Surgery
The standard treatment for a brain tumor is complete or partial removal of the tumor through surgery. This, of course, only applies to accessible tumors. An MRI scan coupled with a three-dimensional axis system (stereotaxy) allows for complete mapping of the brain. This is sometimes done using a fixed frame attached to the skull, or a system of adhesive electrodes that serve as reference points.
The procedure is performed under very light anesthesia. Sometimes the patient is sedated during the opening of the skull and then allowed to regain consciousness. This procedure is called "awake surgery." This allows the patient's cooperation to be obtained in determining whether certain brain cells are still functional or healthy, and also to determine whether they are part of vital functions. In this way, the patient's cooperation will be sought to protect motor, speech, and sensory regions as much as possible. These are crucial for the patient's functioning after the procedure and for their quality of life.
Surgery for Brain Tumors
Surgery is an important step in the treatment of a brain tumor. It is often the first step. Thanks to advanced techniques, surgery is now safer and more effective than ever before. The surgery can have various goals. The neurosurgeon will tailor the strategy to your specific situation:
- Diagnostics (Biopsy): Tissue analysis is crucial for determining the tumor type and genetic characteristics, which guide the rest of the treatment plan. Each brain tumor is biologically unique, and treatment is increasingly based on the molecular characteristics of the tumor, not just what is seen on a scan. This tissue is often obtained through surgery to remove the tumor, but in some cases, a needle biopsy is performed, in which only a small piece of tissue is taken for further examination.
- Maximum safe resection: The goal is to remove as much tumor tissue as possible without damaging vital brain functions (such as speech or motor skills). The goal is not to completely remove every tumor if that would cause severe disability, as that in itself can negatively impact the prognosis. The focus is on maximum safe resection.
- Pressure relief: A tumor can cause fluid retention or pressure in the skull. Removing (part of) the tumor can immediately reduce symptoms such as headaches, nausea, or loss of function.
Modern tools are used to perform the operation as accurately as possible:
- Neuronavigation: A kind of 'GPS for the brain' that indicates exactly where the tumor is located in relation to the instruments during surgery.
- Fluorescence-guided surgery: By drinking a special contrast dye (such as 5-ALA) before surgery, tumor cells can glow under a special light, making them easier to distinguish from healthy tissue.
- Intraoperative monitoring & awake surgery: If a tumor is located in or near areas of the brain where important functions are located (such as the speech center), this function can be mapped during surgery. The patient may also be kept awake during part of the surgery to test these functions directly. This is painless and significantly reduces the risk of permanent damage.
Not every brain tumor can or should be operated on immediately. The decision depends on:
- The location: Tumors in the brainstem or deep-seated structures are sometimes too risky to operate. In that case, a biopsy is usually taken first, after which further treatment options are tailored to the tumor type.
- The nature of the tumor: In the case of very slow-growing, benign tumors that do not cause any complaints, a 'wait-and-see' policy with regular scans may sometimes be chosen.
- General condition: The patient's health must permit the operation and anesthesia.
The recovery period after surgery varies from person to person. Often, surgery is followed by additional treatment (adjuvant therapy), such as radiotherapy or chemotherapy, to address any remaining microscopic cells. This is always discussed in a Multidisciplinary Oncology Consultation (MOC), where several specialists jointly determine the best next steps.
