There are various surgical procedures that may be performed on a patient with a brain tumor. All of these are best performed by highly skilled neurosurgeons with experience in brain tumors. A patient diagnosed with a brain tumor should be seen by a neurosurgeon who specializes in brain tumors in adults, and who has access to other specialists to help develop a comprehensive treatment plan. (See Doctors Who Treat Brain Tumors in Adults and Doctors Who Treat Brain Tumors in Children.)
The first surgery a patient may have is a biopsy, to extract a sample of the tissue to determine what it is. Some tumors are in difficult-to-reach locations in the brain and are not biopsied in advance of resection surgery — samples are sent to a pathology lab during the surgery to remove the tumor. This is called a frozen section and yields a diagnosis within minutes of the surgery.
A highly skilled neurosurgeon will perform a craniotomy or craniectomy to remove a portion of the skull to gain access to the tumor to remove it. The goal of the surgery is to remove as much of the tumor as possible without damaging healthy brain tissue. The skill and training of the neurosurgeon is critical to how much of the tumor can be removed.
Without entering the skull, neurological surgeons can sometimes use stereotactic radiosurgery (highly targeted radiation beams from multiple angles) to treat a brain tumor. This is a rapidly developing technique that requires special expertise from a neurosurgeon specially trained in radiosurgery and utilizing the most sophisticated equipment — such as the Gamma Knife, CyberKnife, proton beams, and linear accelerators. Stereotactic radiosurgery is usually only available in major medical centers (see Doctors Who Treat Brain Tumors in Adults).
A tumor may be blocking the normal flow of cerebrospinal fluid (CSF), leading to a buildup of pressure in the brain (hydrocephalus). A neurosurgeon can place a temporary drain, called a ventriculostomy or external ventricular drain (EVD), to relieve pressure. An internal shunt is a more permanent solution — it drains CSF into the patient’s abdomen, where it is absorbed into the body. Shunts may sometimes need to be repositioned to continue to drain effectively, a procedure known as a shunt revision.
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.)
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.
At Weill Cornell Medicine Neurological Surgery, our neurosurgeons are highly skilled in the most advanced procedures for treating brain tumors. Our relationships with NewYork-Presbyterian allows our surgeons access to the very best facilities and specialists, as well as the most leading-edge research laboratories, to ensure that you get the very best treatment available. You can request an appointment using our online form.
Reviewed by Rohan Ramakrishna, MD
Last reviewed/last updated: December 2020