This page discusses the use of surgery for the treatment of brain tumors. For a thorough review of surgical procedures for cancer treatment, please see the surgery treatment monograph .

If you are healthy enough to tolerate it and the tumor is located in an area amenable to surgery, an operation is the first option to be considered for the treatment of a brain tumor. Surgery and other invasive procedures work by removing cancerous tissues. The hope is always that the entire tumor can be removed and thereby cured. But even if complete removal is not possible, reducing the size of the tumor will improve symptoms.

Surgical options include the following procedures:

Craniotomy

Craniotomy means "cutting into the head." All conventional brain surgery begins this way. The opening will be as close to the tumor as possible. Some tumors are best approached through the nose or the top of the neck. Most approaches go through the scalp and the skull to expose the upper part of the brain (the cortex).

Description of the Procedure

The skin, usually the scalp, is shaved and an incision is made. Then a circular piece of the skull bone is removed to expose the brain. Once the brain is exposed, the surgeon may do some mapping to identify functional areas of the brain. The tumor will be exposed, isolated from normal brain tissue, and removed. The surgery may take many hours. Techniques described under stereotactic surgery , such as ultrasound aspiration and lasers, may also be used during open craniotomy.

Biopsy

At some point your doctors will want a piece of the tumor to examine under a microscope. It may be obtained at surgery, or it may be needed earlier. If earlier, you will undergo a separate procedure, called a biopsy, to obtain it.

In the operating room, a needle will be inserted into the skull. The surgeon may use x-rays or computerized scanners to guide the needle. The needle is able to take a tiny core out of the tumor for microscopic analysis. Because a needle cannot be inserted through the bone, in order to have a brain biopsy, you still must have a limited craniotomy.

Shunts

Pressure inside the skull is a critical factor, since the brain is very sensitive to pressure changes. Rapidly increasing pressure impairs brain function. If the tumor causes such a pressure change, it can be treated with a relatively simple procedure known as a shunt. In a manner similar to taking a biopsy, a small hole is made in the skull. Through this hole, a tube is inserted into one of the fluid-filled spaces inside the brain. The other end of the tube is passed under the skin from the head to the trunk where it drains fluid into the heart or abdomen. A one-way valve in the tube prevents back flow into the brain. This draining of fluid helps to decrease the pressure in the brain.

Microsurgery

Microsurgery is the use of an operating microscope during surgery. The magnification provided by the microscope greatly increases the precision with which an operation can be performed.

Endoscopy

Tiny fiberoptic tubes with lighted tips can be inserted through small holes in the skull, just as they are into joints and other body cavities. Structures not visible with direct or magnified vision can be seen and manipulated through these "scopes."

Mapping

The surgeon may need to know precisely what function is performed by parts of the brain near the surgical site. This is determined by mapping. There are several ways to "map" your brain. Some are used during surgery; others do not require opening the head:

  • Stimulating brain tissue with tiny electrical currents
  • Measuring brain waves as they are stimulated
  • Using ultrasound probes inside or near brain structures
  • Probing the brain with special computerized "wands”
  • Using special MRI techniques, such as PET (positron emission tomography) or SPECT (single photon emission computed tomography)
    • PET – a test that assesses metabolic activity in the tissue. You are given a radioactive substance. This may be done through an injection, or in some cases, you will be asked to breathe in a gas with the substance. The compound travels through the blood to the area of the body under study. It takes between 30 and 90 minutes for the substance to be absorbed by the tissue under study. You lie on a table and are moved into a machine that looks like a large, square-shaped doughnut. This machine detects and records the energy levels emitted from the substance that was injected earlier. The images are viewed on a nearby computer monitor.
    • SPECT – a test that produces pictures that show where your blood flows through your brain. You are given a radioactive substance through an IV in your arm. A few hours later, a scan is done. During the scan, you will lie on your back on a special table; you will need to remain very still. A gamma camera takes pictures over the next 30 minutes. From the pictures, the doctors can assess blood flow through your brain.

Stereotactic Surgery

When tumors are precisely located, several treatment methods can be directed exactly at the tumors so that little or no nearby normal tissue is damaged.

  • External radiation can be aimed at the tumor and focused very precisely.
  • Thermal destruction instruments such as lasers can be directed to the exact spot to destroy tumor tissue.
  • Ultrasonic aspiration breaks up tumor tissue and sucks it out of the brain. Some tumors are most efficiently removed this way with less damage to normal brain tissue.
  • Internal sources of radiation (seeds) or drugs can be exactly positioned for the greatest effect.

Embolization

The blood supply to tumors can be identified by angiography. This blood supply can then be shut off by inserting a variety of plugs (emboli) to block the artery from the inside.

Possible Complications

The complications common to all surgery apply to brain surgery—bleeding, infection, and unexpected reactions to drugs and anesthetic agents. Because the brain is such a vital organ, neurosurgeons exercise phenomenal diligence in preventing complications.

Whatever type of brain surgery you have, complications unique to the brain may also occur:

  • Convulsions (seizures) occur whenever the brain is irritated. After surgery, either the healing process, an infection, bleeding, residual tumor, or scar tissue can cause irritation. It may be necessary to take anti-convulsant medications .
  • Stroke can occur as a complication of brain surgery. It may be an inevitable result of the amount of brain tissue that had to be removed, or it may indicate damage to a blood vessel supplying a part of the brain.
  • Brain swelling may occur during or following brain surgery. It is important to watch for this very closely since it can be lethal. Prompt treatment is effective.

Post-Operative Care

After brain surgery you will remain in the hospital longer than for most other procedures due to both the importance and the fragility of the brain. Your surgeon will watch you closely until all risk of infection, convulsions, or brain swelling has passed.

After discharge from the hospital you may be referred to rehabilitation if the tumor or the surgery has left you with a neurologic deficit. Possible rehabilitation includes speech therapy, occupational therapy, or physical therapy.

If your surgeon suspects that some of your tumor was not completely removed, you will have to be evaluated regularly for signs of recurrence.

For a thorough review of surgical procedures for cancer treatment, please see the surgery treatment monograph