Frequently Asked Questions (FAQs)

Dr Nor Faizal Ahmad Bahuri Consultant Neurosurgeon & Interventional Pain Specialist KPJ Tawakkal Specialist Hospital, Kuala Lumpur

Discipline · Simplicity · Elegance

These answers are provided for general informational and educational purposes only. They are not a substitute for a personal consultation with Dr Nor Faizal or a qualified medical professional. Every patient’s situation is unique, and clinical recommendations must always be based on an individual assessment.

1. About Brain Tumors

Q: What is a brain tumor, and what are the different types?

A brain tumor is an abnormal growth of cells within the brain or its surrounding structures. Tumors can be primary — originating from the brain itself — or secondary (metastatic) — having spread to the brain from cancer elsewhere in the body, such as the lungs, breasts, or colon.

Primary brain tumors include gliomas (which encompass glioblastoma, astrocytoma, and oligodendroglioma), meningiomas (arising from the membranes covering the brain), pituitary tumors, acoustic neuromas (vestibular schwannomas), ependymomas, and many others. Each type has a distinct biology, behavior, and treatment approach. Not all brain tumors are malignant — many, such as most meningiomas, are benign.

Q: What are the symptoms of a brain tumor?

Symptoms depend heavily on the tumor’s location, size, and growth rate. Common presentations include:

• Persistent or worsening headaches, often worse in the morning or when lying down
• First-time seizures in an adult with no prior history of epilepsy
• Progressive weakness or numbness in the arms or legs
• Difficulty speaking, understanding language, or finding the right words
• Visual changes — double vision, loss of peripheral vision, or blurred vision
• Balance problems or difficulty walking
• Changes in personality or behavior
• Cognitive decline or memory issues

It is important to note that many of these symptoms are also caused by benign conditions. The presence of one or more of these symptoms does not mean you have a brain tumor — but persistent or progressive symptoms warrant an evaluation.

Q: How is a brain tumor diagnosed?

Diagnosis begins with a clinical evaluation by a neurologist or neurosurgeon, followed by neuroimaging. Brain MRI with contrast is the gold standard investigation for a suspected brain tumor. CT scans are often performed in emergency settings. In some cases, advanced imaging techniques such as MR spectroscopy, perfusion MRI, or PET-CT are used to provide additional information.

A definitive tissue diagnosis requires a biopsy or surgical resection with pathological examination of the tumor tissue. Modern neuro-oncology also involves molecular profiling — testing tumor tissue for specific genetic markers (such as IDH mutation, MGMT promoter methylation, and 1p/19q codeletion) that influence prognosis and treatment planning.

Q: Are brain tumors hereditary?

The majority of brain tumors are not directly inherited. Most arise from sporadic genetic mutations that occur during a person’s lifetime. However, certain hereditary conditions — such as neurofibromatosis types 1 and 2, von Hippel-Lindau disease, Li-Fraumeni syndrome, and tuberous sclerosis — are associated with an increased risk of developing specific types of brain tumors. If there is a strong family history of brain tumors or related conditions, genetic counseling may be appropriate.

Q: What is a glioblastoma, and can it be treated?

Glioblastoma (GBM, or glioblastoma multiforme) is the most aggressive form of primary brain tumor, classified as a Grade 4 glioma. It is the most frequent malignant primary brain tumor in adults.

Treatment typically involves a combination of surgery (to safely remove as much of the tumor as possible), radiotherapy, and chemotherapy with temozolomide — a regimen established by the well-known Stupp protocol. While glioblastoma cannot currently be fully cured, treatment significantly extends survival and preserves quality of life. Ongoing research into immunotherapy, targeted molecular therapies, and tumor treating fields (TTF) provides hope for continued progress.

Dr Nor Faizal has specific expertise in the surgical management of glioblastoma and coordinates closely with radiation and medical oncology teams to deliver an integrated treatment approach.

Q: Can brain tumors cause epilepsy?

Yes. A first-time seizure in an adult — particularly in someone with no prior history of epilepsy — is one of the most common presentations of a brain tumor, especially low-grade gliomas. The tumor disrupts normal electrical activity in the surrounding brain tissue, triggering abnormal discharges. Not all brain tumors cause seizures, and not all new-onset adult epilepsy is caused by a brain tumor — but any new seizure in an adult requires urgent neuroimaging to rule out a structural cause.

2. About Surgery

Q: When is surgery recommended for a brain tumor?

The decision to operate depends on many factors: the type, size, and location of the tumor; the patient’s neurological function; the patient’s age and general health; and the likelihood of diagnosis based on imaging characteristics. Surgery is typically recommended when:

• The tumor is causing significant mass effect or neurological deficits
• A tissue diagnosis is required (biopsy)
• The tumor can be safely and significantly reduced to improve prognosis and facilitate further treatment
• The tumor is causing hydrocephalus (obstruction of cerebrospinal fluid flow)

Not every brain tumor requires immediate surgery. Some slow-growing tumors — particularly low-grade lesions found incidentally in asymptomatic patients — may initially be managed with active surveillance (waiting and monitoring with serial MRIs).

