Brain tumors are abnormal growths of cells in the brain and can be cancerous (malignant) or non-cancerous (benign). Treatment options depend on the type, size, and location of the tumor. Surgery is often necessary to remove as much of the brain tumor as possible. This article provides an overview of the brain tumor removal process.
What is a Brain Tumor?
A brain tumor occurs when abnormal cells form and grow in the brain. There are two main types of brain tumors:
- Malignant (cancerous) brain tumors – These brain tumors are made up of cancer cells that grow quickly. They often spread into nearby brain tissue. Malignant brain tumors are more serious as they can be life-threatening.
- Benign (non-cancerous) brain tumors – These brain tumors are made up of non-cancerous cells that grow slowly. They usually do not spread into nearby tissue. Many benign tumors can be cured with treatment.
Brain tumors are also classified based on which type of brain cell they start in. Common types include:
- Gliomas – these tumors start in glial cells which support nerve cells
- Meningiomas – start in the membranes covering the brain
- Pituitary adenomas – start in the pituitary gland
- Medulloblastomas – start in primitive nerve cells in the cerebellum
Brain tumors often form in different parts of the brain and can cause headaches, seizures, memory problems, nausea, and other symptoms. An MRI or CT scan of the brain is usually needed to diagnose a brain tumor.
Why is Surgery Necessary to Remove a Brain Tumor?
Once a brain tumor is diagnosed, surgery is often recommended as the first and main treatment. There are several reasons why surgery is performed:
- Remove the tumor – The primary goal of brain tumor surgery is to remove as much of the abnormal tumor cells as possible. This helps eliminate the source of the tumor and prevent further growth.
- Reduce pressure and swelling – Brain tumors take up space and can cause increased pressure inside the skull. Surgery creates more space which reduces swelling and pressure on the brain.
- Reduce symptoms – Removing a tumor often improves or resolves symptoms caused by the tumor’s presence such as headaches, seizures, and neurological deficits.
- Obtain tissue sample – Surgery allows the tumor tissue to be analyzed by pathology. This helps determine the tumor type and grade to guide further treatment.
- Improve treatment response – Removing the bulk tumor makes other treatments like chemotherapy and radiation more effective.
In some cases, surgery may not be able to remove the entire tumor. But taking out even a portion of the tumor can provide major benefits and improve prognosis.
How is Brain Tumor Surgery Performed?
Brain tumor surgery is a complex procedure that requires a neurosurgeon and specialized operating equipment. The steps involved include:
- Pre-operative planning – Extensive imaging tests like MRI, CT, and angiograms are done to map the tumor’s location, size, and relation to surrounding brain areas. This helps plan the best approach and technique.
- Opening the skull – The scalp is cut and folded back to expose the skull. A hole or window is created in the skull bone using specialized drills or saws.
- Accessing the tumor – The protective layers between the skull and brain (dura mater and arachnoid mater) are opened to reach the tumor. Retractors may be used to gently separate and protect surrounding brain tissue.
- Removing the tumor – Using an operating microscope, micro-instruments and suction, the neurosurgeon carefully isolates the tumor margins from normal brain and removes tumor tissue bit-by-bit.
- Closing the opening – After the tumor is removed, the dura and skull opening are closed using sutures, staples and plates. The scalp incision is closed with sutures or staples.
Advanced techniques like intraoperative MRI scans, neuronavigation, and neurophysiological monitoring may be used to safely maximize tumor removal while preserving function.
What are the Different Approaches for Brain Tumor Surgery?
There are several possible surgical approaches based on the tumor location:
- Supratentorial approach – For tumors located in the cerebrum or upper brain. Allows access by creating an opening in the skull (craniotomy).
- Infratentorial approach – For tumors located in the cerebellum or brainstem. Done by craniotomy in the back of the head.
- Transsphenoidal approach – For tumors near the pituitary gland and skull base. The surgeon reaches the tumor by going through the nasal passage and sphenoid sinus.
- Transnasal endoscopic approach – Tiny tumors inside the nasal cavity can be accessed entirely through the nostrils using an endoscope.
