Types of surgery for brain tumours

Types of surgery

You might have an operation to:

• remove the whole tumour to try to cure it

• remove part of the tumour to slow its growth and help with symptoms

• drain a build up of fluid on your brain (hydrocephalus)

• help diagnose a brain tumour

Brain surgery might sound like a frightening procedure, but it is quite safe. Doctors who carry out these surgeries are very skilled specialists.

You can share any concerns with your doctors and cancer nurse specialist. They will be able to tell you what will happen during the operation and the possible side effects. They will answer any questions you have and help you prepare for your operation.

Brain surgery isn’t suitable for everyone. It is a major operation, so you need to be well enough to have it. Some tumours grow in areas of the brain that are difficult for surgeons to reach, such as the brain stem.

Read about the different treatments for brain and spinal cord tumours

Who does your surgery?

A specialist team of doctors does your surgery. They are called neurosurgeons. You might have a team of neurosurgeons working on your operation. They are led by the consultant neurosurgeon.

You might have other specialists working with the team. For example, an Ear, Nose and Throat (ENT) surgeon.

Surgery to remove all or part of the tumour

Surgery is an important part of your treatment. Sometimes the surgeon is unable to completely remove the whole tumour. But they will usually try to remove as much as possible. This can help to slow down the progression of the tumour and relieve your symptoms.

Find out about the possible symptoms of brain tumours

Craniotomy

A craniotomy is the most common type of operation for a brain tumour. You usually have a craniotomy under a general anaesthetic. This means that you will be asleep and won’t feel anything.   

During a craniotomy, the neurosurgeon cuts out an area of bone from your skull. This gives an opening so that they can operate on the brain.

You have scans before the operation to help your surgeon know where the tumour is. You may also have scans during the operation. Some of these scans are loaded into a computer to give the precise position of the tumour.

Your surgeon uses different tools to remove the tumour. They can use:

• a scalpel or special surgical scissors

• an ultrasound to break up the tumour and then a suction device to gently remove the tumour (ultrasonic aspiration)

• a blue fluorescent light and a microscope that helps the surgeon to see the edges of the tumour more clearly

After removing the tumour, your surgeon puts the bone back (this is called a flap). They secure the bone with small metal brackets and stitch the skin over it. For most people, the hair will hide the scar.

Awake craniotomy

Your surgeon might suggest an awake craniotomy if your tumour is close to areas of the brain that control important functions, such as speech, movement or feeling.

There are different ways of having this operation. Some people are awake for part of it, while others are awake the whole time. Your surgeon will explain what will happen in your situation.

The idea of being awake during brain surgery can sound frightening. But this is a common procedure, and you should not feel any pain. You have an anaesthetic to numb areas such as the skin and muscle. The brain itself does not feel pain. You might also have sedation to help make you feel sleepy. But you are awake enough to answer the doctor's questions.

During the operation, your surgical team makes sure you are as comfortable as possible. A nurse stays with you to help you feel calm and supported.

While you are awake, the surgeon may ask you to do simple tasks. This helps them check how different parts of your brain are working. They might ask you:

• to speak

• to move a part of your body

• what you can feel

Once the tumour has been removed, the surgeon repairs the skull and closes the skin.

Some neurosurgeons also monitor the brain’s electrical activity during surgery (neurophysiological monitoring). This can help make the operation safer and may allow more of the tumour to be removed.

Neuroendoscopy

Neuroendoscopy is also called keyhole brain surgery. You might have it to remove all or part of a tumour in the fluid filled spaces of the brain (ventricles). You may also have a neuroendoscopy to remove a build up of fluid in your brain (hydrocephalus).

An endoscope is a medical instrument, made up of a long tube with a camera attached to a monitor and an eyepiece. Endoscopes can be flexible (bendy) or rigid (fixed straight).

Your surgeon carefully makes a small hole into the skull. This is called a Burr hole. They then put the endoscope through the hole. The surgeon can see what is at the tip of the endoscope either through the eyepiece or on a monitor. There are tiny forceps and scissors at the end of the endoscope. They use these to remove the tumour. 

Removing a pituitary tumour via the nose

The pituitary is a small gland that lies in a hollow space above the back of your nose. It may be possible for your surgeon to remove a pituitary gland tumour via the nose. This is called transsphenoidal surgery.

Your surgeon usually makes a small cut on the nasal septum. This is the thin wall of bone and cartilage that separates the nostrils. They put tools through this hole and up to the pituitary gland to remove the tumour.

Your surgeon may also use an endoscope. An endoscope is a long tube that has a camera and an eyepiece. They use the endoscope to operate surgical instruments and remove the tumour.

Possible problems that may happen soon after this type surgery include:

• an infection

• pain

• a headache

• a sore nose

Longer term problems are rare but can include damage to the nerve that controls eyesight. This can cause loss of vision. There is also a risk of a stroke or bleeding inside the brain.

Read more about pituitary tumours

Surgery to drain a build up of fluid on your brain

A build up of fluid in the brain is called hydrocephalus. You might have the build up of fluid drained during surgery to remove the tumour, or as a separate operation.

Find out more about surgery to drain a build up of fluid in your brain

Side effects of brain surgery

It can take time to recover from brain surgery. You might have some side effects immediately after surgery. For example, weakness and dizziness. And some long term side effects such as problems with your speech. You can also feel very tired for some time afterwards.

It can be upsetting to learn about these side effects. Talk to your doctor or clinical nurse specialist about what to expect after brain surgery. Ask them about the side effects you might have and the support that will be available to you.

Read about possible problems and recovery after brain tumour surgery