brain that control language and movement centers. Diffusion Tensor Imaging MRI’s may be used to generate maps of the nerve pathways called “fiber tracking.” Use of fiber tracking may help the surgeon avoid disrupting important nerve connections within the brain itself. Vital areas can also be defined by a procedure called brain mapping. At the beginning of the surgery, tiny electrodes are placed on the outer layer of the brain. Stimulating these electrodes helps the neurosurgeon determine the functions of those sensitive parts of the brain so they can be avoided during surgery. WHAT TYPE OF SURGERY MIGHT BE RECOMMENDED? Before the procedure, the neurosurgeon will talk with you about the type of surgery planned. The words and the terms may be new to you, and therefore sound complicated. The most common types of surgery for brain tumors are listed below. BIOPSY A biopsy is a procedure to remove a sample of tumor tissue. A pathologist then microscopically examines the sample to determine the exact type of tumor. The tissue may also be analyzed for its chromosomal makeup and other chemical (molecular) characteristics. A biopsy may be performed for the sole purpose of obtaining a tissue sample. It may also be done as part of the surgery to remove the tumor. There are three types of biopsy: • Needle biopsy. After a small incision is made and a hole is drilled into the skull, a hollow needle is passed through the hole into the tumor. A small amount of tissue is drawn up into the hollow part of the needle for examination. 8 AMERICAN BRAIN TUMOR ASSOCIATION • Stereotactic biopsy. The same procedure as a needle biopsy but performed with a computer-assisted guidance system that aids in the location and diagnosis of the tumor. • Open biopsy. The tissue sample is taken during an operation while the tumor is exposed. CRANIOTOMY A craniotomy is the most common type of surgery to remove a brain tumor. “Crani” means skull and “otomy” means cutting into. The procedure typically involves shaving a portion of the head, making an incision in the scalp, then using specialized medical tools to remove a portion of the skull. This enables the neurosurgeon to find the tumor and remove as much as possible. After the tumor is removed, the portion of skull that was cut out is replaced, and the scalp is stitched closed. Remember, all of this is done with drugs that relax you or put you to sleep. They also numb the scalp and other tissues. The brain itself does Sample of a head frame used during stereotactic biopsy Electra, LSS frame SURGERY www.abta.org 9 not “feel” pain, so brain surgery can be done with you awake if the surgeon believes it is necessary to minimize the risk of the procedure. CRANIECTOMY A craniectomy is similar to a craniotomy in all ways except one. While “otomy” means cutting into, “ectomy” means removal. In a craniectomy the bone removed for access to the brain is not replaced before closing the incision. The neurosurgeon may perform a craniectomy if he or she expects swelling to occur following surgery, or if the skull bone is not reusable. When the bone is reusable it can be replaced at a later date when it will not cause additional pressure. The skull piece is stored by the medical facility until a time when it might be reused. If a craniectomy is done, you will receive instructions from your health care team for protecting the soft spot created by the missing bone. DEBULKING The term “debulk” means to surgically reduce the size of a tumor by removing as much of it as possible. The term does not tell you how much of the tumor is removed or the type of procedure performed, although it implies the removal was less than complete. To say a tumor was “debulked,” or that a patient underwent a “debulking” procedure, is medical language for saying a tumor was Illustration of Craniotomy 10 AMERICAN BRAIN TUMOR ASSOCIATION surgically removed. PARTIAL REMOVAL A “partial removal” means that the neurosurgeon chose to remove only part of the tumor due to risk of neurological damage. When partial removal is performed, the remaining tumor usually requires additional treatment such as radiation therapy or chemotherapy. Partially removed tumors also tend to regrow. The length of time it takes depends on the type of tumor and the amount of tumor remaining. COMPLETE REMOVAL A “complete removal” means that the neurosurgeon removed the entire tumor. Often the surgeon will call this a “gross total resection.” MRIs taken after the surgery for “complete removal” typically show no presence of tumor. However, it is still possible that tumor cells might remain after a complete removal. These cells, which can grow back, are too small to be seen by the human eye or even by a surgical microscope. Following the surgery, your neurosurgeon can tell you if re-growth is likely, based on your type of tumor. If so, additional therapy may be recommended to treat any remaining cells. SHUNT When there is excess fluid in the brain, or the fluid pathways are blocked due to a tumor or swelling, there may be a build-up of pressure inside the skull. A drainage system called a shunt can be used to remove the fluid. A shunt is a narrow, flexible tube used to move fluid from the brain to another part of the body. One end of the shunt is placed into one of four cavities, or ventricles, in the