Brain Cancer Surgery
Surgery is often one of the first treatments used for brain cancer and may be performed to remove as much of the tumour as safely possible, confirm a diagnosis, or relieve pressure on the brain.
What Is Brain Cancer Surgery?
Neurosurgery is a major but often essential first step in the treatment of many brain tumours. During surgery, the neurosurgeon aims to remove as much of the tumour as possible while protecting nearby healthy brain tissue. In aggressive tumours, the amount of tumour that can be safely removed is strongly linked to patient survival.
Surgery is typically performed for several reasons:
- To obtain a biopsy: a small sample of tumour tissue is removed and examined by a neuropathologist to confirm the tumour type, grade and molecular features. This information helps guide further treatment decisions.
- To remove the tumour: Neurosurgeons aim to remove the tumour completely when possible, or as much as can be safely removed without damaging critical brain structures.
- To relieve pressure in the brain: tumours can increase pressure inside the skull, causing headaches, nausea, or neurological symptoms.
- To reduce symptoms and improve quality of life: removing tumour tissue may reduce symptoms such as seizures, weakness, or speech difficulties.
- To reduce tumour burden before additional treatment: Surgery can improve the effectiveness of therapies such as radiotherapy or chemotherapy.
Although surgery is often the primary treatment, it is rarely able to remove all tumour cells. Some tumours, particularly diffuse gliomas, spread into surrounding brain tissue where individual cells cannot be seen on scans or safely removed during surgery. For these reasons, surgery is often followed by radiotherapy and/or chemotherapy to target remaining tumour cells. This combined approach is especially important for aggressive, infiltrative tumours like glioblastoma, which arise from glial cells.
Types of Brain Cancer Surgery
Several surgical techniques are used to treat brain tumours, each designed to remove as much tumour as possible while protecting healthy brain tissue and preserving neurological function.
The choice of procedure depends on factors such as tumour size, location, depth, growth pattern, and proximity to critical brain areas or major blood vessels, as well as the patient’s overall health and the type of tumour involved. Common surgical procedures include:
Craniotomy
One of the most commonly used procedures in brain surgery. During a craniotomy, the surgeon temporarily removes a section of the skull (called a bone flap) to gain access to the brain. This approach provides a wide view of the surgical area and is often used to remove large or complex tumours.
Keyhole Craniotomy
A minimally invasive form of surgery that uses a much smaller opening in the skull.
Despite the smaller incision, this technique can still provide excellent access to the tumour in selected cases. By inserting an endoscope (a thin instrument with a camera and light) through the small opening, the surgeon can clearly visualise the tumour, even when it is located near delicate or hard-to-reach areas of the brain.
The main goal of keyhole surgery is to remove as much tumour as possible (ideally, the whole tumour) while minimising damage to healthy brain tissue. Compared with traditional craniotomy approaches, keyhole surgery uses smaller openings to access the tumour.
In some cases, this may lead to faster recovery, less postoperative discomfort, and smaller scars. However, the most appropriate surgical approach depends on the tumour’s size, location, and relationship to surrounding brain structures.
Endoscopic Endonasal Surgery
A procedure that allows surgeons to reach certain brain tumours through the nose rather than through the skull. The technique, known as the endoscopic endonasal approach, avoids external incisions and provides access to tumours located at the base of the skull. This approach is commonly used for pituitary tumours, as well as other tumours that develop near the pituitary gland and surrounding structures.
Awake Brain Surgery
Also known as an awake craniotomy, this is a specialised procedure where the patient remains awake during part of the operation. While this may sound intimidating, patients are carefully sedated, kept comfortable, and closely monitored throughout the procedure.
This technique is used when a tumour is located near critical areas of the brain that control movement, speech, language, or sensation, known as eloquent areas. During the operation, the surgeon gently stimulates small areas of the brain using electrodes and asks the patient to speak, move, or respond. If stimulation affects any of these functions, the surgeon knows that area must be preserved. The type of surgery used depends on the tumour’s nature, location, and behaviour. In some cases, a full tumour removal is not surgically possible or necessary, and a biopsy is performed to diagnose the tumour. This is commonly done using stereotactic surgery, a highly precise technique guided by MRI or CT scans and computer-based navigation. During this procedure, the patient’s head is secured in specialised stereotactic equipment, and under anaesthesia, a thin needle is used to obtain a small sample of tumour tissue for diagnosis.