The neurosurgeon determines the best surgical route to access the entire tumor while avoiding damage to surrounding critical structures like blood vessels and nerves.
What are Some Risks of Brain Tumor Surgery?
While great improvements have been made in neurosurgical techniques and safety, risks are involved when removing a brain tumor:
- Bleeding – Surgery can damage blood vessels causing bleeding in the brain (intracranial hemorrhage). This can lead to nerve injury, stroke, or dangerous swelling.
- Infection – Despite precautions, post-operative wound infections can occur requiring antibiotic treatment.
- Brain swelling – Manipulating the brain can cause inflammation and fluid buildup (cerebral edema). This is managed with drugs and monitoring.
- Neurological deficits – If areas that control speech, movement, or sensations are affected during surgery, there may be permanent disabilities.
- Stroke – Vascular injury or blood clots can interrupt blood flow resulting in an ischemic stroke.
- Fluid leak – CSF fluid may leak through the nose or surgical site requiring additional repair procedures.
While the risks can be significant, they are minimized when the surgery is performed by an experienced neurosurgeon at a major medical center. Risks are carefully discussed with patients beforehand.
What is the Typical Recovery After Surgery?
Recovering from brain surgery takes time. Patients can expect:
- Hospital stay – Patients typically stay around 4-7 days after surgery in the neurosurgical ICU for close monitoring.
- Restricted activity – Strenuous activity will be restricted for 4-6 weeks to allow the brain and incision to heal.
- Medications – Drugs will be given to control pain, swelling, fluid buildup, and seizures.
- Follow-up appointments – Frequent visits will monitor recovery and check for complications like infections.
- Rehabilitation – Physical, occupational and speech therapy helps strengthen function and relearn skills impacted by the tumor or surgery.
Recovery is gradual over weeks to months as the patient regains strength, balance, and energy levels. Support from family and friends is very helpful during this process.
What are the Next Treatment Steps After Surgery?
After surgery, additional treatments are often recommended to destroy any remaining tumor cells. This helps prevent recurrence and improve survival.
- Radiation – External beam radiation is focused on the tumor site from outside the body. Used for many malignant and some benign tumors.
- Chemotherapy – Cytotoxic drugs are given systemically to target and kill cancer cells. Used for most malignant brain tumors.
- Other drugs – Medications may be prescribed to help control tumor cell growth. Examples are bevacizumab (Avastin), carmustine (BCNU) wafers.
- Clinical trials – Patients may be candidates for experimental drugs and novel treatments only available in clinical trials.
Treatment is tailored for each patient based factors like tumor type, molecular markers, and overall health. The neuro-oncology team will discuss the best options after reviewing pathology results.
What is the Prognosis After Brain Tumor Surgery?
The outlook after surgery depends greatly on the type and grade of brain tumor. Benign tumors like meningiomas have a very favorable prognosis when totally resected. For malignant tumors like glioblastomas, prognosis remains poor though surgery does help extend survival.
Here are general prognosis trends for common brain tumors:
| Tumor Type | Prognosis Trend |
|---|---|
| Meningiomas (benign) | 90% 10-year survival for low grade tumors if removed |
| Low-grade gliomas (malignant) | 5-year survival around 60% for lower grade tumors |
| Glioblastomas (malignant) | Median survival around 12-18 months |
| Medulloblastomas (malignant) | 5-year survival 70-80% with aggressive treatment |
| Pituitary adenomas (benign) | 95% 10-year survival if surgically cured |
These numbers reflect averages based on data. Each patient’s prognosis is unique and depends on individual disease factors.
Conclusion
Surgery is a critical step in the management of most brain tumors. Removing the tumor provides tissue for diagnosis, immediately reduces pressure and swelling, relieves symptoms, and can significantly improve prognosis in many cases. With careful planning and technique, neurosurgeons are able to safely remove the majority of many tumors. After recovery from surgery, additional treatments like radiation and chemotherapy are often used to improve outcomes. Continued research and progress in surgery, imaging methods, radiation, drugs, and clinical trials provide hope for further advances against these challenging tumors.