So the diagnosis of a malignant brain tumor is really, again, as I mentioned previously, rests upon how the individual presents and again, the usual individual would present with headache, nausea, vomiting, and will either present to the primary care provider on the level of symptoms that they're having. They'll usually be imaged usually with a CT scan and possibly that space occupying lesion being identified. They'll either be discharged from the ER or a neurosurgical console will be requested while they're in the hospital depending on the degree of symptoms the individual has. Shortly thereafter, there'll be a planning MRI done for the planning of the surgical procedure, which is called the stealth MRI. And that's a very thin cut MRI that really defines the anatomy of the tumor and exactly where the tumor is. It gives the neurosurgeon an idea of the degree of difficulty and what are the important vital structures that are around the tumor. So that they can avoid those structures. There are some other very detailed testing that can be done such as functional MRI, particularly if lesions are within the temporal lobe, left temporal lobe, to ensure that language and speech is not disrupted by a surgical intervention. We always hope what we call gross total resection, removing at least greater than 90% of the tumor when compared with the preoperative brain imaging. Quite often, if the neurosurgeon is able to get a majority of the tumor out, there are other therapeutic interventions that can be undertaken including using chemotherapy latent waivers. After the individual has gone through the surgical intervention, they're usually in the hospital for anywhere from 24 to 48 hours, and sometimes longer, depending on whether or not there are any other complicating factors. The diagnosis of malignant brain tumors, again, rests solely on that pathological specimen, the neurosurgeon obtained during the initial surgical intervention, quite often, neurosurgeons will talk about the frozen section. The frozen section refers to the tumor taken while in the OR, and it's given to a pathologist usually in the OR that looks at that specimen and tells the neurosurgeon, yes, this looks like a malignant brain tumor or maybe something else. The permanent section is after that tumor is removed. It is processed by the neuropathologist and is looked at in greater detail what actually the neurosurgeon obtained. And that that really truly defines what type of tumor the individual has. Again, the most common type of malignant brain tumor glioblastoma at that point, the individual will usually be discharged. As I mentioned, about 24 to 48 hours after their surgical intervention. Our goal is to get the individual initiated on their therapy. Usually within two weeks of their surgical intervention, we certainly like to have that done again as quickly as possible in their literature, suggesting that temozolomide, which is the chemotherapy of choice for the treatment of malignant gliomas, if started early, can have better outcomes than if it's so waited until the individual initiates radiation along with temozolomide.
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