Neurosurgery tumor treatment at a glance
- Neurosurgery is performed on the nervous system to remove brain tumors and spinal tumors that are sometimes cancerous and to obtain a biopsy for diagnosis.
- Neurosurgeons use different types of surgeries and techniques based on the type of brain or spinal tumor (of 120 specific types), stage of cancer and the individual’s condition.
- Advances in imaging, equipment and techniques make surgery the preferred treatment option for many brain and spinal cancers and tumors.
- Neurosurgery for tumors carries unique risks and considerations due to the complexity of the brain and spinal cord, as well as normal risks of surgery.
- The cCARE neurosurgery team will discuss side effects, risks and benefits of surgical options with each patient to arrive at the best brain or spine tumor treatment plan.
What is neurosurgery for brain tumors and spinal tumors?
Neurosurgery addresses issues of the brain and nervous system by removing tumors or reducing their size via incisions, by aiding in reducing symptoms of brain and spinal tumor patients, and by serving other functions in the treatment of these tumors. Neurosurgery is also used to obtain biopsies from the brain and spine tumors prior to treatment.
Neurosurgery is the preferred treatment for a brain or spinal tumor that can be removed without unnecessary neurologic damage or risk. Patients with brain tumors or spinal cord tumors are generally treated by a team of physicians.
Brain tumor & spine tumor classifications treated by neurosurgery
The World Health Organization’s (WHO’s) classification system for tumors of the brain and central nervous system identifies 120 different types of tumors. WHO classifies brain and spinal cord tumors by cell origin, and then grades the tumors from benign to least malignant to most malignant. Some types of brain and spinal tumors are more apt to occur in adults than in children, and vice-versa.
Central nervous system tumors that neurosurgery can treat include the following classifications, some of which have several subcategories and various specific tumor types.
- Tumors originating from stem cells of the nervous system (neuroepithelial tissue)
- Tumors originating from the protective covering of the brain and spinal cord (meninges)
- Tumors originating from the bottom of the brain & spinal cord (cranial and paraspinal nerves)
- Cancer of the lymphatic system, blood or bone marrow (lymphomas and haematopoietic neoplasms)
- Germ cell tumors (normally occurring first in the ovaries or testis)
- Tumors originating from the pituitary gland and at the base of the skull (sellar region)
- Metastatic tumors (originated in another part of the body).
Low-grade brain and spinal tumors that are good candidates to be completely removed may only require neurosurgery. Neurosurgery with radiation can also be used on some forms of low-grade tumors. Higher-grade tumors may call for neurosurgery in combination with radiation and chemotherapy.
Neurosurgery cannot cure some types of tumors such as glioblastomas (a very aggressive brain cancer) or anaplastic astrocytomas (a rare brain cancer) that often spread rapidly to other brain tissue. But neurosurgery can help reduce the size of the tumor prior to radiation or chemotherapy, helping those treatments work more effectively and prolong the patient’s life.
Neurosurgery tumor treatment options
Treating brain tumors and spinal tumors can be challenging. The body’s blood-brain barrier normally prevents chemotherapy from reaching these tumors, so neurosurgery is often the more effective treatment. Advances in imaging equipment and neurosurgical techniques greatly improve surgeons’ ability to identify the cancerous cells, thereby leaving healthy brain tissue unharmed.
Operating near a delicate part of the brain or around the spinal cord requires great skill. And as with surgical and other treatments for tumors, it may not be possible to remove all tumors with neurosurgery, and portions of tumor growth may not even be visible to the surgeon during the operation.
Some brain and spinal tumors are inoperable. Such tumors can be too near a vital structure that is likely to result in serious neurologic damage, or they may be in an area of the brain the surgeon cannot access. In such cases, other treatments are necessary.
Types of neurosurgery for brain & spinal tumors
Completely removing a brain tumor or spinal tumor is the best outcome of neurosurgery when treating these lesions. If complete removal is not possible, neurosurgery can also reduce the size of the tumor or treat side effects of the brain or spine cancer or benign tumors.
The general types of neurosurgery for cancer include the following.
Craniotomy removes a section of the skull so the neurosurgeon can extract as much of the tumor as possible, then replaces the skull section. Neurosurgeons use various techniques, depending on the location and stage of the tumor. For example, a neurosurgeon may perform an awake craniotomy when the tumor is very close to a part of the brain that controls a vital function such as speech or vision. This technique utilizes cortical mapping that involves electrical stimulation and the patient’s response that guide the neurosurgeon in avoiding damaging these critical areas of the brain.
