One option for treatment of a brain tumour is a craniotomy. This is the most common type of surgery for brain tumours. You may need a craniotomy to remove all, or part of a brain tumour.
On this page, we’ll cover:
- What is a craniotomy?
- What is an awake craniotomy?
- What happens during a craniotomy?
- Helping you prepare for brain surgery
What is a craniotomy?
To remove your tumour, your neurosurgeon needs to make a hole in your skull, so they can see into your brain. This requires a small hole through the bone that allows a larger flap of bone to be cut. This operation is called a craniotomy.
A craniotomy is the most common type of surgery for brain tumours. Whenever possible, your neurosurgeon will try to remove all of your tumour, or as much as is safe to.
Not all tumours can be operated on because they may be too close to a sensitive area of the brain. For example, a part that controls breathing or sight.
What is an awake craniotomy?
A craniotomy is usually performed when you are asleep under general anaesthetic, whereas an awake craniotomy is performed when you are awake.
An awake craniotomy may be performed if the tumour is close to areas of the brain that control important functions. Waking you part way through the operation allows your neurosurgeon to check where these functions are in your brain by asking you to perform certain tasks during the operation, such as reading out loud or moving your arm or leg. This enables them to reduce the risk of affecting these areas.
This treatment option can sound a bit daunting. But if it is thought to be the best one for you, your healthcare team will discuss it with you first and explain what is done. This will help you mentally prepare for it.
It is important to remember that the brain itself cannot feel any pain, as it has no pain receptors.
What happens during a craniotomy?
- In some cases, patients are first given a drink containing a substance called 5-ALA-around 2-3hours before surgery. This is suitable for some high grade tumours. Sometimes known as the ‘pink drink’, even though it is not pink, this causes the tumour cells in the brain to glow pink under violet light. This helps the surgeon to tell the tumour cells, at the edge of the tumour, apart from the normal cells and therefore remove more of the tumour.
- You will then be given a general anaesthetic to fall asleep
- A small area of your head may be shaved and you may be given a local anaesthetic to a part of your scalp
- An incision (cut) is made in your scalp and a small part of your skull (‘bone flap’) will be removed
- If you are having an awake craniotomy, you will be woken up at this point to allow your neurosurgeon to map where different functions are located in your brain
- As much of the tumour as is safely possible will be removed.
- In an awake craniotomy you may be able to feel a slight bit of movement, but again you should not feel pain as the brain itself cannot feel pain
- If all the tumour is removed, this is known as total resection
- If part of the tumour is removed, this is known as debulking or partial resection.
- A small sample of the tumour (called a biopsy) will be sent to the lab for analysis and diagnosis
- The bone flap will be replaced and the wound closed using stitches or titanium plates and screws. In an awake craniotomy, you may be put back to sleep before this happens. In some parts of the skull the bone may not be replaced, such as the back of the head where there is thick muscle covering the wound.
- You are likely to be given steroids to help with any swelling.
The length of time a craniotomy takes varies according to the part of the brain being operated on. It may take around 4-6 hours, but can be longer too.
Helping you prepare for brain surgery
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Before your craniotomy, your neurosurgeon will discuss with you what to expect. Ask as many questions as you would like – there is no such thing as a ‘silly’ question.
You may like to ask about biobanking a frozen sample of your tumour, so you can be a candidate for certain clinical trials in the future and have any relevant genetic (biomarker) tests for your tumour. These tests, which are currently only available for some tumours, can predict how well you might respond to certain treatments. These test may also only be available if the hospital has the necessary facilities. It is worth talking to your neurosurgeon to see if these facilities are available at your hospital.
Listen to other’s personal experience
In this episode of our podcast ‘Let’s Talk About Brain Tumours’, we talk to Rob, who was diagnosed with a grade 2 glioma, and Carly, with a grade 2 oligodendroglioma, about what it’s like to have a craniotomy.
Both Rob and Carly had an awake craniotomy while Andy, who has a grade 2 meningioma, had a craniotomy under a general anaesthetic.
Listen as they share their experiences and what helped them prepare for surgery.
A biopsy is a sample of tumour tissue removed during a craniotomy. This is primarily used for diagnosis, to find out what type of brain tumour you have. This is done by sending the tumour sample to a lab where its biomarkers and characteristics are analysed.
If, after testing to establish diagnosis, there is tumour tissue left, it may be stored in a tissue bank for use in the future. Tumour tissue can be used for research purposes (e.g. the Tessa Jowell Brain MATRIX study) and could also be used in future and emerging novel treatments, such as cancer vaccines.
How a tissue sample can be used depends on the amount that is obtained during a craniotomy and also how it is stored.
The standard method for storing tissue is known as formalin fixation and paraffin embedding (FFPE). However, this can cause some damage to the genetic material in the sample and make future use limited.
Flash freezing is another type of tissue storage which is better at preserving the tissue. Having your tumour sample flash frozen may mean you are eligible to access specific clinical trials or future and emerging treatments.
The British Neuro-oncology Society (BNOS) have written some guidelines for the tissue sampling of brain tumours.
Ask your neurosurgeon whether flash freezing could be possible for you. Brainstrust have an information sheet on talking to your neurosurgeon about tissue collection.
Download more information
Learn more about neurosurgery including long-term effects and information about when you can return to activities, such as sport or flying.
Clear print version of our neurosurgery factsheet, designed to RNIB standards.
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