Craniotomy Surgery for Brain Tumor
Neurosurgeons perform brain and spinal cord tumor surgery to determine the type of tumor, remove the entire or as much tumor as possible or help prevent or treat symptoms or potential complications from the tumor. Before the procedure, discuss the benefits and risks of brain surgery with your neurosurgeon.
What Is a Craniotomy?
A craniotomy is a surgical procedure that allows neurosurgeons to open a portion of the skull or cranium to access the brain. It is the most common approach for surgery to treat brain tumors and aneurysms. In a craniotomy, the patient may either be under general anesthesia or awake with the surgical area numbed for at least part of the procedure to check the patient’s brain functions during the operation.
Neurosurgeons work with a multidisciplinary team to carry out a successful craniotomy procedure, which includes an operating room head nurse, surgical technologist, anesthesiologist, anesthetist and intensive care unit nursing personnel.
In a craniotomy, part of the patient’s head might be shaved before the procedure. The neurosurgeon will then make an incision in the scalp over the area of the skull near the tumor and fold back the skin to gain access to the affected part of the brain. Neurosurgeons use a special drill to remove the piece of the skull over the tumor. The piece of bone removed from the skull is usually put back in place immediately after the operation.
Depending on the size of the tumor, the incision typically has to be large enough to insert several surgical instruments to allow neurosurgeons access to the parts of the brain needed to operate safely. Neurosurgeons often perform craniotomy while looking at the brain through a special microscope.
In some cases, neurosurgeons may need to cut into the brain to reach the tumor. Patients may need to undergo imaging tests, such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan, before the craniotomy procedure to map the area of tumors deep in the brain. Another option is to use ultrasound once the skull has been opened. Neurosurgeons may also use intraoperative imaging in some cases to find the location of any remaining tumor. This technique uses MRI or other images taken at different times during the operation.
There are different ways to remove the tumor, depending on how hard or soft the tumor is and whether it has many or just a few blood vessels. Many tumors can be cut with a scalpel or special scissors, while some are soft and can be removed with suction devices. In other cases, a handheld ultrasound aspirator can be placed into the tumor to break it up and suck the tumor out.
The goal of craniotomy is to remove as much of the tumor as possible without interfering with the patient’s brain functions. Some of the techniques a neurosurgeon use to lower the risk of complications while performing a craniotomy include:
- Intraoperative cortical stimulation (cortical mapping) – a surgical approach that involves electrically stimulating parts of the brain in and around the tumor during a craniotomy to monitor the response of certain areas of the brain to show if these areas control a vital function that should be avoided.
- Functional MRI – a pre-surgery technique to gather information about the location of a particular brain function. This approach can help a neurosurgeon identify and preserve that region during the operation.
- Fluoresence-guided surgery – a technique that uses a special fluorescent dye to help a neurosurgeon better separate the tumor from normal brain tissue. In fluorescence-guided surgery, the tumor takes the dye, which glows when the neurosurgeon looks at it under fluorescent lighting from the operating microscope.
- Newer types of MRI and surgical approaches
How Long Is a Craniotomy for Brain Tumor Procedure?
The length of a craniotomy varies depending on the part of the brain operated on. It may take around four to six hours or longer.
