Neurosurgery for brain tumours (adults)

One of the main treatment options following the diagnosis of a brain tumour is neurosurgery, to completely remove your tumour or as much of it as possible. This type of surgery is performed on the brain or spinal cord by a highly specialised doctor known as a neurosurgeon.

Neurosurgery may also be performed for other reasons related to the treatment and management of your tumour and its associated symptoms.

Why is neurosurgery performed for brain tumours?

Surgery can have several purposes:

  • diagnosis of tumour type
  • whole or partial removal of the tumour
  • insertion of chemotherapy drugs directly into the brain
  • reduction of associated conditions, such as a build-up of the cerebrospinal fluid

It is important to know that neurosurgery is not always possible. If your brain tumour is too close to an important part of the brain, surgery may be too risky. In this case, another treatment option will be suggested.

Diagnosis of tumour type

To gain an accurate diagnosis of your brain tumour, a small sample of tumour tissue may be taken. This is done by an operation known as a 'biopsy'.

The tumour sample will be sent to the laboratory to be analysed and diagnosed by a neuropathologist.

A biopsy generally takes about 2-3 hours.

Biopsy procedure

  • A very small 'burr hole' will be drilled into your skull by the neurosurgeon
  • A needle is passed through the hole to take a small sample of the tumour
  • The hole is then closed using staples or stitches
  • You may be given steroids to help with any swelling.

Whole or partial removal of the tumour

To remove part or all of your tumour, the neurosurgeon needs greater access to your brain. The operation to do this is known as a 'craniotomy'. It is the most common type of surgery for brain tumours.

A craniotomy can be performed when you are awake or when you are asleep.

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 the neurosurgeon to check where these functions are in your brain by asking you to perform certain tasks, such as reading out loud, during the operation. This enables them to avoid damage to these areas.

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.


  • If you are having an awake craniotomy, you will be woken at this point to allow your neurosurgeon to map where the functions of the brain 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 pulling, but you should not feel pain as the brain itself cannot feel pain
  • If all is removed, this is known as 'total resection'
  • If part is removed, this is known as 'debulking'
  • The bone flap will be replaced and the wound closed using stitches or metal clip
  • You are likely to be given steroids to help with any swelling.

Insertion of chemotherapy drugs directly to the brain

During a craniotomy, you may have chemotherapy drugs inserted directly to the brain to get rid of any remaining tumour cells.This can be done via:

  • Wafer implants

Wafers, coated with the chemotherapy drug carmustine, placed into the space where the tumour was. They gradually dissolve over 2-3 weeks, releasing the chemotherapy.

  • Ommaya reservoir

A dome-shaped device, inserted during surgery, which sits underneath the scalp and delivers chemotherapy directly into the cerebrospinal fluid (CSF) to flow round the brain.

Reduction of associated symptoms

Headaches are a common symptom of brain tumours caused by a build-up of cerebrospinal fluid (CSF). This can happen if the tumour is blocking the flow of CSF.

To reduce this pressure, neurosurgeons can insert a tube, called a 'shunt', through your skull and into your brain to drain some of the excess fluid away. This will stay in place for some time.

After neurosurgery

Immediate effects

When you wake up after surgery, you will have a number of tubes coming in and out of your body to help:

  • drain fluids
  • give you water, nutrients and medicine
  • monitor your body

You may have swelling and bruising on your face, and you may have a dressing on your wound, but not necessarily. You may also feel some temporary worsening of the symptoms you had before the surgery.

Other temporary, post-operative effects include:

  • Sickness and nausea
  • Sore throat
  • Headaches
  • Momentary phases of feeling dizzy / confused
  • Difficulty swallowing
  • Tiredness
  • New symptoms, e.g. personality changes, poor balance / co-ordination, speech problems and epileptic seizures (fits).

Neurosurgery is a major operation - you will need to rest for a number of days.

Follow-on treatment

After a few days, you are likely to have a brain scan to see how much, if any, of the tumour remains and how much swelling you have.You may then be given chemotherapy and/ or radiotherapy, to get rid of any remaining tumour cells.You may also be given:

  • steroids - to reduce swelling and pressure on the brain
  • anti-epileptic medication - as a preventative measure against seizures ( 'fits') due to increased pressure in the head
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