Brain Surgery

When should I consider brain surgery?

Being a candidate for brain tumor surgery or skull base tumor surgery depends on the type, location, and size of the tumor. At NeurosurgeryOne, we use the latest in diagnostic testing to analyze the tumor and determine what treatment approach provides the most benefits with the least amount of side effects. For some patients, radiation or chemotherapy are preferred over surgery. For other patients, tumor surgery is most effective. Some brain tumor and skull base tumor patients benefit most from a combination of radiation and surgery or chemotherapy. The goal of brain tumor and skull base surgeries is to remove as much of the tumor as possible.

For patients with multiple (5-10) metastatic lesions, surgery is typically not recommended. Generally, stereotactic radiosurgery (SRS) will be the first line of treatment with whole brain radiation as a subsequent option. Metastatic tumors are often treated with chemotherapy that targets the systemic disease.

What types of surgery are used to treat brain conditions?

For patients for whom brain tumor surgery or skull base surgery is advised, there is a range of minimally invasive and full surgical options available based on the type of tumor, consistency of the tumor (meaning is the tumor hard, soft, etc.), and its location:

• Minimally invasive brain surgery
  • Minimally invasive endoscopic surgery may be an option for skull base tumors that involve the anterior skull base. Some pituitary tumors may also be removed endoscopically. During minimally invasive endoscopic surgery, the tumor is accessed through the nose. Because the skull is not affected, the procedure has shorter recovery times as surgery time is much reduced from open surgery and there is no incision wound. Generally, neurosurgeons at Neurosurgery One collaborate with otorhinolaryngology (ENT) surgeons to perform minimally invasive skull base endoscopic surgeries.

• • Minimally invasive brain tumor surgery is often referred to as retro-sigmoid craniotomy or “keyhole” craniotomy. During keyhole craniotomy, the tumor is accessed through a small incision behind the ear. Keyhole craniotomy is most often recommended for skull base tumors, meningiomas, acoustic neuromas, and some metastatic brain tumors. Keyhole craniotomy procedures involve minimal scarring, shorter recovery times, reduced hospital stays, and less pain when compared to traditional craniotomy.

• Biopsy is a procedure in which a small sample of the tumor is taken to determine its type and whether or not it’s cancerous. Biopsies are not generally performed if a tumor is too deep within the brain and accessing the tumor presents more risks than benefits.
• Craniotomy is the most common type of surgery for brain tumors and skull base tumors that are not of the anterior skull base. Craniotomies are open brain surgery to remove a portion of the skull to access the brain and eliminate as much of the tumor as possible. During a craniotomy, a resection (removal) of the tumor is performed. Resections can be full or partial, depending on whether the entire tumor is removed or just a portion of the tumor. Based on the consistency of the tumor, the resection might involve removing the tumor with a scalpel or scissors, laser ablation, suction, or ultrasonic aspirator. Traditional craniotomies are performed with the patient asleep.
• Fiber tracked mapping, also called brain mapping or brain GPS,  allows for removal of deep-seated tumors. This specialized MRI mapping allows for a craniotomy to be performed on tumors that were often deemed inoperable in the past.
• Awake craniotomies allow for surgery on tumors that affect eloquent regions of the brain, which are also known as functional areas of the brain like those that control speech, vision, or movement. By performing the craniotomy while the patient is awake, the neurosurgeon can use brain mapping to pinpoint the lesions in the brain causing symptoms and then test the area in surgery to minimize risks of impacting the patient’s functional capabilities. Awake craniotomies are most commonly recommended for patients with intrinsic tumors, meaning the tumor is inside the brain. Interoperative mapping for high-grade gliomas during awake craniotomy show better outcomes for patients, including extent of tumor resection, lower complication rate, and greater postoperative survival rate as compared to traditional asleep craniotomy.

For patients with malignant brain tumors, chemotherapy and radiation may be recommended in addition to surgery or as an alternative to surgery. Lymphomas are generally treated with chemotherapy or radiation and not surgery.

What should I ask a neurosurgeon about brain surgery?

Tumor surgery is nothing to take lightly and choosing a neurosurgeon who you feel comfortable with is an important part of the process. If you move forward with brain surgery, be sure to assess two important aspects of your neurosurgery team:

1. Are you comfortable with and confident in your neurosurgeon?
2. Does the neurosurgery team fully explain and support you throughout the process?

