Surgery for brain tumours

How surgery is planned

Brain or spinal cord surgery is called neurosurgery. Surgery may:

• remove the whole tumour (total resection)
• remove part of the tumour (partial resection or debulking)
• help diagnose a brain tumour (biopsy).

All of the tumour will be removed if it can be done safely, but this will depend on the type and location of the tumour. Removing part of the tumour may be considered when the tumour covers a wider area or is near major blood vessels or other important parts of the brain or spinal cord. This may help reduce the pressure on your brain, which will improve some of the symptoms.

When surgery is not possible

Sometimes a tumour is considered unsafe to remove because it is too close to certain parts of the brain, and surgery would cause blindness, loss of speech, paralysis or other serious complications. Sometimes these may be called inoperable or unresectable tumours. A needle biopsy is still often possible and can help to guide treatment options. Your doctor will talk to you about what treatments you can have and ways to manage symptoms.

What to expect before surgery

The different scans used to diagnose a brain tumour (such as MRI or CT scans) are often done again to plan surgery. Some people may have a functional MRI (fMRI) to help the surgeon avoid damaging the most important areas of the brain. You will be asked to complete brain exercises during the MRI scan to show the exact areas of the brain that are used as you speak or move. These parts of the brain can also be found during surgery with brain mapping.

Tell your doctor about any blood-thinning or other medicines, and any supplements that you take. Some medicines interfere with the anaesthetic used during the operation, so you may need to stop taking them for a while. If you smoke or vape, it is important to stop before surgery, as smoking or vaping can increase the risk of complications.

Types of surgery

Different types of surgery are used for brain and spinal cord tumours.

Removing a brain tumour (craniotomy)

This is the most common type of brain tumour surgery. A craniotomy removes all or part of the tumour (total or partial resection) and may be done while you are asleep under general anaesthetic.

The surgeon cuts an area of bone (called the bone flap) from your skull to access the brain and remove the tumour. The bone is then put back and a small plate is screwed on to hold the piece of skull in place.

If you have a high-grade glioma, you may drink a solution before surgery to make the tumour glow under a special blue light. This helps the surgeon remove as much of the tumour as possible, while avoiding normal brain tissue.

Brain mapping

An electrode is placed on the outside layer of the brain to stimulate and pinpoint important areas of the brain. Brain mapping may be done during surgery, or as part of an awake craniotomy.

Awake craniotomy

This operation may be recommended if the tumour is near parts of the brain that control speech or movement. You are usually put to sleep (general anaesthetic) and are later woken up but relaxed (conscious) for part of the operation. The surgeon asks you to speak or move parts of your body to identify and avoid damaging those parts of the brain.

You may be worried that an awake craniotomy will be painful, but the brain itself does not feel pain and local anaesthetic is used to numb surrounding tissues.

Removing a pituitary tumour (endoscopic transsphenoidal surgery)

The most common surgery for pituitary gland tumours (and other tumours located near the base of the brain) is called endoscopic transsphenoidal surgery. To remove the tumour, the surgeon inserts a long, thin tube with a light and camera (called an endoscope) through the nose and into the skull at the base of the brain. An ear, nose and throat (ENT) surgeon may also assist with this type of surgery. You will be given a general anaesthetic for this operation.

Removing a spinal cord tumour (laminectomy)

The most common surgery for spinal cord tumours is a laminectomy. The surgeon makes an opening through the skin, muscle and a vertebra in the spinal column to remove the tumour. You usually have a general anaesthetic for this type of surgery.

Some spinal cord tumours may also need surgery to the spinal cord itself. Your surgeon will talk to you about this particular surgery, as it may have a risk of nerve or spinal cord injury.

What to expect after surgery

You will be closely monitored for the first 12–24 hours after the operation. For the first day or two, you will be in the intensive care or high dependency unit. You may stay in hospital for only 2 or up to 10 days. How long you stay in hospital will depend on whether you have any problems or side effects after the surgery.

Side effects of surgery

Infection

Although the risk is small, you may develop an infection at the wound site. This can usually be treated with antibiotics. A small number of people may need surgery to have the wound cleaned out and possibly the bone flap removed. Another surgery will usually be done later on to replace the missing area, for safety and to look natural.

Bleeding

This is a rare but serious side effect. You will have a CT or MRI scan the day after surgery to check for any bleeding or swelling.

Swelling

Surgery can cause swelling in the brain, which increases the pressure inside the skull (intracranial pressure). Your medical team will monitor the swelling and try to reduce it with medicines.

Other side effects

You may continue to feel confused and dizzy, have speech problems, weakness in parts of the body and seizures. You and your family or carers may be surprised that you may feel worse than before the surgery and worry that you are not recovering well. These side effects are normal and often improve with time.

Rehabilitation after surgery

Some people recover and can gradually return to their usual activities. For others, there are longer-term changes to speech, movement, behaviour and thinking. A range of therapies can help recovery or show you ways to manage any longer-term changes. These therapies are known as rehabilitation.

At first, you may have some rehabilitation therapies in the hospital or a rehabilitation facility. Once you return home, you can continue rehabilitation therapies as an outpatient. You may also be given equipment to use at home. You will have other changes, such as not being able to drive for a while. See Living with a brain or spinal cord tumour for information about rehabilitation therapies.