Whenever someone in the family is diagnosed with a 'Brain Tumor', it causes a lot of apprehension in in the family. Surgery is usually the first step in treating most benign
and many malignant tumors. It is often the preferred
treatment when a tumor can be removed without
unnecessary risk of neurological damage.
Surgery might be recommended to:
• Remove as much tumor as possible
• Provide a tumor 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.
• 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 a cancer elsewhere in your body), is the 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 if located near a sensitive
area in 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 “fiber tracking.” Use
of fiber 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 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
A 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.
TRANSPHENOIDAL SURGERY
Transphenoidal 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 tumor 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 flowing 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
BRAIN TUMOR SURGERY?
Brain tumor 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 tumor 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 health
Ask 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.
Please send your queries to mumbaistrokecare@gmail.com
