Surgery for brain tumours

Biopsy Back to top

A biopsy is the removal of a small piece (sample) of the tumour. The sample is sent to a laboratory where it is examined by a pathologist (a doctor who specialises in how disease affects the body's tissue) who can tell what kind of cells are present.

Having a biopsy may mean a few days in hospital as it usually involves an operation under a general anaesthetic. An MRI brain scan| or CT scan| is done to find the position of the tumour to the nearest millimetre. During the operation a small hole, called a burr hole, is made in the skull. A fine needle is then passed down through the burr hole to remove a small piece of the tumour to be examined by the pathologist.

Guided biopsy

Sometimes, especially if the tumour is deep within the brain, you may have a specialist type of biopsy called a guided biopsy. This can be done either by stereotactic biopsy or by neuronavigation.

With stereotactic biopsy you will be fitted with a head frame either before or after you have been scanned. This helps the doctors to guide the biopsy needle to exactly the right part of the brain. Once the frame is in place the doctors will drill a small hole in the skull in much the same way as a normal biopsy. The frame will then guide the needle to the right place. A stereotactic biopsy is usually done under a local anaesthetic, but may involve a general anaesthetic.

With neuronaviagtion a frame is not needed. The biopsy is taken with a fine needle (in a similar way to a stereotactic biopsy). The surgeon uses the scan to help guide the needle to the right place. Before the scan you may have markers stuck to parts of your head (called fiduciary markers). These markers show up on the scan and help the surgeon guide the needle to the affected area.

Craniotomy Back to top

Once the type of brain tumour is known, a more extensive operation can be done to remove all or part of it. A craniotomy is an operation that involves opening the skull. For this operation, you will be given a general anaesthetic. However, you may be awake for at least part of the operation (with the surgical area numbed) if doctors need to check your brain function during surgery. This is called an awake craniotomy.

Some of your hair may need to be shaved off in the anaesthetic room before the operation (doctors try to shave only as much as is necessary). The surgeon will cut the scalp and the piece of skull over the tumour, remove the tumour itself, and replace the piece of skull. The flap of scalp is then stitched back in place.

If it’s not possible, or advisable, to remove the whole tumour, only part of the tumour is removed. This is called partial resection or debulking.

Sometimes the only way for the surgeon to remove the tumour is to go through a healthy part of the brain, which may cause damage. The effects of this will vary depending on the area of the brain involved. Your surgeon will talk this over with you very carefully beforehand to make sure that you’re fully aware of how the surgery may affect you.

In some situations it will be too difficult or dangerous to remove even a small part of the tumour, or the doctors may think that other treatments are more suitable. Your surgeon or doctor will discuss the most appropriate type of operation with you and, if you like, with a close relative or friend. Before any operation, do ask questions so that you know exactly what’s involved. No operation or procedure will be done without your agreement.

After your operation

The length of your stay in hospital will depend on the extent of the operation and how well you are. For about the first 12 hours after the operation, you’ll be closely observed, probably in the intensive care unit (ICU/ITU). You will probably have frequent observations taken to begin with. These are known as neurological observations, or ‘neuro obs’. They include checking how alert you are, testing your reflexes, checking that your pupils react to light as well as checking your pulse, blood pressure, the amount of oxygen in your blood and number of breaths each minute. At first you may be cared for on a machine which maintains your breathing (a ventilator).

It’s likely that your head will be bandaged and you may have a tube in the site of the operation, which drains into a bottle. This is used to drain excess blood from the head wound and is usually removed within a day or two. Your face and eyes may be swollen and bruised after the operation. The swelling should go down within 48 hours and the bruising within a few days. You may also have a drip of salt water (saline) to replace any fluids you may have lost and to keep you hydrated.

You may have a headache when you wake up after the operation and you’ll be given painkillers to help relieve this.

It’s unusual to get a lot of pain after surgery to the brain, but tell your nurse or doctor if you are in pain or the pain starts to get worse.

These descriptions may sound dramatic but the effects of the operation should settle fairly quickly and once staff are confident with your condition you’ll go back to the ward to continue your recovery.

Shunts

Brain tumours can cause a wide variety of symptoms.

These are usually caused by a rise in pressure within the brain (raised intracranial pressure). This happens when the tumour blocks the flow of the cerebrospinal fluid (CSF) around the brain (this is called hydrocephalus). A shunt (also called a ventricular catheter) may be inserted to drain excess fluid from the brain. This will stop any further rise in intracranial pressure.

A shunt is a long, thin tube that is placed in the brain and then threaded under the skin to another part of the body, usually into the lining of the abdominal cavity (peritoneum). The tube allows excess fluid from the brain to drain into the abdominal cavity where the body reabsorbs it. The shunt has valves in place so that fluid can drain away from the brain but not back towards it.

The shunt is not visible outside of the body and you won’t be able to feel it.