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BRAIN SURGERY

Surgery usually is the first step in treating most benign and many malignant tumors. Although a second opinion is not always necessary, many patients seek one before proceeding with surgery.

Description

Surgery is the initial treatment for most benign and many malignant tumors. It is often the preferred treatment when a tumor can be removed without any unnecessary risk of neurological damage.

Purpose

Surgery may be recommended to:

• Provide a tumor sample to establish an accurate diagnosis.
• Remove as much tumor as possible, either to relieve symptoms caused by the tumor itself or to reduce the amount of tumor to be treated with radiation or chemotherapy.
• Enable direct access for chemotherapy, radiation implants, or genetic treatment of malignant tumors.
• Relieve seizures (due to a brain tumor) that are hard to control.

Types

The most common types of surgery for brain tumors are listed below. It is important to note that all of these procedures are performed on patients who are either asleep or heavily sedated. In addition, the brain does not “feel” pain, and all of the surrounding tissues (eg, the scalp) are numbed prior to surgery.

• Biopsy: The surgical removal of a sample of tumor tissue.
• Craniotomy: The surgical removal of a portion of the skull. Doing so allows the neurosurgeon to find the tumor and remove as much of it as possible. The piece of skull that was removed is replaced following surgery.
• Craniectomy: Very similar to a craniotomy. The main difference is that, in this procedure, the portion of the skull that was removed to allow access to the brain is not replaced.
• Debulking: The surgical reduction of the size of the tumor.
• Partial Removal: The surgical removal of only part of the tumor (due to risk of neurological damage).
• Complete Removal: The surgical removal of the entire tumor. The surgeon often can tell if regrowth is likely based on the type of tumor.
• Shunt: The insertion of a drainage system designed to move excess fluid from the brain to another part of the body.
• Ommaya Reservoir: The insertion of a small container under the scalp which is attached to a tube. This container can be used to:
         - Deliver chemotherapy treatment to the brain and the surrounding cerebrospinal fluid (CSF).
         - Remove CSF to detect the presence of normal cells.
         - Remove cystic fluid without the need for surgery. 
• Skull Base Surgery: Refers both to the location of a tumor as well as a specialized technique used to remove a tumor in that area.
• Transphenoidal Surgery: An approach often used to operate on pituitary adenomas and craniopharyngiomas. 
• Laser Interstitial Thermal Therapy (LITT):  Laser Interstitial Thermal Therapy (LITT) is a minimally invasive means of ablating (cooking) tissue with heat.  Evidence to date supports that LITT is an effective and safe technique of ablating not only deep and poorly accessible tumors by conventional surgical  techniques, but also can be considered as a minimally invasive option for new or recurrent primary and metastatic tumors nearly anywhere in the brain, as well as metastasis that have failed stereotactic radiosurgery either due to tumor progression or development of focal radiation necrosis. LITT is usually performed under a general anesthetic through small (typically 1/4 inch) twist drill holes through the skull using real-time magnetic resonance thermal monitoring with software that can predict ablative as well as safe zones for critical structures. One system allows remote control of probe depth and rotation with the option of a side-firing laser probe, in addition to the common spherical or diffuse pattern of laser energy distribution. 

Potential RisksGeneral risks for anyone going through surgery for any reason include:

• Infection
• Bleeding
• Blood clots
• Pneumonia
• Blood pressure instability

Specific risks associated with brain tumor surgery include:

• Seizures
• Weakness
• Balance/coordination difficulties
• Memory or cognitive problems
• Spinal fluid leakage
• Meningitis
• Brain swelling
• Stroke
• Excess fluid in the brain
• Coma
• Death

Recovery Time

Recovery time depends on:

• The procedure performed.
• The part of the brain where the tumor is/was located.
• The areas of the brain affected by surgery.
• The patient’s age and overall health. 

It is important to note that the information provided here is basic and does not take the place of professional advice. If you have any questions about how brain tumors are treated, please contact your doctor.