A patient diagnosed with primary or metastatic brain cancer should be seen by a neurosurgeon who specializes in brain cancer, and who has access to other specialists to help develop a comprehensive, multidisciplinary treatment plan.
The goal of surgery is to resect (remove) the tumor. A cancerous brain tumor may be resected entirely or in part, depending on its features and location. Removing even part of the tumor can relieve symptoms caused by pressure on surrounding structures.
Some of the techniques available in modern neurosurgery are:
Microsurgery: Neurosurgeons today can operate using a microscope to visualize the tiniest of brain and spine structures.
Endoscopic neurosurgery: Neurosurgeons who specialize in endoscopic surgery use small, flexible, lighted tubes called endoscopes to visualize various parts of the brain, skull base, or spinal cord through small openings. The evolution of endoscopic neurosurgery has greatly advanced the treatment of cysts and tumors that form in the brain and spine.
Interventional neuroradiology (INR): Interventional neuroradiology is a relatively new specialty that combines advanced three-dimensional imaging techniques with minimally invasive catheter-based surgical procedures. INR specialists – neurosurgeons with advanced training in radiology – can perform minimally invasive endoscopic techniques using high-tech imaging equipment to guide their work. (See more about our Interventional Neuroradiology Program.)
Stereotactic radiosurgery: Neurosurgeons use stereotactic radiosurgery for precise delivery of highly focused radiation that can pinpoint a cancerous brain tumor or other target with little or no effect on normal surrounding tissue. It has been used with great success in the treatment of brain tumors and other conditions as an alternative to “open” surgery. Neurosurgeons who specialize in stereotactic radiosurgery may perform procedures on a Linear Accelerator (LINAC), Gamma Knife, or CyberKnife. (See more about Stereotactic Radiosurgery at the Department of Neurosurgery.)
Intra-operative imaging: Advances in imaging techniques (such as CT, MRI, and PET scans) have allowed neurosurgeons to view highly detailed pictures while they are operating.
Even if a malignant brain tumor appears to have been completely removed, further therapies are often recommended following surgery.
Close follow-up with regular MRI scans is recommended following the successful removal of brain cancers. Complete removal of the cancer is ideal, but sometimes it may be in a region where full resection is too dangerous because of critical brain structures. If some of the cancerous tumor remains, chemotherapy or radiation treatment will likely follow surgery to target any residual tumor. The timing of additional therapies may vary from immediately following surgery to waiting until the tumor appears to be growing again. Some brain cancers that recur may need additional surgery, radiation, and chemotherapy.
Awake surgery and brain mapping: Sometimes, your neurosurgeon will need to map your brain during your procedure. This may entail you being awake for part of the procedure. Don’t worry – it will not be painful. The awake portion of the procedure is designed so that your surgeon can localize the areas of your brain critical for language function or movement. This allows your surgeon to remove the maximal amount of tumor while keeping you safe in the process. (See I Was Awake During My Brain Surgery for a patient’s view of what an awake craniotomy is like.)
Intraoperative Fluorescence: In many brain tumor operations, patients can now benefit from intraoperative fluorescence using 5-ALA technology. Using this novel treatment, surgeons have a new way of visualizing brain tumors separately from healthy brain tissue, thereby maximizing the degree of brain tumor removal.
Advances in microsurgical techniques and high-quality imaging have greatly improved the treatment and care of brain cancer. At the Weill Cornell Medicine Brain and Spine Center, our surgeons perform state-of-the-art procedures and offer many clinical trials. We are fortunate to be a part of the NewYork-Presbyterian/Weill Cornell Medical Center, consistently ranked as the #1 hospital in New York, with one of the top neurosurgery programs in the nation.
Reviewed by: Rohan Ramakrishna, MD
Last reviewed/last updated: December 2020