As you consider neurosurgeons, it might be helpful to ask these questions:

• What is your training in neurosurgery? Are you fellowship trained?
• Do you specialize in brain tumors and/or skull base tumors?
• How often have you completed this type of brain surgery? What are your outcomes and infection rates? (Also ask about the hospital’s infection rate or look online at Medicare’s Hospital Compare)
• What evidence can you provide that supports moving forward with this type of surgery?
• Are there other treatment options besides surgery?
• What are the pros and cons of this type of surgery?
• What can I expect before, during, and after surgery?
• What can I expect in terms of communication with you and your team? Can I contact you directly via phone or email? Can I contact you after hours?

Also, consider these aspects of your interactions with the neurosurgery team:

• How does the team make you feel?
• Do you feel like your goals and needs are understood and addressed?
• Is the team helpful with your questions?
• Does the neurosurgeon make you feel comfortable and confident?

How do I prepare for brain surgery?

To ensure your body and mind are prepared for brain tumor and skull base tumor surgery, adopt a pre-surgery plan that includes maintaining a healthy weight and diet, being well rested, staying active, and keeping well hydrated. In addition, you will want to:

• Continue your regular medications as instructed by your neurosurgery team
• Discontinue blood thinners at least 5 days in advance of surgery unless otherwise directed by your neurosurgeon
• Discontinue use of medications and supplements that increase bleeding, like Vitamin E, 5-7 days prior to surgery
• Bolster your support system and keep members informed
• Discuss your surgery with your primary care physician
• Complete pre-surgery tests and lab work
• Follow any pre-surgery instructions recommended by your neurosurgeon. You may need to start taking a steroid or discontinue certain medications that could interfere with surgery of your ability to recover.

At NeurosurgeryOne in Denver, our expert neurosurgeons and their teams collaborate with you at every stage of the process, ensuring that you are clear about how to prepare for surgery.

What can I expect during brain surgery?

Before brain surgery

Neurosurgery One uses the latest in diagnostic testing to determine what type of tumor surgery may be right for you.

1. Our specially trained brain tumor and skull base neurosurgeons will meet with you to outline your goals, review your symptoms, and discuss the process.
2. We often use image-based testing such as MRI to assess the size and location of the tumor. A biopsy of the tumor may be taken if it is deemed safe and necessary to do so.
3. Based on your type of tumor, we may collaborate with oncologists, radiologists, and or otorhinolaryngology (ENT) specialists.
4. Once the specifics of the tumor are understood, our neurosurgery team will identify the best surgical options and present you with the benefits and risks of surgery as well as any alternative options.

During brain surgery

Each brain tumor and skull base surgery entails a variety of steps unique to each procedure as well as the tumor type, location, and consistency. Generally, you can expect the following during tumor surgery.

• Careful and consistent supervision by a team of anesthesiologists, nurses, and surgeons to ensure your vital signs, including heart rate, blood pressure, and oxygen levels remain in safe ranges. The anesthesiology team ensures you remain asleep unless directed by the neurosurgeon, which may be done to test functional elements such as speech or movement during surgery.
• Your hair may be shaved or cut to reduce the chance of infection.
• Based on whether the surgery is open or minimally invasive, the time of the procedure can vary in length. On average, open surgery craniotomies take between 3-6 hours.
• For craniotomies and tumor resection surgeries, a small portion of the skull is removed to allow the neurosurgeon access to the tumor.
• During some brain tumor or skull base tumor procedures, interoperative imagining such as interoperative CT scans may be used to confirm the tumor edges (margins). Typically, patients undergo an MRI prior to surgery, which is then used to create a 3D map of the brain so neurosurgeons can minimize incision size, localize the tumor, select the best trajectory for accessing and removing the tumor, and avoid eloquent areas of the brain including those that affect speech and movement.
• Once the tumor is removed, if an area of the skull was removed during the procedure, it is replaced and repaired.

After brain surgery

• Patients who undergo craniotomy typically spend 1-2 days in the ICU and then 3-5 days in the hospital recovering before going home.
• Patients who undergo a minimally invasive endoscopic surgery typically spend 2-4 days total in the hospital.
• Based on the location of the tumor and invasiveness of the surgery, some patients may benefit from inpatient rehabilitation before returning home.
• The most common side effects immediately after brain tumor and skull base tumor surgery are headaches; bruising near the eyes, forehead, or around the incision site; and numbness or tingling near the incision site. These side effects are often controlled with medication and subside within a few days of surgery.
• Some brain tumor surgery and skull base tumor surgery patients may have a shortened attention span, become easily irritated, and tire easily for a few months post-surgery.

Most patients recover from surgery within 3-6 weeks and often feel like they never underwent brain surgery after about 6 months.

For any research statistics included on this page, please refer to our Brain Tumor Research page for links to studies and other helpful resources.