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Brain Cancer (cont.)

What Are Surgical Treatment Plans for Brain Cancer?

  • The treatment protocols vary widely according to the location of the tumor, its size, grade, and type, the patient's age, and any additional medical problems that the person may have.
  • The most widely used treatments are surgery, radiation therapy, and chemotherapy. As mentioned in some cases, more than one of these treatment types is used.

Most people with a brain tumor undergo surgery. (Craniotomy is the term used to refer to the surgical opening of the skull.)

  • The purposes of surgery are to confirm that the abnormality seen on the brain scan is indeed a tumor, to assign a grade to the tumor, and to remove the tumor. If the tumor cannot be removed completely, the surgeon will at least take a sample of the tumor to identify its type and grade.
  • In some cases, mostly in benign tumors, the disease can be completely cured by surgical removal of the tumor. A neurosurgeon will attempt to remove the tumor when possible.

Patients may undergo several treatments and procedures before surgery.

Overview of Surgery for Resection of Brain Tumor

The intent of surgery for tumors is to remove as much of the tumor as is safely possible with the minimal possible loss in brain function. The large majority of patients undergo this procedure under general anesthesia. Some surgeries are done awake or under light sedation for the purpose of mapping language function. For surgery done under general anesthesia, an endotracheal tube is placed, while for those done awake, a laryngeal mask airway (or no airway) is placed and the patient is deeply sedated. The head is appropriately positioned using a clamp system that holds the skull motionless. An image-guided navigation system is often used to help determine the precise location of the incision. The scalp is prepped, after the hair is clipped, the planned incision line is infiltrated with local anesthesia, and the scalp is then incised and pushed aside to expose the skull bone. A portion of the skull is temporarily cut away and the lining tissues of the brain are opened. If it is necessary to determine whether brain function is compromised, the patient is awakened from sedation in order to respond as mapping procedures are carried out.

In either case, tumor resection is then carried out. A portion of the tumor is usually sent to a pathologist for analysis. The surgeon may also decide to place biodegradable polymer wafers that deliver chemotherapy drugs (Gliadel wafers) into the tumor cavity. Once the tumor resection is complete, the membranes surrounding the brain are closed and the skull is closed, often with the use of titanium plates and screws that help hold it rigidly in its desired position. The scalp is closed; some surgeons use drains placed under the scalp for a day or two after surgery to minimize the accumulation of blood or fluid.

  • Stereotactic radiosurgery is a newer "knifeless" technique that destroys a brain tumor without opening the skull. CT or MRI scan is used to pinpoint the exact location of the tumor in the brain. High-energy radiation beams are trained on the tumor from different angles. The radiation destroys the tumor. Equipment used to do radiosurgery varies in its radiation source; a gamma knife uses focused gamma rays, and a linear accelerator uses photons, while heavy-charged particle radiosurgery uses a proton beam.
  • The advantages of knifeless procedures are that they have fewer complications and the recovery time is much shorter. Disadvantages include the lack of tissue available to send to a pathologist for diagnosis and brain swelling that can occur after the radiation therapy.
  • If there is excess cerebrospinal fluid buildup because of a blockage of fluid passageways by the tumor, a thin plastic tube called a shunt may be placed to drain the fluid. One end of the shunt is placed in the cavity where fluid collects, and the other is threaded under the skin to another part of the body. The fluid drains from the brain to a site from which the fluid can be easily eliminated.

Inoperable Brain Tumors

Inoperable tumors are those that are located in an inaccessible place in the brain that brain surgeons cannot reach. Alternatively, although they may be able to reach the tumor, to remove it, the surgeons may have to destroy or damage so much nearby brain tissue so that the surgery may damage the patient as much as the tumor. Inoperable tumors can be of any type or size. What makes a tumor inoperable is whether or not a surgeon is confident that they can access the tumor without disrupting other significant brain tissues such as those necessary for essential body functions (for example, speech or movement). Other tumors are deemed inoperable when they are so penetrated by blood vessels that removal of the tumor and its vascular system is likely to severely damage or cause death in the patient. The surgeon determines if a patient's brain tumor is inoperable, so it is advisable to seek a second opinion from another surgeon as another brain surgeon may consider the tumor to be "operable."

Last Reviewed 9/11/2017

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