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Surgery is usually the first step in treating most brain tumors. In some cases, however, such as most brain stem gliomas and other tumors located deep inside the brain, it may be too dangerous to perform surgery. The object of most brain tumor surgeries is to remove or reduce as much of its bulk as possible. By reducing the size, other therapies, particularly radiotherapy, can be more effective.
The standard procedure is called craniotomy.
There are various surgical options for breaking down and removing the tumor. They include:
Relatively benign, grade I gliomas may be treated only by surgery. Most malignant tumors require additional treatments, including repeat surgery.
Imaging techniques, such as CT and MRI, are used along with surgery to help map the area of the tumor in the brain.
The neurosurgeon's skill in removing the tumor as completely as possible is critical to survival. No one should be shy about asking the surgeon the number of similar procedures they have performed. (Asking for complication rates may not be useful, since a very experienced surgeon might operate on many high-risk patients.)
Sometimes a brain tumor can create blockage and cerebrospinal fluid accumulates excessively in the skull, causing increased intracranial pressure. In these cases, a surgeon may implant a ventriculoperitoneal shunt (VP) to help drain the fluid. The procedure involves placing a small catheter into a brain ventricle. Another catheter is tunneled into the abdominal (peritoneal) cavity. A pump that controls the flow of fluid is attached to both catheters.
The most serious concern of brain surgery is preserving brain function. Surgeons will try to be conservative in their approach so as to limit removing tissue that may cause a loss of function. Bleeding and blood clots are other complications. (The blood-thinning drug heparin may be given at the time of surgery to prevent blood clots.) Postsurgical complications include swelling in the brain, which is typically treated with corticosteroid drugs.
Bowers DC, Liu Y, Leisenring W, McNeil E, Stovall M, Gurney JG, et al. Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2006 Nov 20;24(33):5277-82. Epub 2006 Nov 6.
Buckner JC, Brown PD, O'Neill BP, Meyer FB, Wetmore CJ, Uhm JH. Central nervous system tumors. Mayo Clin Proc. 2007 Oct;82(10):1271-86.
Chandana SR, Movva S, Arora M, Singh T. Primary brain tumors in adults. Am Fam Physician. 2008 May 15;77(10):1423-30.
Krex D, Klink B, Hartmann C, von Deimling A, Pietsch T, Simon M, et al. Long-term survival with glioblastoma multiforme. Brain. 2007 Oct;130(Pt 10):2596-606. Epub 2007 Sep 4.
Nathan PC, Patel SK, Dilley K, Goldsby R, Harvey J, Jacobsen C, et al. Guidelines for identification of, advocacy for, and intervention in neurocognitive problems in survivors of childhood cancer: a report from the Children's Oncology Group. Arch Pediatr Adolesc Med. 2007 Aug;161(8):798-806.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Central nervous system cancers. V.1.2008
Neglia JP, Robison LL, Stovall M, Liu Y, Packer RJ, Hammond S, et al. New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2006 Nov 1;98(21):1528-37.
Norden AD, Young GS, Setayesh K, Muzikansky A, Klufas R, Ross GL, et al.Bevacizumab for recurrent malignant gliomas: efficacy, toxicity, and patterns of recurrence. Neurology. 2008 Mar 4;70(10):779-87.
Sathornsumetee S, Reardon DA, Desjardins A, Quinn JA, Vredenburgh JJ, Rich JN. Molecularly targeted therapy for malignant glioma. Cancer. 2007 Jul 1;110(1):13-24.
Wen PY, Kesari S. Malignant gliomas in adults. N Engl J Med. 2008 Jul 31;359(5):492-507.
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