Carl R. Darnall Army Medical Center - Health Library

Surgical Procedures for Brain Tumors

Surgery is done to remove or shrink the size of the tumor. This can lead to a cure. But, certain tumors do grow back. The impact on how the brain works depends on the type of tumor and what surgery is needed.

Taking out some of the tumor may help ease pressure on other structures. It may also help relieve more serious problems. Surgery can help improve outcomes of other treatments you may need.

During surgery, biopsies are taken. These are tissue samples and they will be looked at in a lab. A biopsy can also be done by itself. Sometimes, tumors can't be removed. A type of biopsy is done by inserting a needle through a small hole in the skull.

Mapping

This is a method a doctor uses to see what function is connected to what part of the brain. Mapping tests places in and around the tumor. This helps find what can be taken or what problems may happen after surgery. This is done by:

  • Stimulating brain tissue with tiny electrical currents
  • Measuring brain waves as they are stimulated
  • Using ultrasound probes inside or near brain structures
  • Probing the brain with special computerized devices
  • Functional MRI scan
  • PET or SPECT scans
  • Magnetoencephalogram (MEG) to localize motor, sensory, and language function

Options for Surgery

Craniotomy

Open craniotomy is the removal of a piece of the skull. Some tumors are best removed through the nose or the top of the neck. But, most go through the skull. The placing of the hole depends on where the tumor is. In some cases, the brain may need to be mapped. Brain surgery may take several hours.

Types of craniotomies:

  • Eyebrow—A small hole is made in the eyebrow. This allows access to the pituitary gland or tumors near the front of the brain. This method may be used instead of going through the nose.
  • Keyhole—A small hole is made behind the ear. This allows access to the structures at the base of the skull and inside the ear.
  • Endoscopic—A small hole is made in the skull near the tumor. A lighted tube with a camera is inserted through the hole so structures can be seen or removed.
  • Craniectomy—Removal of a piece of skull. This may be needed when brain swelling is likely. In some cases, the piece of skull can't be replaced.

Once inside, the tumor may be treated with:

  • Thermal destruction—Heat from lasers or other instruments can be sent to the exact location.
  • Ultrasonic aspiration—Can be used to break up tumor tissue and remove it from the brain. Some are removed this way with less damage to healthy brain tissue.
  • Internal radiation therapy or chemotherapy—These are place in or near the tumor.

A biopsy can also be done during a craniotomy.

Embolization

The blood supply can be found by an angiography. It can then be shut off by placing plugs in the blood vessels that supply the brain. The tumor tissue may die from lack of blood. This procedure is rarely done.

Other Surgical Options

Some surgery may be done to ease problems caused by a brain tumor. They can also be used to deliver other treatments.

Cerebral Shunt

Tumors can block the flow of cerebrospinal fluid (CSF) in the skull. This makes pressure in the brain higher. A cerebral shunt may be done if pressure is causing problems. The shunt helps manage the level of CFS. Shunts are named for the way they are routed through the body. For example, a ventriculoperitoneal (VP) shunt drains fluid from the brain to the belly. The CSF is then taken in by the body.

A shunt is created by making a small hole in the skull. A tube is placed into one of the fluid filled spaces inside the brain. The other end of the tube is passed under the skin from the head to the trunk. It will drain fluid into the heart or belly. A one-way valve in the tube prevents fluid from flowing backwards. Some types of cancer cells can travel through the CSF to other parts of the body. Your doctor will talk about your risk beforehand.

Ventricular Access Catheter

There is a barrier around the brain that blocks certain medicines from going into the brain. A ventricular access catheter (VAC) allows the medicines to be passed directly to the brain and surrounding fluid to treat the tumor.

A small hole is made in the skull. A tube is inserted into the fluid-filled space inside the brain. The other end of the tube contains a reservoir, which remains under the scalp. Medicines are given by a putting a small needle into the reservoir.

REFERENCES:

Astrocytoma and oligodentroglioma in adults. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116413/Astrocytoma-and-oligodendroglioma-in-adults. Updated May 13, 2016. Accessed August 9, 2018.

Craniotomy. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/craniotomy_92,p08767. Accessed August 9, 2018.

Meningioma. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116926/Meningioma. Updated January 19, 2017. Accessed August 9, 2018.

Overview of intracranial tumors. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/neurologic-disorders/intracranial-and-spinal-tumors/overview-of-intracranial-tumors. Updated June 2018. Accessed August 9, 2018.

Surgery for adult brain and spinal cord tumors. American Cancer Society website. Available at: https://www.cancer.org/cancer/brain-spinal-cord-tumors-adults/treating/surgery.html. Updated November 7, 2017. Accessed August 9, 2018.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/brain/patient/adult-brain-treatment-pdq#section/_102. Updated July 5, 2018. Accessed August 9, 2018.

Last reviewed June 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 8/9/2018