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I have a far better idea of what to ask my consultant when I next see him and what the long term implications will be. This has given me more sense of not only an understanding of my situation, but I feel like I have regained some control of the situation and my life again.
I really cannot thank-you enough for your help with this. I had no idea where to turn or what to do and although there is still very much a long way to go and many decisions to be made, which will no doubt be hard, I feel better prepared and feel that if I need help I am not alone, but that I can turn to you.
Thank-you, from the very bottom of my heart,
Nadia London, 2011
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.
No decision is going to be straightforward. It’s all a balance of risk v. benefits and the truth is that there is seldom a good reason to remove a brain tumour unless you think you can remove the vast majority. Partial resection can sometimes be a bad thing. I think what we’re saying here is that each case needed to be decided individually; so much depends on quality of life, type of brain tumour, where it is. The list goes on.
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. And thought about some more. 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 the operating theatre.
Here is a really clear video which explains about why you might need surgery, what the different types of surgery are and what happens after surgery. It is Australian – so just make allowances for differences in our healthcare systems. And one day we will make our own!
Types of neurosurgery
This is the most generally used procedure, which involves removing a piece of skull and then replacing it, under a general anaesthetic. It is called a craniotomy because this procedure removes part of the cranium – the skull. And image-guided refers to the use of scans and a computer to precisely locate and target a lesion within the brain. All craniotomies for brain tumours are image guided.
Nowadays your scan can be performed in advance of your surgery (without a frame on), the data is uploaded onto a computer in the operating room, and a navigation system is used to locate the tumour (frameless stereotaxy or image-guidance). This technique is beneficial because it localises the tumour, so the operation is shorter and the area of the head that the surgeon must disrupt is often smaller.
Find out more about image guided craniotomy - click here.
An awake craniotomy is an operation performed in the same manner as a 'conventiona'l craniotomy but with the patient awake during the procedure.
This is a preferred technique for operations to remove lesions close to, or involving, eloquent (functionally important) regions of the brain. This allows us to test regions of the brain before they are incised or removed and allows us to test patient’s function continuously throughout the operation. The overall aim is to minimise the risks of such operations.
Find out more about awake craniotomy - click here.
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Resources used to create this page:
brainstrust patient/carer representative
National Institute for Health and Clinical Excellence guidelines – Improving Outcomes Guidance Brain and CNS Tumours 2008
Living with a Brain Tumour (Peter Black) 2006
Fast Facts – Brain Tumors (Abrey and Mason) 2009
Primary Central Nervous System Tumors – pathogenesis and therapy (Current Clinical Oncology, Humana Press 2011