A craniotomy is an operation where the surgeon removes part or all of the brain tumour. 

What is a craniotomy?

To remove part or all of the brain tumour, you 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.

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 one end and an eyepiece on the other. This type of surgery is sometimes called endoscopic or keyhole surgery. Your surgeon will explain whether this is possible for you.

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 for tests. This is called a biopsy.

We have more information about surgery for brain tumours.

5-ALA (Gliolan)

Some people have a drug called 5-ALA (Gliolan) as a drink before the operation. It is also called ‘the pink drink’ or photodynamic diagnosis (PDD). During surgery, 5-ALA makes brain tumour cells glow pink or red under a blue light. This may help the surgeon decide which areas to remove. It is not used in all brain tumour operations. If your surgeon feels it would be helpful in your situation, they will discuss it with you.

5-ALA makes your eyes and skin sensitive to light for up to 24 hours after taking it. It is important to avoid direct sunlight and brightly focused indoor light during this time. While you are in hospital, the staff will make sure you are protected from bright, direct light.

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 with it well.

Because you are awake, the surgeon 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 to remove more of the tumour. If there are changes to your speech or thinking, the surgeon stops operating and assesses the situation.

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. You should not feel any pain during the operation. This is because the brain has no nerve endings.

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.

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