary issues concerning the future of the technology.

Exercise Protocol for Heart Patients

  • nayati_main
  • May 02, 2019
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While exercise is important in maintaining good heart health, doing it safely and scaling up gradually remain extremely important.

Dr Mitendra S Yadav

There’s a misconception among some people that exercise of any kind should be avoided if they are heart patients. On the contrary, regular exercise is critical if you have heart disease since physical activity strengthens heart muscles, helping one in managing cholesterol levels and blood pressure.

Indeed, a regular, carefully-controlled exercise regimen can make you more active without causing chest pain or other symptoms of a heart ailment. What’s more, if you are diabetic, exercise will help you control blood sugar levels too – however, avoid walking in a fasting state. Moreover, do not walk immediately after a meal; keep a gap of at least an hour after meals. Over the months, regular exercise will ensure you lose weight, making you feel much better, physically and mentally.

For instance, daily walks will help you control knee problems while also making your bones strong. And other forms of aerobic exercises will strengthen your heart and lungs while boosting your body’s ability in using oxygen. In fact, your heart can benefit the most from aerobic exercise, which includes walking. Those suffering from blood pressure, however, should take their BP medication one hour before walking. Done over a prolonged period, aerobic workouts could decrease blood pressure and heart rate while improving your breathing too.

Some safety guidelines

Bear in mind, though, it’s important to consult your physician before beginning any exercise regimen, ensuring every exercise you do is absolutely safe in your condition. This is crucial if you:

  • Recently suffered a heart attack.
  • Have been experiencing shortness of breath and chest pain or pressure.
  • Underwent a heart surgery or procedure recently.
  • Happen to be diabetic.

Your cardiac care provider will be best placed to recommend safe exercises, including the level of intensity that’s permissible. A 30-minute morning or evening walk five or six times a week should be safe initially. Over the weeks, depending upon how your body feels, you may increase the pace and time as required.

As mentioned earlier, aerobic activities (walking, light jogging, swimming, cycling or dancing) are good for your heart. But you need to begin slowly. Although the goal is to make one’s heart work somewhat harder each time, it’s best not to overdo the tempo.

Besides, always remember to warm up sufficiently by stretching or moving around at a slower pace for five minutes before gradually increasing the tempo. Towards the end of your aerobic activity, cool down by slowly decreasing the pace rather than ending the activity abruptly. Adequate warm-up and cool down will ascertain you do not sprain, overstrain or injure any muscles.

Additional safety tips while exercising:

  • Take a break if you feel tired.
  • If you feel fatigued or experience heart symptoms – STOP!
  • Always wear comfortable, compatible clothing.
  • In summers, exercise in the mornings or evenings only, wearing light clothing.
  • In winters, always cover your nose and mouth when outdoors.

Workout within limits

If any activity overstrains your heart, you will experience symptoms such as:

  • Chest pain
  • Light-headedness
  • Irregular pulse or heartbeat
  • Shortness of breath
  • Nausea

If you feel any or all of the above, stop immediately. Rest. Then consult your doctor, if necessary. Make notes of your resting and exercising pulse rate. During the latter, if it remains high, simply slow down. Then recheck it 10 minutes later to see whether it has returned to normal after exercising. Drink adequate amounts of water after exercising.

At any time if you feel pain, pressure, heaviness or tightness in your chest, neck, jaw or arm; shortness of breath; numbness in the arms; are sweaty or lightheaded, it may be advisable to call the doctor. But if you follow the exercise guidelines mentioned above, you will remain safe and healthy while exercising.

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The writer is Senior Consultant – Interventional Cardiology, Vimhans Nayati Super Speciality Hospital

Tips for taking good care of your Back

  • nayati_main
  • May 02, 2019
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Twelve top tips to prevent back pain:

