Surgery is the best treatment for any brain tumor that can be reached without causing severe injury to normal tissue. Although surgery is not possible to completely remove some brain tumors, it is typically performed both to diagnose and treat many primary brain tumors.
Removing the tumor, either in part or completely, can lessen some of the pressure within the skull. Surgery can also help to relieve symptoms, improve neurologic function, and extend the length and quality of a patient’s life.
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Improvements in surgical techniques have revolutionized brain surgery in recent years, and studies have suggested that, on average, greater surgical experience leads to better patient outcomes. At Memorial Sloan-Kettering, neurosurgeons operate on more than 600 patients with brain tumors each year, using the most-sophisticated diagnostic and treatment technologies available.
Although not all technologies are used in treating all patients, doctors at the Brain Tumor Center now routinely use the following approaches during brain surgery.
Advanced Imaging Technology
Imaging technologies that guide surgeons both before and during an operation have led to dramatic improvements in brain surgery in recent years. Being able to see the brain in such fine detail has enabled doctors to improve the precision with which they operate, making surgery safer and more effective.
Functional MRI: Brain Mapping in Surgical Planning
To plan brain surgery, our surgeons use an imaging test called a functional MRI, or fMRI, performed in the days before the procedure. This is a specialized MRI that can create a functional “map” of your brain. During the MRI, you are asked to perform simple tasks such as moving your hands and feet, counting in your head, or thinking of words that begin with a particular letter.
These tests result in a scan that can show which areas of your brain are important to everyday functions such as vision, speech, touch, and movement. From this scan, your surgeon can determine whether the tumor involves these functional areas of the brain and figure out how much of the tumor can be safely removed during the surgery.
In some cases, the tumor is so close to a delicate area that the surgeon also performs mapping of the brain during the operation. Electrodes are used to stimulate the brain surface and identify with great precision the areas of the brain that are involved in specific tasks and that therefore need to be preserved.
MRI during Surgery
To improve the success of brain surgery, Memorial Sloan-Kettering’s neurosurgeons perform procedures in an operating room equipped with an MRI scanner.
Memorial Sloan-Kettering's neurosurgeons perform brain surgery in an operating room equipped with an MRI scanner. At any point during surgery, the neurosurgeon can perform an MRI to determine whether the tumor has been removed completely. If the surgeon finds any remaining tumor tissue, surgery can be resumed immediately to remove it.
The power to reevaluate a patient's tumor with MRI during surgery enables neurosurgeons to operate with remarkable precision and remove as much of the brain tumor as possible. It also reduces the risks that might result from a second operation. Operations performed using intraoperative MRI are likely to reduce tumor recurrence rates and minimize complications.
MRI Surgical Navigation with Frameless Stereotactic Surgery
Our surgeons also use a very precise technique called frameless stereotaxy – sometimes referred to as surgical navigation — to plan operations and guide the team during surgery.
Technicians begin by attaching six plastic self-adhesive dots around the scalp prior to surgery. At the start of surgery, they register the exact location of these dots via MRI and then relay the position of your head to the computer system.
The team directs a wand-like viewing device at the brain, which then projects an image onto a monitor in the operating room. The image is synchronized with the MRI scan, giving your neurosurgeon up-to-the-moment orientation during the procedure. The neurosurgeon can also use the viewing wand to help identify the outermost edges of the tissue to be removed, known as the tumor margins. This helps the surgeon to remove the entire tumor whenever possible.
Advantages of surgical navigation include enhanced accuracy and greater likelihood that the operation can be done by using a smaller incision. The operation may also be shorter in length as a result. This technique is used in conjunction with Memorial Sloan-Kettering's intraoperative MRI.
Awake Brain Surgery
Awake brain surgery, or awake craniotomy, is a surgical technique used for some patients with primary brain tumors. In this procedure, you receive local anesthesia and intravenous medications that result in sedation but not loss of consciousness.
During parts of the procedure, you are awakened and asked to speak or to demonstrate certain movements to help guide removal of the tumor, ensuring that areas of the brain critical to speech or movement remain intact.
Minimally Invasive Surgery: Neuroendoscopy
Neurosurgeons perform certain surgical procedures through a minimally invasive procedure known as neuroendoscopy. Using this technique, only a small opening must be made in the skull. The surgeon performs the operation using a thin tube with a powerful lens, high-resolution video camera, and tiny surgical instruments on its tip.
This minimally invasive procedure enables doctors to use a smaller incision than in conventional surgery, enhances their ability to perform microsurgical procedures, and usually results in less injury to healthy tissue.