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Johnathan Engh, MD, FAANS

Featured Article

Understanding Brain Tumors

Lexington Medical Center Brain Tumor Team Seeks Best Patient Outcomes

Article by Johnathan Engh, MD, FAANS, Lexington Medical Center Brain Tumor Program

Photography by Gerry Melendez/Lexington Medical Center

Originally published in Lake Murray Lifestyle

The thought of a tumor is scary. A growth inside the body that doesn’t belong, whether benign or malignant, can cause a number of health problems. But brain tumors are especially frightening because they disrupt function in the area of the body that makes us who we are.

The human brain is driven by trillions of electrical currents that are transmitted from specific areas to others at set times in order to create consciousness. You can think of the brain as a complex circuit, which generates specific electrical impulses that create movement, speech, and even thought. This circuit is astonishing in its complexity. It is estimated that the brain contains 100 billion neurons, cells that make up the electrical wires of the circuit. The number of connections between these wires is even greater.

Despite this incredible complexity, the symptoms of brain tumors are often vague and non-specific. Common presentations include:

  • Headache
  • Confusion
  • Weakness
  • Changes in personality
  • Seizures

The symptoms are typically not subtle, and usually progress over time. The changes can be so dramatic that a number of people with brain tumors are initially misdiagnosed with strokes. However, proper brain imaging with computed tomography (CT scans) or magnetic resonance imaging (MRI) can usually confirm the presence of a brain tumor if a patient is experiencing these symptoms.

Most headaches that we experience are NOT from a brain tumor. Headaches from brain tumors are almost always different than the headaches that most of us are used to experiencing from time to time. Headaches that are more severe than usual, associated with vomiting or passing out, worse in the morning or associated with confusion usually warrant investigation with further imaging.

Confusion can be caused by many things, including drug side effects, electrolyte disturbances, sleep disorders, and aging, to name a few. When confusion is caused by a brain tumor, family and friends may witness progressive behaviors that are unusual or bizarre and out of character for the patient. When these behaviors escalate over a period of weeks or even months, patients are usually brought in for evaluation. The same is true when patients experience personality changes from a brain tumor.

Weakness from a brain tumor is the symptom most often misdiagnosed as a stroke. Similar to a stroke victim, brain tumor patients may present with facial, arm, or leg weakness, usually on one side of the body, and often in combination. But, unlike stroke patients, tumor weakness tends to be progressive rather than sudden, and does not tend to improve at all without intervention.

Seizures are uncontrolled bursts of electrical activity from the brain that may manifest as staring spells, bouts of confusion and word slurring, or even convulsions. Sometimes seizure may be the only sign indicating the presence of a brain tumor. After medication is given to control seizures, brain imaging can delineate the tumor causing the seizure problem. In general, safe tumor removal is the best way to prevent further seizures in these cases.

Because the tissues of the brain are critical and unable to regenerate, treatment for a brain tumor must be carefully monitored so that it not only treats the tumor, but also avoids injury to the patient.

Brain surgery is essential, and even life-saving, to the care of many patients with brain tumors or other brain conditions. However, it is not without substantial risk. One of the central principles of medicine is “primum non nocere,” or “first do no harm.” It’s a reminder that our interventions for disease may cause injury to a patient, and that we must avoid injury whenever possible.

Few interventions in medicine are more potentially dangerous than brain surgery. Stroke, hemorrhage and infection are just a few of the potentially devastating complications that can harm a patient or even lead to death. At Lexington Medical Center, we utilize specialized techniques, not widely used at most medical centers, to reduce the risk of brain injury from tumor surgery.

Awake craniotomy is a specialized method of brain tumor surgery in which the patient remains awake and alert during surgery. While being kept comfortable, the patient can talk, move an extremity of interest, or name objects on a screen. This allows the neurosurgeon to track the patient’s motor function and speech in real time during the operation.

It is critical that the entire operating room team be specially trained in this technique in order for it to be successful. Otherwise, the patient can be more prone to problems like breathing complications or seizures in the operating room. Lexington Medical Center has a dedicated team that specializes in awake craniotomy for brain tumors. Using this technique allows us to work in functional regions of the brain while keeping track of the patient’s neurologic state. As a result, we can remove brain tumors that would otherwise not be safely removable.

Minimally invasive port surgery is another specialized technique utilized to prevent injury in the operating room at Lexington Medical Center. Using a small, cylinder-shaped retractor, the neurosurgeon can access deep brain regions with less disruption to the surrounding brain tissue. With this technique, patients with deep brain tumors and tumors in the fluid system of the brain (intraventricular tumors) can have successful surgery and achieve relief of their symptoms while minimizing the risk of being injured during their operation.


The Lexington Medical Center Brain Tumor Program, led by Dr. Engh, combines the expertise of talented specialists with the most advanced and effective treatment options to help patients achieve the best possible outcomes.


  • Johnathan Engh, MD, FAANS