Whenever someone in the family is diagnosed with a 'Brain Tumor', it causes a lot of apprehension in the family. Surgery is usually the first step in treating most benign and many malignant tumours. It is often the preferred treatment when a tumour can be removed without unnecessary risk of neurological damage.

Surgery might be recommended to: 

  • Remove as much tumour as possible
  • Provide a tumour tissue sample for an accurate diagnosis and for genomic testing
  • Remove at least part of the tumor to relieve pressure inside the skull (intracranial pressure), 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 difficult to control with medications“Radiosurgery” is a type of intense radiation delivered to a tumor. It may be used instead of, or in addition to, conventional surgery. Radiosurgery is not surgery in the conventional sense, as no opening is made in the skull. In certain cases, it may offer similar benefit and lower risk or discomfort than conventional surgery.

Before surgery your doctor will consider the following: 

  • Location of the tumor: Where the tumor is located will determine whether it is operable or inoperable.
  • Diagnosis and size of tumor: If a tumor is benign, does not cause intracranial pressure (due to its small size) or cause problems with sensitive areas, avoiding or postponing surgery might be considered.
  • A number of tumors: The presence of multiple tumors creates additional challenges to safe removal.
  • The borders, or edges, of the tumor: If the tumor is poorly defined around the edges, it may be mixed with normal brain tissue and more difficult to remove completely.
  • Your general health: Are your heart, lungs, liver and overall general health strong enough to endure the strains of surgery? If this is a metastatic brain tumor (one which began as cancer elsewhere in your body), is primary cancer controlled?
  • Your neurological status: Do you have symptoms of increased intracranial pressure? Are there signs of nerve damage possibly caused by the tumor? If so, further evaluation may be needed before surgery is attempted.
  • Previous surgery: If you’ve had recent surgery, it is usually necessary to recover from the previous procedure before going through another one.
  • Other options: Is it likely that another treatment would provide equal or better results at comparable or lower risk? Your doctor will take these points into consideration in forming your treatment plan.

What is an "Operable Tumor?"

An operable tumor is typically one that your doctor believes can be surgically removed with minimal risk of brain damage.

What is an Inoperable Tumor?"

In some cases, surgery may not be possible because the tumor is so deep within the brain that it is not accessible without excessive risk of brain damage. Tumors located in the brain stem and thalamus are two examples. Other tumors may present a problem is located near a sensitive area of the brain that controls language, movement, vision or other important functions. However, with advances in technology, the so-called "Inoperable Tumors" can also not be safely resected with minimal damage to the surrounding brain. Highly sensitive scans are used for this purpose and may include: 

  • Computerized Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Magnetic Resonance Spectroscopy (MRS)
  • Positron Emission Tomography (PET)
  • Diffusion Tensor Imaging MRI’s may be used to generate maps of the nerve pathways called “fibre tracking.” Use of fibre tracking may help the surgeon avoid disrupting important nerve connections within the brain itself. Vital areas can also be defined by a procedure called brain mapping. At the beginning of the surgery, tiny electrodes are placed on the outer layer of the brain. Stimulating these electrodes helps the neurosurgeon determine the functions of those sensitive parts of the brain so they can be avoided during surgery.

What type of surgery might be recommended?

Craniotomy: A craniotomy is the most common type of surgery to remove a brain tumor. “Crani” means skull and “otomy” means cutting into. The procedure typically involves shaving a portion of the head, making an incision in the scalp, then using specialized medical tools to remove a portion of the skull. This enables the neurosurgeon to find the tumor and remove as much as possible. After the tumor is removed, the portion of the skull that was cut out is replaced, and the scalp is stitched closed. Remember, all of this is done with drugs that relax you or put you to sleep. They also numb the scalp and other tissues. The brain itself does Sample of a head frame used during stereotactic biopsy Electra, LSS frame not “feel” pain, so brain surgery can be done with you awake if the surgeon believes it is necessary to minimize the risk of the procedure.

Craniectomy: A craniectomy is similar to a craniotomy in all ways except one. While “otomy” means cutting into, “ectomy” means removal. In a craniectomy, the bone removed for access to the brain is not replaced before closing the incision. The neurosurgeon may perform a craniectomy if he or she expects swelling to occur following surgery, or if the skull bone is not reusable. When the bone is reusable it can be replaced at a later date when it will not cause additional pressure. The skull piece is stored by the medical facility until a time when it might be reused. If a craniectomy is done, you will receive instructions from your health care team for protecting the soft spot created by the missing bone.

Stereotactic biopsy: The same procedure as a needle biopsy but performed with a computer-assisted guidance system that aids in the location and diagnosis of the tumor.

Transsphenoidal surgery: Transsphenoidal surgery is an approach often used with pituitary adenomas and craniopharyngiomas. The term “trans” means through and “sphenoid” refers to the sphenoid bone located under the eyes and over the nose. The entry point for the neurosurgeon is through an incision made under the upper lip and over the teeth or directly through the nostril.

Embolization: If a tumour has a large number of blood vessels, surgery can be difficult due to the bleeding that could result. Embolization is a technique neurosurgeons use to stop the blood flow to the tumor prior to removing it. A diagnostic test, called an angiogram, is performed to determine if a significant amount of blood is going to the tumor. If so, the neurosurgeon or neuroradiologist can insert a small “plug” made of wire or glue-like material into the vessel. This stops the blood flow to the tumor, but not to normal parts of the brain. Tumor removal usually follows within a few days. This technique might also be used with tumors that contain a high number of blood vessels – referred to as “vascular” or “well-vascularized” tumors. Meningiomas, meningeal hemangiopericytomas and glomus jugulare tumors are typically well-vascularized tumors.

What are the common risks of the brain tumour surgery?

Brain tumour surgery poses both general and specific risks. The general risks apply to anyone going through surgery for any reason and are not limited to brain tumour surgery. These include:

  • Infection
  • Bleeding
  • Blood clot formation (hematoma)
  • Blood pressure instability
  • Seizures
  • Weakness
  • Balance/coordination difficulties
  • Memory or cognitive problems
  • Spinal fluid leakage
  • Meningitis (infection causing inflammation of membranes covering the brain and spinal cord)
  • Brain swelling
  • Stroke
  • Hydrocephalus (excessive fluid in the brain)
  • Coma
  • Death 

Risks specific to brain tumor surgery depend greatly on the particular location of the tumor. Particular areas of the brain control functions such as vision, hearing, smell, movement of the arms and legs, coordination, memory, language skills, and other vital functions. The process of operating on the brain always includes some risk that nerves or blood vessels serving these areas will be damaged. This could result in partial or complete loss of sensation, vision, movement, hearing or other functions. When a tumor is located deep within the brain it increases the risk and range of possible complications. 

How long will it take for me to recover from surgery? 

Any type of surgery is a trauma to your body. Some people will recover faster than others. While there is no “normal” recovery period that applies to all people, your recovery time will depend on:

  • The procedure used to remove your brain tumor
  • The part of your brain where the tumor was located
  • The areas of your brain affected by the surgery
  • Your age and overall general healthAsk your neurosurgeon what you can expect as a reasonable recovery time. This will help you set realistic goals for yourself in the weeks following surgery