Brain Cancer (cont.)
IN THIS ARTICLE
What Are Surgical Treatment Plans for Brain Cancer?
Most people with a brain tumor undergo surgery. (Craniotomy is the term used to refer to the surgical opening of the skull.)
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.
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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