Types of surgery for primary brain tumours

You may have surgery to remove part, or all of a primary brain tumour or to improve symptoms of raised pressure in the skull.

A biopsy is when a surgeon removes a piece of the tumour. This is examined to find out more about the tumour. There are different ways to take a brain biopsy. Your surgeon will explain what to expect.

A craniotomy is an operation when the surgeon removes a piece of the skull over the tumour. They carefully remove part or all of the tumour and replace the piece of skull. Some of this operation may be done while you are awake so the surgeon can check your speech and movement.

If the tumour is causing increased pressure in the skull, the surgeon may place a tube called a shunt. They make a small hole in the skull to put the shunt in. The other end of the shunt is threaded to another area of the body. Extra fluid drains from inside the skull, through the shunt and lowers the pressure.

Biopsy

A biopsy is when the surgeon removes a piece of the tumour. This can then be examined by a doctor who studies cell types (pathologist). They do tests to find out the type and grade of the tumour and check for biomarkers.

There are different ways to take a brain biopsy. Your surgeon will explain what to expect in your situation. Sometimes it is only safe to remove a tiny part of the tumour to look at under the microscope. But often the biopsy is taken as part of a larger operation to remove the tumour.

You usually have a biopsy taken under a general anaesthetic. But sometimes a local anaesthetic is used. During the operation the surgeon may take the biopsy:

  • through a small hole they drill in the skull (burr hole)
  • by removing a small area of skull over the tumour (craniotomy). This is called an open biopsy.

The surgeon uses scans taken before and sometimes during the operation to guide them while taking the biopsy.


Craniotomy

To remove part of, or all of the tumour, you need an operation called a craniotomy. You will usually have a general anaesthetic. During the operation, the surgeon cuts the scalp and removes a piece of the skull over the tumour. They use specialised instruments and a powerful microscope to look at the brain. This means they can carefully remove the tumour without taking healthy areas of the brain.

After removing part of, or all of the tumour, the surgeon replaces the piece of skull and uses stitches or staples to close the scalp. Sometimes the surgeon uses keyhole surgery which is done through a smaller opening in the skull. They use an instrument called a neuroendoscope. This is a thin, flexible tube with a camera on the end and an eyepiece to look through. The surgeon attaches special instruments to the neuroendoscope to remove the tumour. They will explain whether this is suitable in your situation.

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

After the operation, the tissue is sent to a laboratory to be examined by a pathologist.

Craniotomy while you are awake

Sometimes the surgeon will suggest that you have a craniotomy while you are awake. This may sound frightening but people usually cope well with it. Because you are awake, the surgeon can check that your speech and movement are not being affected by the surgery.

Usually you are given sedation or a general anaesthetic for the first part of the surgery. The surgeon uses local anaesthetic injections to numb the scalp. They gently wake you when they are ready to operate on the brain. The brain has no nerve endings so you shouldn’t feel any pain during the operation.

You can see the doctors and nurses and talk to them while you are awake. They will ask you questions and check your speech or movement. If anything changes, the surgeon will stop operating and assess the situation.


Shunts

If the tumour is blocking the flow of cerebrospinal fluid (CSF) around the brain, pressure can build up and cause symptoms. The surgeon can drain away the extra fluid by putting in a long, thin tube called a shunt.

The surgeon makes a small hole in the skull behind your ear and places one end of the tube (shunt) into the brain. They thread the tube under the skin to another part of the body. This is usually to a space in your tummy called the peritoneal space. The extra cerebrospinal fluid drains into this area and is re-absorbed by the body.

The tube has a valve that controls the amount of CSF that drains through it. It only allows fluid to drain away from the brain and not back towards it.

You cannot see the tube from outside of the body but you may be able to feel it under the skin behind your ear.

Back to Surgery explained

When is surgery used?

Surgery can be used to remove all or part of the tumour or to give chemotherapy into the brain.

Having your operation

A team of healthcare professionals will help you before and after surgery for a brain tumour.