Surgery is often a key component of brain tumor treatment. The goal is to remove all or as much of the tumor as possible while minimizing any damage to the surrounding healthy tissues. The type of surgery performed can vary based on the type, size, location and grade of the tumor and the patient’s age and overall health. Some brain tumors can be removed with minimally invasive techniques, such as endoscopy or stereotactic surgery, while others may require traditional open surgery. Brain tumor surgery is often performed in conjunction with other treatments, such as radiation therapy and chemotherapy, to shrink the tumor and make it easier to remove or to help prevent a recurrence.

The types of brain tumor surgery include:

Biopsy

To obtain a sample for testing, a surgeon will guide a hollow needle into the brain tumor and withdraw a small amount of tissue. A stereotactic biopsy is performed with the aid of a computer-guided imaging system, such as computed tomography (CT) or magnetic resonance imaging (MRI), for heightened precision. A biopsy is necessary to conclusively diagnose brain cancer.

Craniotomy

Using specialized surgical instruments, a surgeon will remove a small section of the skull (bone flap) to access the brain tumor. After completely or partially removing the tumor, the surgeon will replace the bone flap. During an awake craniotomy, the patient will remain awake for most of the procedure to allow for enhanced monitoring, and general anesthesia is not needed.

To maximize tumor removal, a craniotomy may be performed with the aid of 5-aminolevulinic acid (5-ALA). Known as the “pink drink,” 5-ALA is a special fluorescent dye that can be injected into the bloodstream before surgery. As the dye circulates throughout the body, it will accumulate in rapidly dividing cells, such as brain tumor cells. When viewed under a special light, the cells will glow red. During surgery, 5-ALA tumor fluorescence can help the surgeon visualize and differentiate between tumor tissue and normal brain tissue and identify areas where the blood-brain barrier is disrupted.

Shunt procedure

A brain tumor can sometimes cause an overproduction of cerebrospinal fluid (CSF) or interfere with its proper drainage. If CSF has accumulated in the brain (hydrocephalus), a surgeon may temporarily or permanently place a thin tube (shunt) to drain the excess fluid into another part of the body, such as the abdomen, where it can be reabsorbed. Often performed in conjunction with brain tumor removal surgery, a shunt procedure can help relieve pressure on the brain caused by hydrocephalus.

Endonasal endoscopy

A minimally invasive surgical technique, endonasal endoscopy involves the use of a thin, flexible tube with a light source and miniature camera attached to the end (endoscope). After guiding an endoscope through a nostril, a surgeon can visualize the nasal passages and sinuses and remove a pituitary tumor or skull base tumor without making an external incision. Compared to traditional open surgery, endonasal endoscopy is associated with less pain, a faster recovery and a lower risk of complications.

Neuroendoscopy

Neuroendoscopy is a minimally invasive surgical technique that can be used to treat various neurological conditions in the brain or spinal cord. After inserting an endoscope through a small incision in the skull or spine, a surgeon can visualize and treat a tumor or hydrocephalus. Compared to traditional open surgery, neuroendoscopy is associated with smaller incisions, less trauma to surrounding tissues and a faster recovery.

Skull base surgery

Skull base surgery is a specialized procedure that allows a surgeon to access the base of the skull, a complex area that contains many vital structures, including major blood vessels, nerves and the base of the brain. To minimize any damage to the surrounding tissues and reduce the recovery time, the surgeon may use minimally invasive techniques, such as endoscopy and robotic assistance. Skull base surgery may be performed to remove a brain tumor or relieve pressure on the brain caused by hydrocephalus.

Services and features at Moffitt McKinley Hospital include:

Surgery operating and recovery rooms
Radiology/diagnostic imaging
Pathology and laboratory
Publix Pharmacy
Ancillary clinical services
Patient and Family Center
Café and cafeteria
Gift shop

Stereotactic radiosurgery

Stereotactic radiosurgery is a noninvasive procedure that involves the use of highly focused beams of radiation to destroy tumor cells. Despite its name, stereotactic radiosurgery is not a surgery and does not require an incision. Instead, to treat a brain tumor, a surgeon may use a Varian Truebeam linear accelerator with a BrainLab ExacTrac image guidance system to precisely deliver narrow beams of high-dose radiation directly to the tumor from multiple angles.

Laser ablation/laser interstitial thermal therapy (LITT)

A minimally invasive surgical technique, LITT involves the use of a laser ablation system such as Visualase® to heat and destroy abnormal tissue, such as a brain tumor. Guided by real-time MRI, a surgeon will insert a laser probe into the brain through a small opening in the skull, then use the laser to heat and destroy the targeted tissue while sparing the surrounding healthy tissue. LITT may be an alternative to traditional open surgery for treating a deep-seated or difficult-to-access brain tumor tumor.

Kyphoplasty

A minimally invasive surgical procedure, kyphoplasty may be performed to treat a compression fracture in the spine caused by a tumor. After making a small incision in the back, the surgeon will utilize fluoroscopic guidance to insert a narrow tube into the fractured vertebra. Next, the surgeon will insert a balloon-like device through the tube and inflate it to create a cavity within the vertebra. Once the cavity is created, the surgeon will deflate the balloon and remove it, then inject a special bone cement into the cavity to stabilize the fracture and restore the vertebra to its original height. Kyphoplasty can help relieve pain, improve mobility and prevent further collapse of the damaged vertebra.

Spinal stabilization

Spinal stabilization involves the surgical placement of spinal instrumentation, such as screws, rods or plates, to stabilize the spine and promote the fusion of vertebrae damaged by a tumor. The goals are to improve spinal alignment, relieve pressure on the spinal cord and spinal nerves, reduce pain and restore spinal function.

What are the risks of brain tumor surgery?

Like any cancer treatment, brain tumor surgery is associated with some side effects and complications, which can range from mild to severe. The specific risks can vary depending on the type, location, size and grade of the tumor, the type of surgery and the age and overall health of the patient. Before suggesting brain tumor surgery, a patient’s treatment team will thoroughly analyze the potential benefits and risks and help the patient make a fully informed decision.

The risks of brain tumor surgery include:

Swelling and bleeding in the brain
Infection of the surgical site
Allergic reaction to the anesthesia medications
Blood clots
Impaired memory or motor skills
Seizures

What factors can influence the outcome of brain tumor surgery?

The outcome of brain tumor surgery may be influenced by a combination of individual factors, such as:

The type, location, size and grade of the tumor
The patient’s age and overall health
The extent of tumor removal
The extent of cancer spread (metastasis)
The expertise of the neurosurgeon
Any treatments administered after surgery

Benefit from world-class care at Moffitt Cancer Center

Moffitt is widely known and respected for its robust brain cancer clinical trial program, which allows many of our patients to benefit from exciting breakthroughs in treatment, such as brain tumor surgery, as soon as those options become available. In addition to a full range of treatment options and multiple expert opinions, our patients receive highly individualized and compassionate care in a single location.

If you would like to learn more about brain tumor surgery, you can request an appointment with a specialist in our Neuro-Oncology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.

Treatment

Brain Tumor Surgery