  1. Pillow under the knees: Sleeping on your back pressurises the spine. A pillow under your knees reduces 50% of the pressure by elevating the legs. Or sleep on either side.
  2. Back exercises: Do back and abdomen-strengthening exercises, five or six times a week, during your workout routine for a more flexible, stronger back.
  3. Increase Vitamin D and calcium intake: Deficiency of key substances is a common cause of back pain in adult years.
  4. High heels hurt: High-heel shoes are another cause of back pain. Wear heels of less than an inch.
  5. Maintain proper posture: Bad posture stresses your back, even changing the spine’s architecture. Standing or sitting, don’t slouch, but keep shoulders straight.
  6. Support your back: In an office chair or the car, sit erect with a cushion under your lower back for support, if required.
  7. Move around: While sitting or standing, don’t stay motionless for long; move around periodically. Standing continuously pressurises your spine.
  8. Stop smoking: Nicotine curbs blood flow to the spinal discs, cracking, drying or rupturing them. Smoking also lowers the blood’s oxygen supply, reducing nourishment to back muscles and tendons, making them vulnerable.
  9. Reduce the load: Heavy bags are bad for the back. Reduce their weight or keep shifting from one shoulder to the other. Use a trolley/bag with wheels, if possible.
  10. Avoid tight clothes: Tight trousers/belts hamper sitting, bending or walking, worsening back pain.
  11. Don’t keep wallets in back pockets: Overstuffed wallets in back pockets cause silent discomfort and cumulative back pain, particularly when driving. Avoid, or lighten their load.
  12. Lift properly: Never bend your waist when lifting heavy objects. Instead, bend the knees and then lift. If an extremely-heavy object needs to be moved, push instead of pulling it.

Are you suffering from Hypertension?

  • nayati_main
  • May 01, 2019
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A silent killer globally, BP is best treated – not ignored.

High blood pressure (or hypertension) is a common condition wherein the long-term pressure of blood against artery walls is high enough to eventually trigger health problems, including heart disease. The volume of blood pumped by the heart and the degree of resistance to the blood flow in the arteries determines blood pressure. Therefore, the more blood the heart pumps and the narrower the arteries, the higher is the blood pressure.

Signs and Symptoms
You could suffer hypertension for years devoid of symptoms. Without symptoms too, damage to your heart and blood vessels can continue undetected. Uncontrolled BP raises the risks of severe health problems such as heart attack and stroke, even resulting in death.

Affecting almost every person, high BP can develop gradually over the years. Nonetheless, it can be easily detected. Once aware of your status, you can control it with the doctor’s help. Many afflicted with high BP show no obvious signs or symptoms – even when it reaches dangerously high levels. Some people, however, may suffer headaches, shortness of breath and nosebleeds. Yet, such symptoms may not be specific and generally not occur until the BP reaches alarming or life-threatening levels.

So it’s safer to have your BP checked once in two years after age 18. If BP runs in your family, or if you are 40-plus, take BP readings annually. Also, BP should be checked in both the arms to discover any difference. If already diagnosed with high BP – or suffering risk factors such as cardiovascular disease – your doctor will recommend frequent check-ups. BP machines are also available, allowing one to check readings at home. If BP readings remain high consistently, your doctor will recommend suitable drugs to control it.

Causes and Control
Stress, excess salt consumption and underlying conditions such as kidney disease can cause high BP. Though blood pressure can be controlled through diet, after it reaches the hypertension stage, medications are advisable.

To control high BP, moderate-intensity exercise of minimum 30 minutes, 5-6 times a week is essential. Avoiding stress and abstaining from alcohol, drugs, tobacco as well as junk food can all help control BP. Remember, globally, BP is one of the major silent killers that’s best not ignored but treated immediately.

April 2019

Rising Cardiac Problems in Children

  • nayati_main
  • Apr 30, 2019
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Wrong dietary and lifestyle habits are raising the risk of cardiovascular ailments in children.

The age-old saying, ‘You are what you eat’, holds much water! The universal fall in healthy dietary habits among children is leading to rising numbers of kids falling prey to ailments once associated only with adults. Besides various other diseases, it includes cardiovascular problems.

For instance, increasing evidence indicates atherosclerosis (an arterial disease caused by the deposition of fatty material on the inner arterial walls) begins in childhood while being directly linked with the same cardiovascular disease (CVD) risk factors found in adults. Such worrying results stress the importance of robust CVD prevention policies for children, which can ensure low-risk status in adulthood.

Healthy dietary habits are best developed in childhood for promoting primary prevention of CVD risk factors across adolescence and adulthood. The changes must occur through both the macro (dietary fat, carbohydrates, etc.) and micro (sodium and calcium) nutrients that impact the CVD risk. The amount of calories a child/adolescent can consume will be contingent on the age, gender, stage of growth, weight, size and level of physical activity. Youngsters consuming more calories than they burn will gain extra weight and body fat, increasing CVD risks.

