If you are healthy enough to tolerate it, surgery is the first option to be considered when approaching the treatment of
. The goals of surgery depend on what type of tumor is suspected based on the history, clinical findings, and images. The hope is always that the entire tumor can be removed, although some tumor will remain after surgery with most tumor types. If only a small amount of tumor can be safely removed, most surgeons prefer to take a
only to identify the tumor type. Then, non-operative therapies such as
Surgical procedures include: CraniotomyBiopsyShuntsMicrosurgeryMappingEmbolization
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, which is called the cortex.
Description of the Procedure:
The skin, usually the scalp, is shaved and an incision is made. Then a piece of the skull is removed to expose the brain. In some cases, after 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, and removed. The surgery may take many hours.
A biopsy is a sampling of tissue. The doctor examines the biopsy to make a diagnosis. Biopsy tissue can be obtained via a craniotomy, or it can be obtained through a smaller surgery called a stereotactic biopsy. The surgeon drills a small hole through the skull. Then, images are used to guide a needle into the brain and tumor. A sample of tissue is removed. The decision of whether to proceed with a biopsy or a larger craniotomy will be made by your surgical team.
Pressure inside the skull is a critical factor, since the brain is very sensitive to pressure changes. Increasing pressure impairs brain function rapidly and can be potentially fatal. If this happens, it can be treated with a procedure known as a shunt.
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.
A potential problem with a shunt is that when fluid is moved from the brain to the lower portions of the body, the brain tumor cells are also moved. This is a risk the patient and surgeon must discuss prior to the placement of a shunt.
Operating microscopes are commonly used during neurosurgery. Magnification increases the precision with which an operation can be done.
The surgeon may need to know exactly what function is performed by parts of the brain near the surgical site. There are several ways to map your brain. Some are used during surgery; while others do not require surgery. They may involve: Stimulating brain tissue with tiny electrical currentsMeasuring brain waves as they are stimulatedUsing ultrasound probes inside or near brain structuresProbing the brain with special computerized devices
techniques, such as functional MRI
Positron emission tomography
(PET) or single photon emission computed tomography (SPECT)
Magnetoencephalogram (MEG) to localize motor, sensory, and language function
Additional surgical procedures may include: Thermal destruction instruments such as lasers—can be placed in the exact spot to destroy tumor tissueUltrasonic aspiration—breaks up tumor tissue and removes it from the brain; some tumors are most efficiently removed this way with less damage to normal brain tissueInternal sources of radiation or medications—can be administered within the tumor cavity
The blood supply to tumors can be identified by
. This blood supply can then be shut off by introducing a variety of plugs. These plugs can block the artery from the inside, causing the tumor to die from lack of blood flow.