Surgery for brain cancer

The types of scans used for diagnosing the tumour (e.g. CT, MRI or MRS scans) are often done again when planning surgery.

The surgeon needs to locate the most important areas of the brain to make sure these are not damaged during the operation. A special MRI scan called a functional MRI (fMRI) shows the exact areas of the brain that are used as you speak or move. Brain mapping is another way to find these parts of the brain. A tiny electrode is placed on the outside layer of the brain during the surgery and stimulated with a low dose of electrical current.

Before surgery, talk to your doctor about any medicines you are taking. Some medicines interfere with the anaesthetic used during the operation, so you may need to stop taking them for a while. You may also be advised to stop smoking before surgery.

Different types of operations may be used for brain and spinal cord tumours. You may already have had a biopsy to remove a sample of tissue or the biopsy may be done at the same time as the surgery to remove the brain tumour.

Craniotomy to remove a brain tumour – This is the most common type of brain tumour operation. A craniotomy removes all or part of the tumour (total or partial resection) and is done under a general anaesthetic. The surgeon removes part of the skull to access the brain. The tumour is then taken out, and the bone and scalp are put back. The surgeon uses small plates and screws to permanently hold the piece of skull in place.

Patients with a high-grade glioma may be given a solution to drink before surgery that makes the tumour glow under ultraviolet light. This may help the surgeon remove as much of the tumour as possible, while avoiding normal brain tissue.

Computer guidance

It is now usual for craniotomies to be done using a computer navigation system to guide the surgeon.

The computer uses the results of planning scans to create three-dimensional images of the brain and tumour. During the operation, the computer then monitors the surgical instruments, allowing the surgeon to be very precise.

Surgery that uses computer navigation is known as stereotactic surgery. It is safer, more accurate and requires a smaller cut in the skull than non-computer guided surgery.

Awake craniotomy – This operation may be recommended if the tumour is near parts of the brain that control speech or movement. All or part of this operation is done with the patient awake (conscious) but relaxed, so they can speak, move and respond. You may be worried that an awake craniotomy will hurt, but the brain itself does not feel pain and local anaesthetic is used to numb surrounding tissues. During the surgery, the surgeon asks the patient to speak or move parts of the body. This helps the surgeon identify and avoid certain parts of the brain. An electrode is also used to stimulate and pinpoint important areas of the brain.

Endoscopic transsphenoidal surgery – This surgery is used for tumours near the base of the brain (e.g. pituitary gland tumours). To remove the tumour, the surgeon inserts a long, thin tube with a light and camera (endoscope) through the nose and into the skull at the base of the brain. An ear, nose and throat (ENT) surgeon may assist with this type of surgery.

Laminectomy – The most common surgery for spinal cord tumours is called a laminectomy. In this procedure, the surgeon makes an opening through the skin, muscle and a vertebra in the spinal column to remove the tumour that is affecting the spinal cord. You will be given a general anaesthetic for this operation.

For more information on surgery, call Cancer Council 13 11 20 or see Surgery.

You will be closely monitored for the first 12–24 hours after the operation. The length of your hospital stay will depend on whether you have any problems or side effects following surgery. Your doctor will tell you when you can start regular activities again.

Neurological observations

For the first day or two, nurses will regularly check your breathing, pulse, blood pressure, temperature, pupil size, and arm and leg strength and function. You will also be asked questions to assess your level of consciousness. These neurological observations check how your brain and body are recovering from surgery.

Spinal cord checks

If you have had an operation on your spinal cord, the nurses will regularly check the movement and sensation in your arms and legs. You may need to lie flat in bed for 2–5 days to allow the wound to heal. A physiotherapist will help you learn how to roll over and how to get out of bed safely so the wound is not damaged.

Pressure stockings

You will need to wear pressure stockings on your legs to prevent blood clots from forming while you are recovering from surgery. Tell your doctor or nurse if you have pain or swelling in your legs or suddenly have difficulty breathing.

Headaches and nausea

You may have a headache or nausea after the operation. Both can be treated with medicines.

Shunting

Some people have a build-up of cerebrospinal fluid in their brain. This is called hydrocephalus and it may occur before surgery as a result of the tumour, but can also happen after surgery. The surgeon may place a long, thin tube called a shunt into your brain to drain out extra fluid. A temporary shunt drains into a bag on the outside of the body. A permanent shunt is completely inside your body. It drains into your abdomen and the fluid is then safely absorbed into the bloodstream.

Bandages and bruising

The dressing on your head may vary from a simple bandaid to bandaging that covers your whole head. Some or all of your head may have been shaved. After surgery to certain parts of the head, your face and eyes may be swollen or bruised − this is normal. It is not usually painful and should ease within about a week.

Rehabilitation

The surgery may cause a range of short-term or longer-term side effects. Before you can return home, you may require further treatment known as rehabilitation. This may be offered in the same hospital or in a rehabilitation facility.

Surgery to remove a brain tumour can cause swelling that leads to pressure inside the skull (intracranial pressure). Your medical team will monitor this and try to reduce it, but you may still experience side effects such as confusion, speech problems, dizziness, weakness and seizures. You and your family or carers may worry that you aren’t recovering well, but the side effects often improve over time. Your doctor will explain that such side effects are normal and give you an idea of how long they will last.

In some cases, people recover fully and can gradually return to their usual activities. In other cases, the tumour position may mean that there are longer-term changes to how you speak, move and think.

A range of therapies can speed up recovery or help you learn to manage any changes. These therapies are known as rehabilitation.

At first, you may have some rehabilitation therapies in the hospital or in a rehabilitation facility. Once you return home, you can continue to access these therapies as an outpatient. See Rehabilitation for more information.

     Ian

Find out more about the surgery options for brain cancer, including craniotomy, awake craniotomy, and endoscopic surgery.