Since dietary choices are established in childhood, early intervention is imperative in improving dietary habits. Combined with regular physical activity, this helps in maintaining a healthy weight throughout childhood, adolescence and adulthood, thereby preventing the development of CVD during these years.

Given this backdrop, primary care providers need to counsel paediatric patients as well as their families about adhering to judicious dietary patterns that limit the intake of saturated fats and cholesterol. Instead, they should consume more fresh fruits, vegetables and fibre. Dietary salt and sugar should also be limited while sugar-saturated beverages should be avoided.

The other point to be emphasized is the benefits of regular physical activity in boosting cardiovascular fitness, bone mass and a sense of well-being while lowering the risk of obesity and high blood pressure. Conversely, sedentary lifestyles and decreased physical activity lead to higher obesity levels and CVD risk factors, including insulin resistance and hypertension.

Therefore, children six years and above should have at least an hour of moderate-to-vigorous physical activity daily. Moreover, intense physical activity, including muscle-and-bone-strengthening activities, should be undertaken at least thrice a week. But these minimum targets may be falling since children as young as two and three years are now getting addicted to mobile, TV and gaming screens.

Additionally, periodic trips to fast-food joints are leading to higher intake of sodium, sugar and processed foods containing harmful preservatives. Such foods are fattening and carcinogenic, leading to increasing cases of childhood diabetes, CVDs and even cancer. These trends being a cause for concern, family clinicians need to assess the level of physical activity as well as sedentary behaviour among children visiting their clinic.

As per the feedback, clinicians can provide age-specific suggestions for improving physical activity while controlling sedentary behaviours among children. Furthermore, parents should be advised to restrict their screen time and make sure no TVs are installed in the child’s bedroom. Of course, the parents themselves need to act as role models by controlling their own overall screen time! Also, parents participating with their kids in various physical activities can boost the well-being of the entire family.

In essence, the focus must remain on preventing childhood obesity and eliminating the risks of CVD and other ailments. On each visit to the clinic, the child’s weight, height and BMI (body mass index) should be recorded. Ultimately, dietary precautions, more physical activities and the prevention of risk factors are the best safeguards against childhood cardiovascular diseases.

By- Dr BK Mohanty, Director – CTVS (Adult & Paediatric), Nayati Healthcare

The importance of Vaccination/Immunization in Adults

  • nayati_main
  • Apr 30, 2019
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A general misconception prevails that vaccination is only required in our formative years. Yet, thousands of adults fall ill annually and are hospitalised due to ailments that vaccines can prevent. Besides, the effect of some childhood vaccines wears off over the years, making adult re-immunisation safe and efficacious.

Indeed, some diseases need immunisation even in adulthood. For example, the:

  • Hepatitis B vaccine lowers liver cancer risk.
  • HPV vaccine lowers the risk of cervical cancer.
  • Flu vaccine lowers the risk of flu-related heart attacks or other complications from existing health conditions such as diabetes and chronic lung disease.

Additionally, all vaccines:

  • Are tested and monitored for years before being cleared for public use.
  • Have mild side effects (soreness, swelling, redness, etc.) that vanish within hours or days. Major side effects are extremely rare.
  • Remain one of the safest ways to preventive healthcare.

Given the threat from HPV (causing certain cancers), hepatitis, meningococcal disease, measles, mumps, rubella and chickenpox, among others, vaccines are the safest means to reduce disease and death rates.

Adding Activities to Subtract Sedentary Lifestyles

  • nayati_main
  • Apr 26, 2019
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The global onslaught of technology, competitive living and incorrect lifestyles has inevitably turned people into sedentary beings. Be it food habits or the quality of food products, everything across the globe has experienced deterioration due to numerous factors.

