Brain and Spine Tumor Surgery
When dealing with the sensitive areas of the brain and spine, it’s important to choose an expert neurosurgeon that has experience with your type of tumor.
You can contact our clinic to discuss your particular case and whether surgery would be a successful treatment option. Our neurosurgeons have decades of experience in treating complex brain and spine surgeries.
Are All Tumors Operable?
With advances in neurosurgery and technology, most tumors are operable, and many are curable. While some may be inoperable, there are protocols available to treat all tumors. At ANA, we also collaborate with pediatric and adult oncologists to consider and implement every possible treatment option.
For operable tumors, however, surgery is often performed. At ANA, we are widely experienced in all brain tumor surgery. In addition, follow-up surgical treatment is a comprehensive and ongoing process.
Following surgery, a multi-disciplinary team of medical experts, called the Tumor Board, convenes to review the patient’s condition, needs and test results. This collaborative approach is part of a patient’s personalized treatment protocol that ANA is an integral part of.
Does Benign or Malignant Relate to Surgery?
Benign brain tumors are noncancerous while malignant brain tumors are fast-growing cancers that can originate in the brain (primary tumors) or originate in another part of the body and spread to the brain (secondary tumors).
Malignant tumors typically grow quicker than benign tumors, aggressively invading surrounding tissue. These types of tumors most often require additional treatments such as radiation and/or chemotherapy or biological agents.
As a slower growth, benign brain tumors usually have clearly defined borders and are not deeply rooted in brain tissue. Assuming they are in an area of the brain that can be safely operated, this makes them easier to surgically remove.
Once removed, benign tumors are less likely to recur than malignant ones. They can still return, but it is unlikely.
What Is a Typical Brain Tumor Surgery?
For a typical brain tumor surgery, there are two main objectives:
- Obtain tissue to make a diagnosis
- Remove the tumor (total or partial removal)
At ANA, our multidisplinary team of experts is committed to the best possible result and that team includes surgeons, neurologists, neuro-pathologists, neuro-oncologists, radiologists, radiation oncologists and specialized nurses.
Brain Tumor Surgery
The most common types of surgery performed for brain tumors are:
A biopsy of the brain or spine involves removing a piece of tissue or cell, typically for the purpose of examination and deciding on your course of treatment.
Debulking is the surgical removal of a portion of a tumor in order to decrease the tumor burden on a patient and/or to decrease the mass effect on surrounding structures. This technique is often performed in brain surgery when the entire tumor cannot be removed without serious damage to proximate structures.
Gross Total Resection (GTR)
GTR is the removal of all visible tumor, and in which subsequent scans show no apparent tumor. GTR is considered when the surgeon believes the entire tumor can be safely removed without substantial risk of unacceptable injury.
An innovative and minimally invasive surgical technique, Endonasal Endoscopy allows the neurosurgeon to remove brain tumors or lesions from the base of the skull, such as in the pituitary area, or the top of the spine through the nose and sinuses. It may also be referred to as a Transsphenoidal Approach Endoscopy.
ANA is experienced in stereotactic radiosurgery, also known as Gamma Knife® or CyberKnife® radiosurgery. It is a non-invasive (no cutting) procedure used to treat brain lesions that are small, inoperable or are residual tumors left after a debulking.
It is a same-day radiation treatment procedure done to halt the growth and sometimes shrink these lesions.
Spine Tumor Surgery
Reasons surgery would be a good option for spine tumors:
- Control of tumor growth by surgical removal, sometimes accompanied by radiation and/or chemotherapy.
- Improving symptoms by reducing pressure on nerves and stabilizing spine to prevent deformities, collapse or paralysis.
The goal is usually to reduce the severity of symptoms, including:
- Lessen pain
- Restore spine stability to improve mobility
- Preserve neurological function
- Alter or change outcomes
- The type of spine surgery will depend on the type of tumor, its location, and the patient’s symptoms.
Types of Surgical Procedures
There are several approaches to brain and spine surgery.
