Brain Cancer Surgery & Surgical Oncology Procedures

Surgery for Brain Cancer

Brain cancer treatment at Cancer Treatment Centers of America (CTCA) commonly involves surgery as the first line of treatment. Our cancer experts are experienced in performing minimally invasive surgical procedures for brain cancer that precisely and safely remove tumors.

The goal of brain cancer surgery is to locate and remove as much of the cancerous tissue as possible, called debulking, and to understand the extent of cancer in the brain.

Surgery can also help to relieve pressure inside the skull and restore lost neurological function. It can help to relieve difficult-to-control seizures caused by the tumor. Sometimes, surgery is used to enable direct access for other treatments, such as chemotherapy or radiation therapy.

Brain cancer surgery often begins with a biopsy. In a biopsy, we remove samples of cancerous tissue from the brain, and a pathologist examines the samples under a microscope for a definitive diagnosis. Often, during a biopsy, we’ll remove the tumor in its entirety, which is particularly important when the tumor threatens important brain structures.

Resectable vs. Unresectable Brain Tumors 

The location and size of the brain tumor, along with other individual factors, determine whether a tumor is resectable or unresectable. Some tumors are considered unresectable if they’re located in critical areas of the brain, where surgical removal would be too dangerous or cause too much damage to healthy brain tissue. The safety of tumor resection may be increased by the use of neuro-physiological monitoring “brain mapping.” We use brain mapping techniques whenever possible during brain and spinal surgery.

Minimally Invasive Surgical Techniques for Brain Cancer

In the past, brain cancer surgery often required larger incisions to fully expose the area of the tumor. With advances in technology, we much less frequently need to make large incisions to completely remove a tumor from the brain.

We're now able to use endoscopy to examine a brain tumor very closely. With an endoscope (a long, thin tube-like device equipped with a video camera and light), we can work through small channels and around corners to position the camera right near the tumor. This technique is particularly suited for anterior skull base tumors.

The following are some potential advantages of minimally invasive surgical techniques for brain cancer:

• Improves speed of recovery
• Lessens pain during recovery process
• Allows other cancer treatments to resume sooner
• Helps you return to normal activities more quickly

Surgical Procedures for Brain Cancer

Depending on the type and grade of the tumor, the following are some brain cancer surgeries our doctors perform:

• Craniotomy: Using specialized tools, we first remove a piece of bone from the skull for access to the tumor. Then, we remove all or most of the tumor. After surgery, the bone is usually replaced. In a craniectomy, the bone is replaced later (or not replaced at all) for various reasons, like if swelling is expected after surgery.
• Endonasal Endoscopy: We use an endoscope to navigate and access tumors through the nose and sinuses. Using image guidance and special instruments attached to the endoscope, this type of brain cancer surgery allows us to then remove tumors or take samples for biopsy.
• Neuroendoscopy: Through a small opening in the skull, we use an endoscope to see inside the brain. We can then remove tumors or take biopsy samples using special instruments attached to the endoscope.

Other Procedures

• Shunt: We place a thin tube (called a shunt) into a ventricle of the brain, through a small hole in the skull. The shunt moves excess fluid from the brain to another part of the body, such as the abdominal cavity, where it’s absorbed into the bloodstream. A filter catches stray tumor cells that may be in the cerebral spinal fluid (CSF). This procedure can help relieve pressure in the skull.
• Placement of an Ommaya Reservoir: During this brain cancer surgery, we implant a small reservoir attached to a tube under the scalp. The tubing leads into a ventricle of the brain where the CSF circulates, allowing us to deliver chemotherapy to the brain and CSF, or to remove fluid for biopsy. The reservoir can be removed when it’s no longer needed.

Sophisticated Brain Mapping Tools

We use sophisticated tools that enhance the precision and safety of brain cancer surgery. These tools allow us to remove tumors that may otherwise have been inoperable, while preserving neurological function:

• Intraoperative neuronavigation uses an advanced MRI system to map areas of the brain responsible for important functions. The map then allows us to precisely plan surgery to avoid damage to those important areas.
• Intraoperative electrophysiology “brain mapping” (also called motor mapping and language mapping) is like GPS for the brain. We use small electrodes placed on the outer layer of the brain to stimulate the brain and areas around the tumor. This helps us locate regions of the brain to avoid, such as those responsible for speech or movement.

Delivering Other Treatments During Brain Cancer Surgery 

We can also deliver other cancer treatments at the time of surgical resection. For example, during surgery we can deliver local chemotherapy, also known as BCNU, or Gliadel^®, wafers directly to the brain. This technique targets chemotherapy to the brain tumor and resection area, helping to minimize side effects related to systemic chemotherapy, like nausea and vomiting.

In addition, another treatment under investigational use for brain cancer treatment is Intraoperative Radiation Therapy (IORT). With this technology, we can deliver radiation directly to the area of the tumor resection at the time of surgery, helping to avoid damage to adjacent normal structures, particularly the scalp and the skin on the scalp.

Next Topic: Chemotherapy for Brain Cancer