Given below are some simple and easy ways to overcome sedentary lifestyle habits:

  1. Walking the Talk! Treat the mobile phone like your friend. So each time you talk, take a walk! Take a stroll in the balcony, go around the office aisle, walk across corridors and go to the terrace – there are innumerable ways in which mobiles can make people walk often.
  2. Standing Often: Identify routine tasks that can be done standing. Watching 10 minutes’ news headlines, cleaning the workstation, drinking tea in the office, folding clothes at the wardrobe, etc. These tasks will help one stretch and strengthen the back and legs.
  3. Doing Chores: Identify some tasks to do on your own. Wash the dishes, clean the mug, keep the wardrobe intact, streamline the shoe rack, etc. This requires effort as well as thought, thereby helping a person become active and systematic.
  4. Be a Sport: Take up some moving sport. Join a cycling club, play gully cricket, go to a volleyball club, play badminton after finding a suitable partner, etc.
  5. Go Green: Treat at least five plants at home as your responsibility. Water and trim them, trowel the soil, etc. This will make you active and sensitive towards nature.
  6. Conveyance Cues: Adopt public transport or a mix of modes to commute. This will require some effort each time one is moving. If still using one’s own vehicle, park it some way off or take the stairs in reaching the destination.
  7. Dance with Abandon: Even if dancing seems unfamiliar, still try shaking a leg, adding music to the routine. When getting ready every morning, play some favourite music that will help in grooving a little. If possible, join a dance class or form a dance club.

Know everything about Brain Stroke

  • nayati_main
  • Apr 25, 2019
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What is a Stroke?
Also termed ‘brain attack’, Stroke is caused by the lack of blood supply to the brain, usually because of the formation of a clot. Brain cells become inactive due to a shortage in the supply foxygen and nutrients. This may leave a person partially or completely paralysed. Stroke affects one in six persons in their lifetime.

What are the risk factors of Stroke?
Anyone can be vulnerable, irrespective of age, race or gender. But people with the following conditions are at a higher risk of suffering a Stroke:

  • High blood pressure
  • Obesity
  • Physical inactivity
  • High cholesterol
  • Diabetes
  • Tobacco abuse
  • Alcohol abuse
  • Smoking

 

What are the types of Stroke?
The two main types:

  • Ischaemic Stroke: This happens due to the blockage of blood vessels, which reduces the brain’s blood supply.
  • Haemorrhagic Stroke: It occurs due to the rupture of blood vessels.

What are the symptoms of a Stroke?
The symptoms include sudden:

  • Numbness or weakness of the face, arm or leg, especially on one side of the body.
  • Confusion, trouble speaking or understanding.
  • Severe headache without a known cause.
  • Trouble seeing from one or both eyes.
  • Trouble walking, dizziness, loss of balance or coordination.

A person showing one or some of the above symptoms should be rushed to the hospital immediately.

How is Stroke diagnosed?
It is diagnosed through the help of physical examinations and tests. Imaging studies such as Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) help in diagnosing Stroke.

How is Stroke treated?
Medical treatment: It can be treated with drugs that dissolve blood clots obstructing blood flow to the brain.

Surgical treatment: If a clot does not dissolve by medicine, surgical intervention is required to remove the clot from the brain.

Immediate treatment can save victims from disability and increase their chances of successful recovery. But one of the biggest obstacles to emergency treatment is most people don’t know they are having a stroke.

What disabilities can result from a Stroke?
Besides being a life-threatening condition, Stroke can affect the entire body, causing paralysis. Brain cells die during Stroke and functions controlled by that area of the brain can be lost such as speech, movement and memory.

What’s the importance of rehabilitation?
Stroke is a disaster for patients, mentally and physically. A Stroke patient needs prolonged rehabilitation in returning to normal life. A combined team of physiotherapists, psychologists and psychiatrists play a pivotal role in a Stroke patient’s recovery.

The Perils of Hypertension in Women

  • nayati_main
  • Apr 24, 2019
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High BP is A SILENT KILLER – because it kills without  noticeable symptoms.

By Dr Gaurangi Shah

High blood pressure (or hypertension) is a serious ailment affecting millions worldwide, including women. Termed a ‘silent killer’, many persons have the dangerous disease but aren’t aware about this. Left untreated over the years, it could strike suddenly with dangerous consequences such as stroke(paralysis), heart attacks,heart failure, blindness and kidney failutre.

