Surgery

Brain surgery. Scary words. If you are reading this then it is highly likely you have recently learnt that you are going to have neurosurgery. This is one of the first major decisions you will face. In fact, I don’t think there is anything as frightening as facing this decision – ever. If you can make this decision – one way or the other – then nothing you do will ever be as scary as this.

But you are not facing this alone. You will have a brilliant team behind you, your family will be there and of course, brainstrust is just a call away.

First decision – whether to proceed with an attempted complete surgical removal or whether to have just a biopsy. Evidence shows that wherever possible it is better to resect as much as is possible. Surgery to remove a tumour, even malignant ones, has several theoretical advantages over a biopsy:

By removing tumour mass, room can be made to allow for the swelling of brain tissue which occurs both with radiation therapy and if the tumour recurs.
The more that can be taken out, the less will need to be treated with other forms of therapy.
More tumour to diagnose, better the accuracy of the diagnosis and grading, because there are more cells to examine.

This is theoretical – everything depends on the individual’s well being, the nature of the tumour, potential complications. All of these must be talked through and thought about. But don’t think for too long. It can be very wearying and will occupy your head so that in the end you will not feel able to make a decision. And no decision is irreversible – until you go down to surgery.

Types of neurosurgery

Standard Craniotomy

This is the most generally used procedure, which involves removing a piece of skull and then replacing it, under a general anaesthetic.

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Awake Craniotomy

An awake craniotomy is an operation performed in the same manner as a conventional craniotomy but with the patient awake during the procedure.

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Image Guided Craniotomy

Image-guided refers to the use of scans and a computer to precisely locate and target a lesion within the brain.

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Craniotomy in a MRI

This is what enabled Meg to have her surgery. This technology has been around for about twenty years in the USA and was pioneered by Peter Black. It is only just arriving in the UK.

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Lasers in brain surgery

This is a new technique and sometimes using lasers can help to remove a brain tumour. They do require opening the skull and are used during a craniotomy.

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Preparing for neurosurgery – a timeline

Hopefully you will have time to get your head around the fact that you are going to have neurosurgery. It is scary but you need to remember that neurosurgeons perform hundreds of these operations each year.

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