Open procedures may be done with a surgical incision on the anterior or posterior.
- Decompression: A procedure to remove the bone that has the tumor and to increase the space around the spinal cord and nerves.
- Stabilization: An application of screws, rods or cement to stabilize the spinal column.
- Combination: A combination of the above procedures; may be staged one or more days apart.
Minimally Invasive Procedure
A number of small incisions are made during this procedure, into which a tube or tubes are inserted. The number of incisions depends on the type of surgery. The tube or tubes let the doctor insert tiny video cameras and specially designed surgical instruments to perform the procedure.
Complete En Bloc Resection
Primary spinal tumors may be removed through complete en bloc resection – resection of a large bulky tumor without dissection – for a possible cure. In patients with metastatic tumors, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine and alleviating pain. For cases in which surgical resection is possible, preoperative embolization may be used to enable an easier resection. This procedure involves the insertion of a catheter or tube through an artery in the groin. The catheter is guided through the blood vessels to the tumor, where it delivers a glue – like liquid embolic agent that blocks the vessels that feed the tumor. When the blood vessels that feed the tumor are blocked off, bleeding can often be controlled better during surgery, helping to decrease surgical risks.
Brain and Spine Tumor Recovery
Recovery from brain surgery requires substantial rest. The duration depends on the type of procedure.
In addition, surgery is often combined with other cancer treatments, such as chemotherapy, radiation therapy or hormone therapy. While some of these treatments are administered before surgery (neoadjuvant therapy) others are administered after surgery (adjuvant therapy). These also affect the recovery process.
Longer-term recovery treatment is designed by our collaborative team of specialists. Depending on its location, a brain tumor in particular can cause weakness, loss of balance, speech problems, and loss of vision. Various types of rehabilitation, such as physical and occupational, are important to address these side effects.
In addition, those recovering from brain tumor surgery may experience emotional or cognitive difficulties and changes. These outcomes are also dealt with by special cognitive rehabilitation therapy.
Periodic MRI scans are also performed to check for any new tumor growth.
The patient’s recovery after spinal tumor surgery and length of stay in the hospital will vary by the extent and type of surgery. Each patient responds and recovers differently.
After surgery, you may need help with daily activities. This is referred to as rehabilitation. Rehabilitation may be done in an inpatient setting, which means you are admitted to a rehab unit or hospital. It can also be done as an outpatient, which means you could receive therapy in your home or be transported to a rehab facility during the week.
The possible effects of the tumor and its treatment on your physical and mental function can range from mild to severe. After surgery, the patient may need to see a psychiatrist or psychologist to determine the extent of any damage caused by the tumor or surgery.
If the patient was treated with surgery for a tumor near the base of the brain, pituitary hormone production may be affected and an endocrinologist might be recommended. If hormone levels are affected, hormone treatments to restore normal levels may be needed for the rest of your life.
Post-Surgery and Recovery
Following treatment, the tumor is sent to the pathologist. Genetic testing is often performed, as well.
The ANA multidisciplinary team of medical experts – your or your child’s Tumor Board – including surgeons, neurologists, neuro-pathologists, neuro-oncologists, radiologists, radiation oncologists, physical therapists, nurses, psychologists and social workers meet to review your or your child’s condition, needs and test results. This team approach is also taken in the recommendation of the personalized treatment protocol for you or your child.
The tumor board is a conference where a neurosurgeon, neuro-oncologist, radiation oncologist, neuroradiologist, social worker and other medical professional convene to discuss the plan and care for the individual patient.
What Is Our Experience with Tumors?
At ANA, we have nearly three decades of experience treating brain and spine tumors. This includes pioneering many procedures that are commonly used today. For example, ANA was one of the first groups in the region to utilize minimally invasive approaches in neurosurgery for the treatment of brain tumors.
In addition to other advanced training, Dr. Arno Fried completed a fellowship in neuro-oncology with the American Cancer Society.
For printable information, you can download our FAQs for brain tumor surgery.