Q: What is an awake craniotomy, and why is it performed?

An awake craniotomy is a surgical technique where the patient is kept conscious and responsive during critical phases of tumor removal. It is used when a tumor is located near or within eloquent areas of the brain — areas responsible for speech, language, movement, or sensation — where accidental damage would result in significant neurological deficits.

During the procedure, the patient is asked to perform specific tasks (such as naming objects, counting, or moving limbs) while the surgeon simultaneously maps the functional boundaries of the brain and removes the tumor. If a surgical maneuver causes an interruption in the task, the surgeon adjusts accordingly, preserving function.

Awake craniotomy is demanding for both the patient and the surgical team. It requires thorough preoperative preparation, strong trust between the patient and surgeon, and an experienced anesthesia and nursing team. The result — a higher chance of preserving neurological function while maximizing tumor removal — is well-supported by evidence.

Q: What are the risks of brain surgery?

All surgery carries risks, and neurosurgery is no exception. Specific risks depend on the location and nature of the surgery, but general risks include bleeding, infection, neurological deficits (weakness, speech difficulties, sensory changes), stroke, seizures, blood clots, and complications from anesthesia.

Dr Nor Faizal discusses risks transparently with every patient before surgery. He believes that informed consent is not just a formality — it is a genuine process of shared decision-making. Understanding the risks, along with the expected benefits and the risks of not operating, is essential for every patient facing a neurosurgical procedure.

Q: How long is the recovery period from brain surgery?

Recovery varies depending on the surgery performed, the patient’s preoperative neurological status, and individual factors. Many patients undergoing elective craniotomy are mobile within one to two days after surgery and are discharged within three to seven days, subject to clinical progress. Full functional recovery — including returning to work — may take several weeks to months, especially if the surgery involved eloquent brain regions.

Dr Nor Faizal will discuss the expected recovery timeline in detail before any planned procedure and will provide clear guidance on what to expect at each stage of recovery.

Q: What is the difference between a biopsy and a craniotomy?

A biopsy involves taking a small sample of tumor tissue — either through a small hole (stereotactic biopsy) or during a larger surgical exposure — for pathological examination. It is performed when a tissue diagnosis is needed but complete removal is not the immediate goal.

A craniotomy involves the temporary removal of a section of the skull to access the brain and surgically remove (resect) the tumor. The extent of resection can range from partial (debulking) to complete (gross total resection), depending on the tumor’s location and its relationship to critical structures. A craniotomy may also include a biopsy if a complete resection cannot be achieved.

3. About Pain Management

Q: What is interventional pain management?

Interventional pain management refers to a range of minimally invasive procedures designed to diagnose and treat pain conditions that have not responded adequately to medications, physiotherapy, or other conservative measures. These procedures target specific pain pathways — nerves, joints, or spinal structures — to interrupt pain signals at their source.

Dr Nor Faizal’s pain practice leverages his neurosurgical expertise to offer procedures that go beyond the capabilities of general pain physicians. His interventional repertoire includes epidural steroid injections, nerve root blocks, facet joint injections, radiofrequency ablation, spinal cord stimulation, and intrathecal drug delivery systems.

Q: What conditions can be treated with interventional pain techniques?

Interventional pain techniques are effective for a wide range of chronic pain conditions, including:

• Chronic back and neck pain
• Radiculopathy (nerve root pain — sciatica, cervical radiculopathy)
• Failed back surgery syndrome
• Neuropathic pain
• Complex regional pain syndrome (CRPS)
• Cancer-related pain
• Trigeminal neuralgia
• Pain related to spinal stenosis
• Facet joint arthropathy

Not every patient is a candidate for every procedure. A thorough evaluation is required before recommending any interventional treatment.

Q: What is spinal cord stimulation?

Spinal Cord Stimulation (SCS) is a well-established interventional technique where a small device is implanted near the spinal cord to deliver mild electrical impulses that modify pain signals before they reach the brain. It is particularly effective for failed back surgery syndrome, neuropathic leg pain, and complex regional pain syndrome.

The procedure is typically performed in two stages: a trial phase to confirm effectiveness, followed by permanent implantation if the trial is successful. Advances in SCS technology — including high-frequency and burst stimulation — have significantly improved outcomes in recent years.

Q: Are interventional pain treatments a permanent solution?

The degree and duration of pain relief vary between patients and procedures. Some interventions, such as radiofrequency ablation, provide relief for months to years and can be repeated. Spinal cord stimulation often provides sustained long-term pain reduction. Other procedures, such as epidural steroid injections, provide targeted relief that may need to be repeated over time.

Interventional pain treatment is most effective when integrated into a broader pain management plan that may include medication optimization, physiotherapy, psychological support, and lifestyle modifications. The goal is to improve function and quality of life — not just temporarily suppress pain.

