WHAT IS SURGERY FOR A BRAIN TUMOR AND WHY IS IT DONE? Whether you use the word “surgery,” “resection,” “operation,” “brain operation” or “brain surgery,” surgery is usually the first step in treating most benign and many malignant tumors. It is often the preferred treatment when a tumor can be removed without unnecessary risk of neurological damage. Surgery might be recommended to: • Remove or destroy as much tumor as possible • Provide a tumor tissue sample for an accurate diagnosis and for genomic testing • Remove at least part of the tumor to relieve pressure inside the skull (intracranial pressure), or to reduce the amount of tumor to be treated with radiation or chemotherapy • Enable direct access for chemotherapy, radiation implants or genetic treatment of malignant tumors • Relieve seizures (due to a brain tumor) that are difficult to control “Radiosurgery” is a type of intense radiation delivered to a tumor. It may be used instead of, or in addition to, conventional surgery. Radiosurgery is not surgery in the conventional sense, as no opening is made in the 4 AMERICAN BRAIN TUMOR ASSOCIATION skull. In certain cases, it may offer similar benefit and lower risk or discomfort than conventional surgery. Radiosurgery is discussed in our free publication Stereotactic Radiosurgery. Please call us at 800-886-ABTA (2282) or visit www.abta.org if you would like a copy. WHEN MIGHT SURGERY NOT BE RECOMMENDED? Before surgery your doctor will consider the following: • Location of the tumor. Where the tumor is located will determine whether it is operable or inoperable. WHAT IS AN “OPERABLE TUMOR?” An operable tumor is typically one that your doctor believes can be surgically removed with minimal risk of brain damage. WHAT IS AN “INOPERABLE TUMOR?” In some cases surgery may not be possible because the tumor is so deep within the brain that it is not accessible without excessive risk of brain damage. Tumors located in the brain stem and thalamus are two examples. Other tumors may present a problem if located near a sensitive area in the brain that controls language, movement, vision or other important functions. Computer technology is an aid in tumor removal. Gene Barnett, MD, The Cleveland Clinic Brain Tumor Institute, Cleveland, Ohio www.abta.org 5 SURGERY New imaging technologies, mapping and planning systems, navigational tools, and imaging devices used during surgery can now provide neurosurgeons with a picture of the precise location and size of a tumor during a biopsy or surgery. These advances have greatly increased the accuracy of diagnosis and enable neurosurgeons to safely remove some tumors previously thought to be “inoperable” or “inaccessible.” • Diagnosis and size of tumor. If a tumor is benign, does not cause intracranial pressure (due to its small size) or cause problems with sensitive areas, avoiding or postponing surgery might be considered. • Number of tumors. The presence of multiple tumors creates additional challenges to safe removal. • The borders, or edges, of the tumor. If the tumor is poorly defined around the edges, it may be mixed with normal brain tissue and more difficult to remove completely. • Your general health. Are your heart, lungs, liver and overall general health strong enough to endure the strains of surgery? If this is a metastatic brain tumor (one which began as a cancer elsewhere in your body), is the primary cancer controlled? • Your neurological status. Do you have symptoms of increased intracranial pressure? Are there signs of nerve damage possibly caused by the tumor? If so, further evaluation may be needed before surgery is attempted. • Previous surgery. If you’ve had recent surgery, it is usually necessary to recover from the previous procedure before going through another one. • Other options. Is it likely that another treatment would provide equal or better results at comparable or lower risk? Your doctor will take these points into consideration in forming your treatment plan. 6 AMERICAN BRAIN TUMOR ASSOCIATION WHAT TESTS MIGHT BE USED TO HELP PREPARE FOR SURGERY? Once surgery is confirmed, you will be given instructions for “pre-operative” lab work. Depending on the procedure to be done and your age, the doctor will order blood tests and a chest X-ray to verify your overall health. These will be done a few days before the procedure. Additional images of your brain may be taken to help your doctor locate the tumor’s precise location. These scans can also be used to help the team plan your surgical procedure. Highly sensitive scans are used for this purpose and may include: • Computerized Tomography (CT) • Magnetic Resonance Imaging (MRI) • Magnetic Resonance Spectroscopy (MRS) • Positron Emission Tomography (PET) Your doctor might request functional imaging scans taken while you speak, read, write, or move your arms or legs. These are called functional MRIs, echo-planar MRIs, or ultrafast or BOLD MRIs. These scans help MRI scans Medtronic Surgical Navigation Technologies, PoleStar iMRi images www.abta.org 7 SURGERY define vital areas of the