Tumor removal & debulking
Complete removal surgically extracts all of the spine or brain tumor. A neurosurgeon may perform a partial removal when complete removal is likely to result in neurologic damage. Debulking refers to reducing a brain tumor or spine tumor’s size.
Neuroendoscopy, also known as key-hole surgery, is a minimally invasive surgery that utilizes an endoscope (a long tube with a camera and eyepiece for viewing) inserted through small holes made in the skull or through the mouth or nose.
Microsurgery allows the surgeon to use a high-powered microscope to more accurately tell the tumor cells from healthy cells.
Ultrasonic aspiration uses vibrating sound waves to break up a brain tumor or spinal tumor, with suction used to remove the tumor pieces.
Fluid draining is accomplished by inserting a shunt (a narrow piece of tubing) to remove excess fluid from the brain that can cause symptoms such as nausea, drowsiness and headaches, which can sometimes be life threatening.
Neurosurgeons can surgically implant chemotherapy into the brain tumor or spinal tumor tissue, or place chemotherapy after neurosurgery is performed to remove a tumor.
Ventricular access device
Also called an Ommaya reservoir, a ventricular access device is placed under the scalp with tubing going to the brain’s fluid-filled spaces (ventricles) so the neurosurgeon can sample the fluid, drain it or deliver chemotherapy into the fluid.
Other surgical techniques
Neurosurgeons utilize other techniques and types of surgeries, such as removing pituitary tumors through the nose (transphenoidal surgery). The cCARE neurosurgery team will discuss all appropriate treatment options with each patient, taking many factors into consideration before establishing a treatment plan involving surgery.
Imaging assistance in neurosurgery
Being able to locate the brain tumor or spine tumor and then tell cancerous cells from nearby healthy ones is one of a neurosurgeon’s primary objectives. Several techniques, such as the microsurgery or awake craniotomy mentioned above, can aid the neurosurgeon’s identification.
MRI and CT scans are often conducted prior to surgery to locate tumors, as well as during neurosurgeries after the brain has been exposed. Interoperative imaging can be performed at different times during surgery to track remaining parts of the tumor so the neurosurgeon can remove them.
A type of fluorescence-guided neurosurgery called M5-ALA (Gliolan) involves a liquid solution of aminolevulinic acid hydrochloride taken by adults who have high grade glioma cancers. The cancerous tumor absorbs the liquid, making it more visible under a special fluorescent light so the surgeon can more accurately remove tumor cells.
Risks & considerations of neurosurgery for tumors
All surgeries, including neurosurgery, carry risks. These general surgical risks include blood loss, pain, scaring, risk of infection, blood clotting, pneumonia, damage to tissue or organs, and negative reaction to anesthesia.
When operating on brain tumors, neurosurgeons try to limit swelling of the brain, which is a major concern. Corticosteroid drugs are generally given before and after neurosurgery to prevent potential problematic swelling.
One of the neurosurgeon’s primary concerns in treating brain tumors and spinal tumors is to avoid damage that can occur to brain and neurologic functioning. This makes identification and removal of only tumor cells very important and drives many of the neurosurgical techniques and approaches when treating such.
Specific risks of neurosurgery for tumors can be related to the area of the brain or spinal cord being treated. For instance, surgery on a tumor close to nerves of the eye could result in vision loss or impairment.
Risks and possible side effects associated with neurosurgery for cancerous and benign tumors include:
- Difficulties with balance and coordination
- Brain swelling
- Memory and thinking problems
- Impaired vision or speech
- Stroke, coma and/or death.
Side effects from neurosurgery or the tumor itself range from mild to serious. Some side effects may last quite a while, and some side effects may not be present until long after surgery.
Neurosurgery recovery & follow-up care
Recovery from brain and spinal tumor surgery can take weeks or longer. Length of recovery and related complications depend on the area where the tumor was located, the tumor’s type and/or stage, the neurosurgery procedure performed, and the patient’s health and age. The American Cancer Society has resources that can help neurosurgery patients prepare for recovery and follow-up care.
The cCARE neurosurgery team can provide extensive follow-up care for brain tumor and spinal tumor survivors, due to the complexity of the operation and its effect on areas of the nervous system. This can involve monitoring, medications, testing and rehabilitation services. Rehabilitation therapy can be very important after nervous system cancer and tumor surgeries, which can affect parts of the brain and spine and hamper motor skills and thinking.