Almost everyone is at risk of developing BP, although some have higher chances of falling victim, including those with a family history of hypertension and people more than 55 years of age. Others at risk include those who:

  • Are overweight / obese
  • Consume excess salt
  • Don’t exercise regularly
  • Smoke heavily
  • Indulge in alcohol abuse

Most people with high BP may not notice any signs. Indeed, in 85% of cases, there may be no overt symptoms. It’s only when the person suffers a heart attack or paralytic stroke that the underlying cause is clear.

Some symptoms of high BP include:

  • Severe headache
  • Blurry vision
  • Confusion or fatigue
  • Chest pain
  • Breathing difficulty
  • Irregular heartbeat
  • Pounding in the chest, neck or ears

It is crucial to understand the causes of BP, which can be hereditary or non-hereditary. In the former, it generally manifests between 40 and 60 years of age. In non-hereditary cases, it usually arises before age 40 or after age 60. In the latter, the person should visit a cardiologist or endocrinologist to discover the cause of high BP. If the underlying cause is addressed, it may be possible to eliminate hypertension.

In the case of many Indian women who are home-makers, do not take regular walks and are fond of salty food items such as namkeens, the risks of developing high BP without being aware are much higher. Normally, BP should not exceed 120/80 mm. Therefore, it’s important to check one’s BP regularly.

If a woman has just been diagnosed with BP, it should be checked twice daily during the initial period. First, immediately after waking up and second, in the evening. Note that BP in the evening/night may be 10mm higher than the morning. Moreover, like diabetes, high BP is a multi-organ disease affecting all vital organs, including the eyes. Therefore, it’s safer to have eye tests annually to prevent blindness.

When pregnant, women must monitor BP as advised by their doctor. High BP in pregnant women is termed preeclampsia or toxaemia. The doctor will prescribe daily medications to control high BP. As per activities undertaken, BP can rise and dip throughout the day. But the risk arises if the pressure stays high for some time. If the pressure goes beyond 140/90 for prolonged periods, treatment is required. If there are other risk factors such as diabetes and the blood pressure stays higher than 120/80, treatment may still be needed.

Women can ascertain high BP does not become a silent killer by:

  • Monitoring BP daily
  • Exercising regularly
  • Ensuring low salt intake
  • Keeping bodyweight at healthy levels
  • Abstaining from cigarettes/tobacco/alcohol
  • Having regular/annual medical check-ups

Meanwhile, continue taking brisk walks for 30–45 minutes daily, which is the best way to control your weight, BP and other lifestyle ailments. Best of all, remember your daily walks are free!

Know everything about Brain Tumour

  • nayati_main
  • Apr 24, 2019
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What’s a Brain Tumour?
This is a mass or growth of abnormal cells in the brain. Some brain tumours are non-cancerous or benign while others are cancerous or malignant. Brain tumours can originate in the brain (primary brain tumours), or in other parts of the body and then spread to the brain (secondary, or metastatic, brain tumours).

What are its symptoms?
The signs and symptoms vary, depending on the tumour’s size, location and growth rate. Some signs/symptoms may include:

  • New onset or change in the pattern of headaches
  • Headaches gradually becoming more frequent and severe
  • Unexplained nausea or vomiting and general sickness
  • Vision problems, such as blurred vision, double vision or loss of peripheral vision
  • Gradual loss of sensation or movement in an arm or a leg
  • Difficulty with balance
  • Speech difficulties
  • Confusion in daily matters
  • Personality or behaviour changes
  • Fits and seizures, especially in someone without a history of this
  • Hearing problems

If you have persistent signs and symptoms as above, visit your doctor immediately.

What causes Brain Tumour?
The causes can be described as:
Primary brain tumours: Cancers emerging in the brain.
Secondary brain tumours: Cancers that spread to the brain from elsewhere in the body, termed secondary brain tumours or brain metastases. These are more common than the primary ones.

What are the risk factors?
These include:
Age. The risk of a tumour increases as we age. Brain tumours are common in older adults. But a tumour can occur at any age.
Radiation exposure. People exposed to a type of radiation called ionizing radiation run a greater risk of brain tumour.
Family history. A small percentage occurs in those with a family history of brain tumours or a history of genetic syndromes that increase the risk of brain tumours.

How are Brain Tumours treated?
Treatment options depend on the type of the tumour as well as its size and location. Typically, brain tumours are treated via surgery, radiation therapy and chemotherapy.