Craniotomy

To remove part or all of the brain tumour, you usually have an operation called a craniotomy.

You usually have the surgery under a general anaesthetic. The surgeon removes a piece of skull over the tumour to make an opening. They use a powerful microscope and sometimes scans to look at the brain. This means they can carefully remove the tumour without taking away healthy areas of the brain. After they have removed part or all of the tumour, the surgeon replaces the piece of skull. They will usually fix it place with small titanium plates.

Sometimes the surgeon can remove the tumour through a very small opening in the skull using a neuroendoscope. This is a thin, flexible tube with a camera on 1 end and an eyepiece on the other. This type of surgery is sometimes called endoscopic or keyhole surgery.

For some types of tumours affecting the pituitary gland or at the base of the skull, this surgery can also be done by passing the endoscope up the nose into the brain.

Your surgeon will explain which type of surgery is best for you.

If it is not possible to remove the whole tumour, the surgeon will remove as much as they can. This is called a partial or sub-total resection, or debulking.

After the operation, the tissue is sent to a laboratory for tests. 

Sometimes the surgeon will suggest a craniotomy while you are awake. This may be offered if they think that keeping you awake during the operation may make it possible to:

• remove more of the tumour
• remove it more safely.

This is instead of general anaesthetic, when you are put to sleep for the whole operation.

This may sound frightening, but people usually cope with it well. You will have lots of chances to discuss the risks and benefits and any worries you may have with the neurosurgical team. This includes doctors, nurses and psychologists.

Because you are awake, the surgical team can ask you questions and check that your speech and movement are not being affected by the surgery. This reduces the risk of damage to your brain. It also means the surgeon may be able remove more of the tumour. If there are changes to your speech or thinking, the surgeon stops operating and assesses the situation.

This surgery can be done with sedation or a general anaesthetic for the first part of the surgery. This is when the surgeon makes an opening through the skull. The surgeon uses local anaesthetic injections to numb the scalp. They gently wake you when they are ready to operate on the brain. You should not feel any pain during the operation. This is because the brain has no nerve endings.

Some surgeons may suggest doing the operation with you awake throughout. They will numb the scalp and head with local anaesthetic injections.

You can see and talk to the doctors and nurses during the operation. You can tell them straight away if you are worried about anything that is happening.

Following diagnosis and treatment for a brain tumour, most people will not be allowed to drive for a period of time. If you drive, it is important to discuss with your doctor how your diagnosis and treatment for a brain tumour affects your right to drive.

If you have a driving licence, you must tell the licencing agency (DVLA or DVA) that you have been diagnosed with a brain tumour. We have more information about how a brain tumour may affect your right to drive.