Brain tumor surgery is most often needed when the lesion is causing symptoms. It is a complex medical procedure.
Doctors try to remove the tumor as completely as possible without damaging surrounding brain tissue. They also may take a sample of the tissue for analysis to determine your tumor type and grade.
The most common type of brain tumor surgery is a craniotomy. This is an operation in which a piece of bone is removed from the skull to allow access to the brain. It is used to treat conditions such as brain tumors, blood clots and brain injury. It can also be used to implant devices such as deep brain stimulation for Parkinson’s disease or epilepsy. Craniotomies can be performed using a general anesthetic or local anesthesia.
Before a craniotomy is carried out, the neurosurgeon will perform imaging of the brain to determine the best way to operate. This will usually include a CT scan and an MRI scan. This will provide information on the size and location of the tumor and will also help to plan the operation.
The surgeon will make an incision in the scalp and remove a window of bone (the bone is then secured back into place at the end of the procedure). This is known as a craniectomy. Once the opening is made, the surgeon can access the brain to operate on the lesion or bleed.
In some cases a biopsy will be taken before the craniotomy is completed. This can be done via a closed biopsy or an open biopsy. Closed biopsies are performed through a small hole in the skull (known as a burr hole) and involve taking samples from inside the tumor through a needle. This is usually done under a general anesthetic.
An open biopsy involves performing a craniotomy to obtain samples of the brain or tumor from outside the skull. An open biopsy can be done under a general anesthetic or a local anesthetic. In some situations it may be necessary to perform a craniotomy and a biopsy simultaneously, for example when a patient has multiple tumors.
During the operation, the neurosurgeon will use a computer to guide the surgery (stereotaxy). This uses the contours of the skull and brain to serve as points of reference that can be seen on the operating images. This allows the surgeon to reach difficult areas of the brain with a higher degree of accuracy. It can also reduce the amount of damage that is caused to the surrounding brain tissue by reducing the force applied to the brain during surgery.
During surgery, doctors can confirm the diagnosis of your tumor and remove as much of it as possible without damaging healthy tissue. They can also use the operation to reduce symptoms, such as pain or seizures, by relieving pressure on parts of your brain or removing a damaged area. Surgery can also be used to biopsy your tumor for further examination and to determine if it’s cancerous or benign.
Some surgeries may require your surgeon to make an incision (cut) in the skull or brain, but many are minimally invasive. Depending on the procedure, you may need general anesthesia or sedation. Before surgery, your doctor will review your medical history and perform tests to see if you are fit for the operation. You might have to stop or start taking certain medications before your operation, such as steroids to lower the risk of swelling and anti-epileptic medication to help control seizures.
Your doctor will insert a thin tubing that transmits video images into the brain through a small opening in your head or neck, called an endoscope. This enables your neurosurgeon to see the problem areas in your brain clearly and guide other surgical tools into place.
With this type of surgery, your recovery time is shorter and you spend less time in the hospital. Usually, you can go home on the same day or in as few as four to eight hours after the procedure.
Most brain tumors aren’t cancerous, but if they are, your neurosurgeon might use this surgery to separate the tumor from surrounding brain tissue and remove it. If the tumor can’t be separated or is in a very important part of your brain, your doctor might simply take out the largest part of the tumor that they can safely remove.
If your surgery is complex, you may benefit from treatment at a high-volume institution, which conducts a lot of similar operations. Studies have shown that patients with brain tumors and other complex surgeries have better outcomes at these institutions than at lower-volume hospitals. This is thought to be due to the experience of the surgeons and other members of your care team.
In a healthy person, cerebrospinal fluid (CSF) circulates throughout the brain and spine, acting as a cushion to protect against damage. But tumors can block CSF flow, creating excess pressure within the skull (called hydrocephalus). During a ventriculoperitoneal shunting procedure, your surgeon uses a shunt to drain excess CSF and alleviate pressure in your head.
Your doctor may perform this surgery under general anesthesia. They will make a small hole in your skull and then guide one end of a plastic tube, called a catheter, into a ventricle inside your brain. The shunt valve is attached to this tube. The other end of the tube goes under your skin and out of the ventricle. It then reaches your chest or belly area, where the body can reabsorb it.
The catheter may be programmable or non-programmable, although both types have shown equal clinical efficacy in studies. You can ask your doctor which one is best for you. Most of the time, a non-programmable shunt will work just fine. Occasionally, the catheter can develop a problem that requires a shunt revision. This might be due to a blockage or other complications, such as pseudocyst recurrence (which can be prevented by ensuring that the shunt is in a retro-hepatic position).
After surgery, you will receive instructions on how to manage your shunt. You should contact your neurosurgeon if you experience symptoms that suggest a shunt issue, such as low-grade fever, soreness of the neck or shoulder muscles and redness or tenderness along the shunt pathway. Your doctor can also inject fluid into the system to test shunt function and can use the shunt reservoir to measure pressure.
It’s important to follow your doctor’s shunt maintenance schedule. You should only pump the shunt reservoir if explicitly instructed to do so by your doctor. A shunt can become infected, so it’s important to get it checked and treated right away. The shunt can also wear out over time, moving or getting blocked. If the shunt gets infected, you may experience headaches, nausea, vomiting and seizures. You should always contact your doctor immediately if you experience these symptoms.
If the tumor is too small to remove surgically, your doctor may recommend radiation. This can kill cancer cells and reduce symptoms such as swelling or pressure on the brain. It can also help prevent the tumor from recurring or spreading to other parts of the body.
Radiation therapy involves using high doses of focused radiation to destroy your tumor or shrink it. It can be done as one treatment or in fewer treatments, and you won’t need to stay in the hospital. Your healthcare provider will use imaging to target the area of your tumor. It’s important to remain very still during the treatment, so your healthcare provider can get accurate images. You’ll wear a head frame or individual body molds to limit movement. The radiation machine may make sounds like clicking, knocking and whirring.
Before surgery, your healthcare team will do a physical examination and blood tests to check that you’re healthy enough for anesthesia and surgery. They’ll also order other tests, such as computed tomography (CT or CAT scan), magnetic resonance imaging (MRI) and positron emission tomography (PET).
After you have surgery, they might suggest a procedure to drain excess fluid from your skull. This can relieve increased intracranial pressure caused by the tumor or other conditions, such as brain hemorrhages, skull fractures and pituitary tumors. The procedure uses a narrow piece of flexible tubing called a shunt. It’s inserted into a ventricle in the brain and then to another body cavity, such as the right atrium of your heart or the abdomen.
Your healthcare provider might recommend a biopsy to find out if your brain tumor is cancerous. They might perform a needle biopsy to get tissue from the tumor and compare it to a sample of normal brain. They might also take a sample of spinal fluid with a needle to look for signs of a brain tumor.
Other procedures used to diagnose or treat brain tumors include angiography, stereotactic radiosurgery and chemotherapy. An angiogram uses a dye to highlight blood vessels in your brain. Your surgeon might also use ultrasound imaging during surgery. This works by sending sound waves into the brain, which reflect off of your tissues. It shows the position and size of your tumor, as well as other structures in your brain.