Surgery for brain cancer

Surgery in the central and peripheral nervous system is called neurosurgery (surgery for brain tumours). In many cases, removing all or part of the tumour may allow you to fully recover and return to leading an active life. However, you may also have other treatments, including radiotherapy and chemotherapy.

You can have surgery:

  • to remove the tumour (gross total resection)
  • to remove part of the tumour (partial resection or debulking). This may be recommended if the tumour is widespread, near major blood vessels, or cannot be removed without damaging other important parts of the brain or spinal cord. A partial resection may improve your symptoms by reducing the pressure on your brain.

Sometimes a tumour cannot be removed because it is too close to certain parts of the brain and would cause serious problems. This is called an inoperable or unresectable tumour. Your doctor will talk to you about other ways to try to ease the symptoms.

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Preparing for surgery

The types of scans used for diagnosing the tumour (e.g. CT, MRI or MRS scans) are often repeated when planning surgery to precisely pinpoint the location of the tumour.

If a stereotactic surgery is planned, these scans will be be imported into a computer and be used to guide the surgeon during the operation. You may also have what is called a ‘functional MRI scan’ to help the doctors work out which areas of your brain control speech and movement.

Identifying the brain’s sensitive areas can help the surgeon avoid causing damage during the operation. Brain mapping is used 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. The night before or on the day of surgery you may be sent for a stereotactic CT or MRI scan. Stereotactic surgery may require the surgeon to use small markers called fiducial markers.


Surgery for a brain tumour

The surgeon will remove as much of the tumour as possible without damaging healthy parts of your brain. Surgery may be done as open surgery (a relatively large opening made in the skull) or a stereotactic surgery.

Biopsy

A small sample of tumour is removed using a needle and examined under a microscope. A biopsy can also be done at the same time as a craniotomy.

Craniotomy

The most common type of brain tumour operation.

You are given a general anaesthetic, some hair is shaved off. The surgeon cuts through the scalp and moves it aside, then removes a piece of skull above the tumour.

After the tumour is taken out, the bone and scalp are put back. The surgeon uses small plates and screws to hold the piece of skull in place.

Patients with a high grade glioma may be given a solution of Gliolan® (5-ALA) prior to surgery. This makes the tumour glow red under ultraviolet light. It ensures the surgeon is able to remove as much of the tumour as possible, while avoiding normal brain matter.

     – Debbie

 

Awake craniotomy

This operation is used 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. This is not painful because 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, so they can identify and avoid certain parts of the brain. An electrode is also used to stimulate and identify the important areas of the brain.

Endoscopic transphenoidal surgery

A rarer type of surgery used for tumours near the base of the brain (e.g. a pituitary gland tumour).

The surgeon puts a long tube (endoscope) into the nose, then removes all or part of the tumour through the nostrils. 

Recovery may be faster than a craniotomy.

An Ear, Nose and Throat surgeon (ENT) may assist with this type of surgery.

Craniectomy

This is similar to a craniotomy, except the piece of skull removed is not replaced.

Bone (or a piece of plastic or mesh) may be replaced in the future when it won’t cause extra pressure.

This procedure is very uncommon.

Stereotactic surgery

This is when surgery is done using a computer to guide the surgeon.

The computer creates 3D images of the brain and tumour and monitors the surgical instruments during the operation, allowing the surgeon to operate precisely.

Stereotactic surgery may require the surgeon to use small markers called fiducial markers. These are taped or glued to the scalp before a scan. Less commonly, a lightweight frame is screwed to the scalp. The scan shows the
brain and tumour in relation to the markers or frame.

Stereotactic surgery is safer, more accurate and requires a smaller cut in the skull than non-computer guided surgery.


Surgery for a spinal cord tumour

The most common surgery to access a spinal cord tumour 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.


After your brain or spinal cord operation

  • Neurological observations – For the first 12–24 hours after the operation, you will be closely monitored. Nurses will regularly check your breathing, pulse, blood pressure, temperature, pupil size, arm and leg strength and function, and you will be asked questions to assess your level of consciousness. These neurological observations show how your brain and body are recovering from surgery.
  • Build-up of fluid in the brain (hydrocephalus) – Some people develop hydrocephalus. The surgeon may place a long, thin, permanent or temporary tube called a shunt from your brain into your abdomen to drain the extra fluid. The fluid can then be safely absorbed into the bloodstream. A small valve is inserted just under the scalp to make sure the fluid flows away from the brain.
  • Pressure stockings – You may 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 develop difficulty breathing.
  • Wound management – If you are recovering from a craniotomy, your head will be bandaged. Your face and eyes may be swollen or bruised, but this is not usually painful and should ease within about a week.
  • Headache or nausea – These may occur after the operation. Both can be treated with medicines.
  • Getting up – 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. Your doctor will tell you when you can start regular activities again.
  • Length of stay – How long you stay in hospital will depend on whether you have any problems or side effects following surgery. You may require a period of rehabilitation before you can return home.

Video: Surgery for brain cancer

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


This information was last reviewed in May 2016
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