Brain Tumors: Primary - Surgery

Highlights	Diagnosis	Other Treatments
Introduction	Common Brain Tumors	Treatment for Complications
Symptoms	Treatment	Resources
Risk Factors	Surgery	References
Causes	Radiotherapy
Prognosis	Chemotherapy

Surgery

Surgery is usually the first step in treating most brain tumors, although in some cases, such as most brain stem gliomas, it may be too dangerous. The object of most brain tumor surgeries is to remove or reduce as much of its bulk as possible. By reducing the size, other therapies, particularly radiotherapy, can be more effective. (Although there have been significant advances in brain surgeries, some experts argue that in high-grade gliomas extensive surgery may not improve survival rates at all and patients are best served by radiation therapy.)

Craniotomy

The standard procedure is called craniotomy.

The neurosurgeon removes a piece of skull bone to expose the area of brain over the tumor.
The tumor is located and then removed.

Click the icon to see an illustrated series detailing craniotomy surgery.

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The surgeon has various surgical options for breaking down and removing the tumor.

They include:

Standard surgical procedures
Laser microsurgery (which produces great heat and vaporizes tumor cells)
Ultrasonic aspiration (which uses ultrasound to break the glioma tumor into small pieces, which are then suctioned out)

Relatively benign, grade I gliomas may be treated only by surgery. Some controversy exists over whether surgery for low-grade astrocytomas improves survival, although insufficient research has been conducted to prove its benefits for these gliomas. Most malignant tumors require additional treatments, including repeat surgery.

The surgeon's skill in removing the tumor as completely as possible is critical to survival. No one should be shy about requesting the number of similar procedures a surgeon has performed. (Asking for complication rates may not be useful, since a very experienced surgeon might operate on many high-risk patients.)

Additional Procedures to Enhance Brain Surgery

In most cancers outside the brain, surgical removal of a tumor usually involves taking out surrounding healthy tissue to be sure all cancer cells are gone. In the brain, however, removing healthy nearby nerve tissue can be as disastrous for the patient as the cancer itself. Special techniques have been developed to allow maximum removal of tumor while protecting healthy brain cells.

Stereotaxy. Stereotaxy has become a useful adjunct to both surgery (stereotactic surgery) and radiotherapy (stereotactic radiotherapy).