Neurosurgery to remove all or part of the tumour
Whenever possible, your neurosurgeon will try to remove all of your tumour, or as much as is safe to. (Not all tumours can be operated on, as they may be too close to a sensitive area of the brain, e.g. that controls breathing or sight.)
To remove your tumour, your neurosurgeon needs to make a large-ish hole in your skull, so they can see into your brain. This operation is called a craniotomy. It is the most common type of surgery for brain tumours.
A craniotomy is usually performed when you are asleep under general anaesthetic, but it can be performed when you are awake.
An awake craniotomy may be performed if the tumour is close to areas of the brain that control important functions. Waking you part way through the operation allows the neurosurgeon to check where these functions are in your brain by asking you to perform certain tasks during the operation, such as reading out loud. This enables them to avoid damage to these areas.
This can sound rather scary, but if it is thought to be the best option for you, your healthcare team will discuss it with you, explaining what is done to prevent you feeling any pain and to help you mentally prepare for it.
It's important to note that the brain itself cannot feel pain, as it has no pain receptors.
Before your surgery, your neurosurgeon will discuss with you what to expect. Ask as many questions as you would like - there is no such thing as a 'silly' question.
You may like to ask about biobanking a frozen sample of your tumour, so you can be a candidate for clinical trials in the future and have any relevant genetic (biomarker) tests for your tumour. These tests, for some tumours only, can predict how well you might respond to certain treatments.
What happens during a craniotomy?
- In some hospitals, patients are first given a drink containing a substance called 5-ALA.
- Sometimes known as the 'pink drink', even though it is not pink, this causes the tumour cells in the brain to glow pink under violet light. This helps the surgeon to tell the tumour cells, at the edge of the tumour, apart from the normal cells and so remove more of the tumour.
- You will then be given a general anaesthetic to fall asleep
- A small area of your head may be shaved and you may be given an local anaesthetic to part of your scalp
- An incision (cut) is made in your scalp and a small part of your skull ('bone flap') will be removed
- If you are having an awake craniotomy, you will be woken at this point to allow your neurosurgeon to map where the functions of the brain are located in your brain
- As much of the tumour as is safely possible, will be removed - this can take some time
- In an awake craniotomy you may be able to feel pulling, but you should not feel pain as the brain itself cannot feel pain
- If all the tumour is removed, this is known as total resection
- If part of the tumour is removed, this is known as debulking or partial resection
- A small sample of the tumour (called a biopsy) will be sent to the lab for analysis and diagnosis
- The bone flap will be replaced and the wound closed using stitches or metal clips - in an awake craniotomy, you may be put back to sleep before this happens
- You are likely to be given steroids to help with any swelling.
The length of time a craniotomy takes varies according to the part of the brain being operated on. It may take around 4-6 hours, but can be longer.