Neurosurgery for brain tumours (adults)

Neurosurgery is one of the main treatment options following the diagnosis of a brain tumour. Learn more about neurosurgery and brain tumours, including biopsy procedures, tumour removal and brain surgery side-effects.

Every hospital or surgeon may have slightly different practices, so what you experience may differ slightly from what's described on this page and fact sheet.

Why might I need neurosurgery?

Neurosurgery can have several purposes:

  • Removing all or part of the tumour (craniotomy)
  • Diagnosis of tumour type (biopsy)
  • Putting chemotherapy drugs directly into the brain
  • Reducing associated conditions, such as a build-up of the cerebrospinal fluid, by putting in a shunt.

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.

Neurosurgery is performed by a highly specialised doctor, known as a neurosurgeon.

Neurosurgery to remove all or part of the tumour

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, as they may be too close to a sensitive area of the brain, e.g. that controls breathing or sight.)

To remove your tumour, your neurosurgeon needs to make a large-ish hole in your skull, so they can see into your brain. This operation is called a craniotomy. It is the most common type of surgery for brain tumours.

A craniotomy is usually performed when you are asleep under general anaesthetic, but it can be 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 the 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. This enables them to avoid damage to these areas.

This can sound rather scary, but if it is thought to be the best option for you, your healthcare team will discuss it with you, explaining what is done to prevent you feeling any pain and to help you mentally prepare for it.

It’s important to note that the brain itself cannot feel pain, as it has no pain receptors.

Before your surgery, 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 clinical trials in the future and have any relevant genetic (biomarker) tests for your tumour. These tests, for some tumours only, can predict how well you might respond to certain treatments.

For more information, see our webpages and fact sheets on Questions to ask, Biomarkers, and Biobanking.

What happens during a craniotomy?

  • A small area of your head may be shaved and you may be given an local anaesthetic to 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 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 - this can take some time
  • 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 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 metal clips - in an awake craniotomy, you may be put back to sleep before this happens
  • 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.

Neurosurgery to diagnose brain tumour type

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

If you are having a craniotomy, a biopsy will be taken at the same time, but sometimes if a craniotomy is not possible, a smaller operation may be performed to get a sample of the tumour for diagnosis.

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.

What happens during a biopsy?

Neurosurgery to insert chemotherapy drugs

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

  • Wafer implants (Gliadel® wafers)
    Wafers, coated with the chemotherapy drug carmustine, are placed into the space where the tumour was. They gradually dissolve over 2-3 weeks, releasing the chemotherapy.
    (These are only licensed for people with high grade gliomas and only if the surgeon can remove at least 90% of the tumour and the tumour has not affected the fluid-filled spaces in the brain, called the ventricles.)
  • Ommaya reservoir
    A dome-shaped device, put in during surgery, which sits underneath the scalp and delivers chemotherapy directly into the cerebrospinal fluid (CSF) to flow round the brain.

Neurosurgery to reduce brain tumour 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. The fluid is drained into other parts of the body that can easily absorb it. This is not your stomach, so it will not affect your eating. The shunt may have to 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. This is usually due to swelling of the brain following the surgery. You may be given steroids to help with this.

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

For more information, see our Steroids and Seizures webpages and fact sheets.

How will this affect my work?

You will have to take some time off work for treatment and for some time afterwards to recover. Side-effects, such as tiredness, nausea or cognitive (thinking) difficulties, may mean you need a longer period of time off work.

Our Employment resources provide help and information on how to approach your employer about your diagnosis and treatment effects, and how they can support you through this time.

Other brain tumour treatments

Find our more about adult brain tumour treatments, treatments for children and complementary therapies:

Adult brain tumour treatments

Information about different brain tumour treatments available for adults.

Child brain tumour treatments

Information about different brain tumour treatments available for children.

Complementary therapies

Therapies used alongside conventional treatments to help manage the side-effects of having a brain tumour and its treatment

Neurosurgical Outcomes Data

In planning for your surgery you may wish to know more about who you are being seen by or seek a second opinion, The Society of British Neurological Surgeons Neurosurgical National Audit Programme has information about neurosurgeons at each centre in the UK along with their neurosurgical outcomes data. You can also view information on the NHS website about consultants specialising in neurosurgery in England.

When looking at this information its important however to remember that statistics are not always able to allow for additional influencing factors such as the complexity of cases seen and the level of risk involved. Some surgeons may have lower survival rates as they are willing to take on more complex cases therefore it's important that these aspects are also taken into consideration.

Our neurosurgery factsheet explains what to expect when you have surgery and our Information and Support Team are also here to help answer any questions you might have.

Page last reviewed: 06/2018
Next review due: 06/2021

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