Brain cancer surgery: How it works and what to expect

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Surgery is usually the initial treatment for brain tumors and may be the only treatment necessary for low-grade brain tumors.

During surgery, a surgeon attempts to remove all, or as much, of the brain tumor as possible without damaging healthy brain tissue.

Removing or reducing the size of the brain tumor can help relieve symptoms caused by the pressure created by the tumor pressing on the brain.

Surgery may also help treat cancers, including brain cancer, in the following ways:

• confirm a cancer diagnosis through biopsy and help doctors learn more about the type of cancer
• investigate the tumor’s size and spread to help with staging and treatment decisions
• treat low-grade or early-stage cancers
• “debulk” or reduce the size of the tumor, if removing it entirely is not possible to help make other cancer treatments more effective
• prevent cancer
• repair tissues damaged by the tumor removal
• insert a tube for drug delivery

Learn more about brain cancer here.

There are a few different types of surgery that may be used for brain cancer. The surgery used may depend on the type, location, and size of the tumor.

Craniotomy

Craniotomy involves the removal of part of the skull to have an opening where a doctor can operate on the brain and remove all or most of the tumor. After removing the tumor, the surgeon returns the bone and secures it with small metal brackets and stitches.

A person undergoes a craniotomy under general anesthesia, meaning they will be asleep and not feel anything.

A surgeon may use a scalpel, special scissors, or ultrasound to break up the tumor with a suction device to remove it, known as ultrasonic aspiration.

Aside from these, they may use different tools to aid in the removal of the tumor, including:

• A fluorescent dye — a person will take by mouth — highlights tumor cells and doctors use this with a special microscope to differentiate healthy cells from tumor cells.
• Cortical mapping helps doctors identify brain areas used for vital functions, such as motor skills, language, and sensation. Intraoperative language mapping is an example of this.
• Enhanced imaging devices, including image-guided surgery (IGS), help surgeons get an accurate map of the tumor’s location.

Learn more about craniotomy.

Awake craniotomy

This is similar to a craniotomy, but a person stays awake during the surgery. A surgeon may suggest this procedure if the tumor is near the parts of the brain that controls essential brain functions, such as speech, senses, or movement.

A person will have a general anesthetic at the start of the operation, which a doctor reduces so that the person wakes up. The surgeon may also ask a person to do tasks during the surgery to check the functioning of different body parts.

Neuroendoscopy

Neuroendoscopy, or keyhole brain surgery, aims to remove all or part of tumors in the ventricles, the fluid-filled spaces in the brain.

A surgeon uses an endoscope, a long tube with a camera attached to an eyepiece, and a monitor.

The procedure involves making a small hole — called a burr hole — into the skull, where the surgeon inserts the endoscope. The surgeon uses small forceps at the end of the endoscope to remove the brain tumor.

Laser interstitial thermal therapy

Laser interstitial thermal therapy (LITT) is an emerging surgical treatment for intracranial lesions. It uses light energy to create a thermal reaction with the target tissue, removing the lesion.

Endoscopic transsphenoidal surgery

This is a type of surgery for tumors at the base of the brain. This involves a surgeon inserting an endoscope through the nose and skull into the lower part of the brain.

A person may experience immediate side effects related to the surgery, which may include:

• weakness
• dizziness
• lack of coordination and balance
• personality and behavior changes, including agitation
• confusion
• speech problem
• seizures

It is also possible to have long-term issues after brain surgery. This depends on which area of the brain may have damage. Long-term issues may include:

• difficulty walking
• speech problems
• memory and concentration difficulties
• behavior changes

Complications related to surgical intervention may include:

• infection
• bleeding
• fluid buildup in the brain (postoperative hydrocephalus)
• new neurological deficits
• lack of seizure control
• injuries to brain structures near the tumor, such as blood vessels and nerves
• brain swelling
• death

Risk factors for surgical complications

A person’s overall health, age, and tumor position can influence surgical outcomes.

Younger patients who receive an early diagnosis and only have focal partial seizures typically have a more favorable outlook regarding postoperative improvement.

The following non-medical factors may affect surgical outcomes, according to a 2021 review:

• age
• gender
• socioeconomic status
• type of hospital
• preoperative psychological status
• preoperative cognitive status

After surgery, a person goes to the recovery room, where the medical team monitors their status. A person may need to go to the intensive care unit (ICU) or neuro-critical care unit for immediate nursing care and observation.

A person may:

• receive frequent neurological checks
• have vital sign monitors, including a blood pressure cuff, oximeter, and ECG
• have a bandage on their head and dressing over the wound
• have several tubes in place, including a urinary catheter, a drain in the wound site, an intravenous (IV) line into an artery, and an intracranial pressure monitor

Medical staff typically remove surgical clips or stitches between 5–14 days after surgery.

The length of stay in the hospital after brain cancer surgery depends on the following:

• the type of surgery performed
• a person’s age and overall health
• location of the tumor in the brain
• presence of complications

A person’s medical team continues to check the person’s status to check for tumor recurrence. They will also help manage side effects and complications and monitor their health.

Follow-up care may include routine monitoring with physical exams and medical tests. A person may also need certain rehabilitation therapies to help them improve, including:

• speech therapy
• occupational therapy
• physical therapy
• medications
• neuropsychological testing

It is important for an individual to speak with their doctor about concerns they may have and follow all follow-up care instructions.

A 2022 study of patients who underwent brain surgery found that their quality of life dropped 5 days after surgery but significantly improved within 30 days after surgery. This was especially true with patients who underwent meningioma and neuroblastoma surgery and lowest in patients treated for metastatic tumors.

Surgery, however, may not be as effective for some types of brain tumors, such as lymphomas.

Approximately 79% of those who underwent gross total tumor resection were seizure-free compared to 43% who underwent subtotal resection.

Many factors play a role in the effectiveness of surgery for brain cancer. An individual should discuss these factors with a doctor.

Brain cancer surgery is the initial treatment for many types of brain tumors. It can effectively remove the tumor, reduce intracranial pressure, and improve seizure control. It also carries certain risks, such as bleeding, fluid buildup in the brain, and new neurological problems.

Factors, such as age, overall health status, type of tumor, and location, may influence surgery outcomes. Follow-up care after surgery and rehabilitation therapies are also crucial for recovery and long-term health.