Surgery for brain tumours

Surgery is one of the main treatments for brain and spinal cord tumours. You might have an operation to:

• remove the whole tumour to try to cure it
• remove part of the tumour to slow its growth and help with symptoms
• drain a build up of fluid on your brain (hydrocephalus)
• help to give other treatments such as chemotherapy
• help diagnose a brain tumour

Brain surgery might sound like a frightening procedure, but it is quite safe. Doctors who carry out these surgeries are very skilled specialists. You can share any concerns with your doctors and cancer nurse specialist. They will be able to tell you what will happen during the operation.

Brain surgery is not suitable for everyone. It’s a major operation so you need to be well enough. And some tumours grow in areas of the brain that are difficult for doctors to operate such as the brain stem.

Who does your surgery?

A specialist team of doctors does your surgery. They are called neurosurgeons. You might have a team of neurosurgeons working on your operation. They are led by the consultant neurosurgeon.

You might have other specialists working with the team. For example, an Ear, Nose and Throat (ENT) surgeon.

Surgery to remove all or part of the tumour

Surgery is an important part of your treatment. Your surgeon might think they can't completely remove the tumour. But they are still likely to try to remove as much as possible. This can help to slow down the progression of the tumour and relieve your symptoms.

Craniotomy

A craniotomy is the most common type of operation for a brain tumour. You usually have a craniotomy under a general anaesthetic. This means that you will be asleep and won’t feel anything.   

During a craniotomy, the neurosurgeon cuts out an area of bone from your skull. This gives an opening so that they can operate on the brain.

You have scans before the operation to help your surgeon know where the tumour is. You may also have scans during the operation. Some of these scans are loaded into a computer to give the precise position of the tumour.

Your surgeon uses different tools to remove the tumour. They can use:

• a scalpel or special scissors
• an ultrasound to break up the tumour and then a suction device to gently remove the tumour (ultrasonic aspiration)
• a special microscope to look at the brain tissue so that they can see what is tumour and healthy tissue (microsurgery)
• a blue fluorescent light that helps the surgeon to see the edges of the tumour more clearly

After removing the tumour, your surgeon puts the bone back (this is called a flap). They secure the bone with small metal brackets and stitch the skin over it. In most cases, the hair will hide the scar. 

Awake craniotomy

Your surgeon might suggest that you have an awake craniotomy. You may have it if your tumour is close to a part of the brain that controls important functions. For example, speech, movement or feeling.

There are different ways of having an awake craniotomy. Some people are awake (conscious) for part of the operation. Other people are awake the whole time. Ask your surgeon what will happen in your situation.  

If you are going to be awake for part of the operation, you have a general anaesthetic at the start of it. The anaesthetic is then reduced so that you wake up for the main part. You then have another general anaesthetic for the last part of your operation.

During an awake craniotomy, the surgeon asks you to do tasks. And they check the function of different parts of the brain. For example, they might ask you:

• to speak
• to move a part of your body
• what you can feel

Once the surgeon has removed the tumour, they repair the skull and stitches up the skin. 

You have an anaesthetic during the operation to numb any areas that feel pain such as the skin and muscle. The brain itself does not have pain receptors so it doesn’t feel pain.

Your surgical team will make sure that you are as comfortable as possible. You have a nurse with you all the time, to help you feel calm and safe.

Some neurosurgeons do the operation while monitoring the brain electrical activity. This is called neurophysiological monitoring. It can make surgery safer and allow the surgeon to remove more tumour.

Neuroendoscopy

Neuroendoscopy is also called keyhole brain surgery. You might have it to remove all or part of a tumour in the fluid filled spaces of the brain (ventricles). You may also have a neuroendoscopy to remove a build up of fluid in your brain (hydrocephalus).

An endoscope is a medical instrument, made up of a long tube with a camera attached to a monitor and an eyepiece. Endoscopes can be flexible (bendy) or rigid (fixed straight).

You surgeon carefully makes a small hole into the skull. This is called a Burr hole. They then put the endoscope through the hole. The surgeon can see what is at the tip of the endoscope either through the eyepiece or on a monitor. There are tiny forceps and scissors at the end of the endoscope. They use these to remove the tumour. 

Removing a pituitary tumour via the nose

The pituitary is a small gland that lies in a hollow space above the back of your nose. It may be possible for your surgeon to remove a pituitary gland tumour via the nose. This is called transsphenoidal surgery.

Your surgeon usually makes a small cut on the nasal septum. This is the thin wall of bone and cartilage that separates the nostrils. They put tools through this hole and up to the pituitary gland to remove the tumour.

Your surgeon may also use an endoscope. An endoscope is a long tube that has a camera and an eyepiece. They use the endoscope to operate surgical instruments and remove the tumour.

You may have side effects after transsphenoidal surgery, but this is rare. Side effects include:

• damage to the nerve that controls the eyesight (optic nerve), causing loss of vision
• a stroke or bleeding inside the brain
• infection of the layers of tissue that cover the brain (meninges)
• damage to the healthy part of the pituitary gland which can reduce the levels of certain hormones in your body

Talk to your surgeon about the possible side effects if you are worried.

Surgery to give chemotherapy

During brain surgery, you might have chemotherapy into the area of the tumour as a wafer (implant). Or you might have a ventricular access device (an Ommaya reservoir) put in. Ventricular access devices allow you to have chemotherapy straight into the ventricles. The ventricles are the fluid filled spaces of the brain.   

We have information about chemotherapy wafers and ventricular access devices. You can read this in the chemotherapy section.

Surgery to drain a build up of fluid on your brain

A build up of fluid in the brain is called hydrocephalus. You might have the build up of fluid drained during surgery to remove the tumour, or as a separate operation.

Side effects of brain surgery

It can take some time to recover from brain surgery. You might have some side effects immediately after surgery. For example, weakness and dizziness. And some long term side effects such as problems with your speech.

It can be upsetting to learn about these side effects. Talk to your doctor or clinical nurse specialist about what to expect after brain surgery. Ask them about the side effects you might have and the support that will be available to you.