Q: Is there a difference between a neurosurgeon and a pain specialist?

Yes. Neurosurgeons are trained in the surgical management of conditions affecting the brain, spine, and peripheral nerves. Pain specialists may be anesthesiologists, physiatrists, neurologists, or other physicians with additional training in pain medicine and interventional procedures.

Dr Nor Faizal is unique in holding both qualifications: he is a board-certified neurosurgeon and a fellowship-trained interventional pain specialist. This dual expertise means he can evaluate patients with complex spinal and neurological pain conditions from both surgical and interventional perspectives — and recommend the right treatment approach for each individual.

4. About Appointments and Process

Q: Do I need a referral to see Dr Nor Faizal?

No, a referral letter is not mandatory. Self-referring patients are welcome. However, if you have seen a GP or another specialist, a referral letter containing your clinical history, investigations, and the referring doctor’s concerns is very helpful as it allows Dr Nor Faizal’s team to prepare for your consultation and review your records in advance.

Q: How long will I have to wait for an appointment?

Appointment availability varies. For routine consultations, appointments can usually be arranged within a few days to two weeks. For urgent clinical situations — such as a newly identified brain lesion on imaging or rapidly escalating neurological symptoms — please specify the urgency when contacting the clinic, and the team will make every effort to see you as soon as possible.

Q: What happens if I need emergency care outside of clinic hours?

If you experience a medical emergency outside of clinic hours, proceed immediately to the Emergency Department at KPJ Tawakkal Specialist Hospital or your nearest emergency facility, and call 999 if necessary. Do not wait for a clinic appointment in an emergency situation.

Q: Can Dr Nor Faizal provide a second opinion on my diagnosis or treatment plan?

Yes. Second opinion consultations are welcomed and treated with the same thoroughness as any new consultation. Please bring all available records, imaging CDs, pathology reports, and previous clinic letters. Dr Nor Faizal will review your case independently and provide his assessment. All information shared is treated with strict confidentiality.

Q: Are consultations available in English and Bahasa Melayu?

Yes. Dr Nor Faizal conducts consultations in both English and Bahasa Malaysia. Patients can communicate in the language they are most comfortable with.

5. After Treatment and Recovery

Q: How often will I need follow-up after brain tumor surgery?

Follow-up intervals after brain tumor surgery depend on the tumor type and grade, the treatment received, and the clinical course. Typically, postoperative MRI imaging is performed within 24 to 72 hours of surgery to assess the extent of resection, followed by further imaging at regular intervals (usually every three to six months) to monitor for tumor recurrence or progression.

Patients undergoing concurrent radiotherapy and chemotherapy will be followed up jointly by the neurosurgery, radiation oncology, and medical oncology teams. Dr Nor Faizal will outline a specific follow-up plan for your case during discharge and review appointments.

Q: What symptoms after surgery require me to seek immediate review?

Following neurosurgery, please seek an immediate review — go to the Emergency Department or contact the clinic urgently — if you experience:

• A new or significantly worsening headache
• Fever (temperature above 38°C)
• Redness, swelling, or discharge from the surgical wound
• New-onset seizures, or a change in seizure frequency
• New weakness, numbness, or difficulty speaking
• Confusion or changes in consciousness
• Uncontrollable nausea and vomiting
• Changes in vision

If in doubt, contact the clinic or proceed to the Emergency Department. It is always better to be evaluated and reassured than to delay the assessment of a potentially serious complication.

Q: Can I drive after brain surgery?

This depends on your clinical situation. In Malaysia, patients who have undergone brain surgery or who have been diagnosed with epilepsy or seizure disorders are required to follow fitness-to-drive guidelines. Generally, you should not drive until you have been formally cleared to do so by your neurosurgeon, and until any mandatory seizure-free periods (if applicable) have been met. Dr Nor Faizal will provide specific advice on driving during your postoperative consultations.

Q: Can I return to work after brain surgery?

Returning to work depends on the nature of your job, the type of surgery performed, and your rate of recovery. Many patients with office-based or sedentary jobs can return to work within four to eight weeks after an elective craniotomy. Those in physically demanding or safety-critical roles may require a longer recovery period and formal occupational assessment. Dr Nor Faizal will discuss return-to-work expectations as part of your recovery planning.

Q: Where can I find support during treatment?

Receiving a brain tumor diagnosis — or undergoing any serious neurosurgical treatment — is emotionally and psychologically demanding for both patients and their families. Dr Nor Faizal encourages patients to seek support through:

• Hospital social work and counseling services at KPJ Tawakkal
• National patient support groups for brain tumor and cancer patients in Malaysia
• Palliative care services, if symptom management and quality-of-life support are priorities
• Peer support — connecting with others who have lived experience with a similar diagnosis

You do not have to face this alone, and asking for help is a sign of strength, not weakness.

Book an Appointment | Contact Clinic | Symptom Checklist