Accurately distinguishing tumour tissue from normal brain tissue can be challenging, especially in tumours that spread into surrounding brain areas. One technique that helps improve precision is intraoperative fluorescence-guided surgery. Patients are given a dye called 5-aminolevulinic acid (5-ALA) before surgery, which causes tumour cells to glow under a special light. This allows surgeons to better identify cancerous tissue during the operation and remove it more accurately while sparing healthy cells and surrounding brain tissue.
Preparing for Surgery
Before undergoing surgery, your healthcare team may arrange certain preoperative assessments to gauge your overall health. This may include reviewing your past medical history and any prescription or over-the-counter medicines you are taking.
- Your doctor may recommend certain blood and urine tests to assess organ function and determine if there is any risk to these organs due to surgery. An electrocardiogram and a chest X-ray may be recommended to evaluate your heart and lung health, respectively.
- Your doctor may adjust some medicines before surgery, including medicines that affect bleeding or interact with anaesthesia. The surgical plan, potential risks of the procedure, and recovery expectations will be discussed with you. You will also meet members of your healthcare team, such as the anaesthetist, who will review your health history and determine the appropriate anaesthesia and pain management plan.
- You may also undergo MRI and CT scans to help your medical team decide the treatment plan and the best possible surgical approach, depending on the type and location of the tumour. You may be asked to stop taking medicines that could increase the risk of bleeding after the procedure. Similarly, you may be prescribed medicines to help manage pain and neurological symptoms after surgery. If you have an advance care directive, you may be asked to bring a copy, and to tell your team who your substitute decision-maker is. This will help guide your medical team.
- You will also be given fasting instructions before surgery to reduce the risk of aspiration during anaesthesia.
The Surgical Procedure
Preparation and Access
On the day of surgery, after anaesthesia is administered, your head is positioned to allow better surgical access. Your hair may be clipped or shaved around the surgical site and your scalp cleaned with an antiseptic. During surgery, your surgeon will make a small incision in your scalp and create a temporary opening in the skull so they can safely reach the tumour.
Tumour Resection and Monitoring
If the tumour is located near the surface of the brain, surgery may be performed to remove as much of it as safely possible. However, if the tumour is not easily visible on the brain surface, the image guidance system is used to locate the tumour and proceed with resection. Throughout the procedure, an anaesthesiologist closely monitors vital signs such as heart rate, blood pressure, and oxygen levels.
In low-grade gliomas, greater extent of tumour removal is associated with improved survival and disease control. High-grade gliomas are far more aggressive; however, survival outcomes improve when a greater volume of tumour tissue is removed. In these cases, the benefit of removing more tumour must be carefully balanced with preserving important brain pathways, which can be challenging.
Closing and Immediate Aftercare
After the procedure is complete, the bone flap is replaced, and the surgeon sutures the incision and closely monitors the patient as consciousness returns. Throughout the procedure, care is taken to avoid damage to surrounding healthy brain tissue by using highly specialised surgical tools and computer-guided navigation systems to precisely locate the tumour within the brain.
Beyond Surgery: Advanced Treatment Options
For many primary brain tumours, surgery is the first step in a broader treatmentplan. While the goal of surgery is to remove as much of the visible tumour as possible, other treatments are often needed to address tumour cells that cannot be safely removed.. Radiation therapy (also referred to as radiation treatment) uses high-energy beams to damage or destroy tumour cells and is commonly used after surgery to target microscopic disease that may remain. Because radiation can reach areas deep within the brain, it can treat regions that may be too risky to access surgically.
In addition to established treatments, newer advancements such as targeted therapy are emerging and may change the landscape of brain cancer treatment. These treatments are designed to interfere with specific molecular pathways that drive tumour growth in certain patients. While surgery alone may be sufficient for some benign tumours, malignant brain tumours often require a combination of treatments to achieve the best possible outcomes.
Potential Risks and Complications
As with any surgical procedure, there are certain risks involved. These can include bleeding during surgery, swelling of the brain after the operation, and infection.
Managing Common Surgical Risks
Surgeons take careful steps to control bleeding during the operation using specialised instruments, cautery, and haemostatic agents. In most cases, bleeding is minimal and managed at the time of surgery. Brain swelling after the operation is usually managed with steroid medications, and the risk of infection is reduced through the use of antibiotics.
These risks are carefully managed through detailed surgical planning, including the use of preoperative imaging to determine the safest and most effective approach to tumour removal while preserving as much healthy brain tissue as possible. Close monitoring after surgery also helps detect and manage complications early.
Neurological and Functional Considerations
While many risks can be anticipated and managed, some are harder to predict. These include neurological complications such as difficulties with communication, movement, or coordination, paralysis, and cognitive changes affecting learning and memory. In all cases, your healthcare team will discuss these risks with you in advance and proceed with informed consent, always prioritising patient safety.
Recovery and Rehabilitation
Brain surgery can be physically and emotionally demanding for both patients and their families. Your healthcare team’s top priority is your safety. After surgery, you will remain in the hospital for monitoring before discharge. This stay may range from a few days to several weeks, depending on your recovery.
Soon after surgery, you may be admitted to the intensive care unit for close observation. This allows your care team to quickly detect and manage any post-operative complications. Nausea and vomiting are common within the first 24 hours after surgery. During your hospital stay, you may be given medications to reduce brain swelling and anti-seizure medicines to reduce the risk of seizures.
Post-Operative Care and Long-Term Recovery
Recovery after brain surgery can take weeks to months and depends on how invasive the procedure was and your overall health. Some patients may require rehabilitation to help return to daily activities.
Rehabilitation can significantly improve function and may include physiotherapy to support mobility, balance, and coordination; occupational therapy to assist with everyday tasks such as dressing and showering; cognitive support to help with attention, memory, and learning; and speech and language therapy for communication difficulties.
Before discharge, your healthcare team will discuss an ongoing monitoring plan, including follow-up scans to check for tumour recurrence. Detecting tumour regrowth early allows for more effective management.
Neuro-Rehabilitation and Brain Health
Recovery after brain tumour surgery involves more than just physical healing.. Some patients experience changes in memory, attention, or other cognitive functions as the brain recovers from surgery or treatment. Neuro-rehabilitation programs, including cognitive rehabilitation, are often used to help patients regain or adapt these skills.
Cognitive rehabilitation involves structured mental activities (or brain exercises) designed to improve functions such as focus, problem-solving, and information processing. Guided by rehabilitation specialists, these programs help the brain adapt and reorganise through a process known as neuroplasticity. Over time, this can support recovery, improve independence, and enhance quality of life following treatment.
When Surgery Is Not an Option
Even though surgery is often the primary treatment for brain cancer, it may not be suitable in all cases. Surgery may not be possible if the tumour is located very close to critical (eloquent) areas of the brain or in regions that are difficult to access safely; In these situations, the tumour may be considered unresectable, meaning it cannot be safely removed, or inoperable if surgery cannot be performed at all.. A patient’s overall health can also influence whether surgery is recommended.
In these situations, your healthcare team will carefully weigh the potential benefits of surgery against the risks, including how well your body can tolerate the procedure and recover afterwards. If surgery is not feasible, your multidisciplinary team may recommend alternative treatments such as radiotherapy, with or without chemotherapy.
In some cases, patients may also be considered for participation in clinical trials, including immunotherapy trials, if the tumour type makes them a suitable candidate.
Questions to Ask Your Neurosurgeon Before Brain Surgery
Facing brain cancer surgery can feel overwhelming, and knowing what to ask your neurosurgeon can make a big difference. Clear, focused questions help you understand the type of surgery recommended, the expected benefits and risks, what recovery will look like, and any alternatives that may be available. Use the questions below to guide your conversation and feel more informed and prepared.
What type of surgery is recommended and why?
What are the expected benefits vs risks?
What should my recovery expectations be and when do I need to follow-up?
What is the possibility of a successful brain tumour removal surgery?
How will this impact my quality of life pre- and post-surgery?
Disclaimer: All Cure Brain Cancer Foundation website content is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. You should seek your own medical advice from your doctor or other qualified health professionals.
References
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