Surgery for Oligodendroglioma

Treatment for an oligodendroglioma usually starts with surgery. The goal of surgery is to resect (remove) the tumor. An oligodendroglioma 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.

Advances in microsurgical techniques and high-quality imaging have greatly improved the treatment and care of oligodendrogliomas. At the Weill Cornell Brain and Spine Center (the clinical arm of the Department of Neurosurgery), our surgeons perform state-of-the-art procedures for a wide range of brain and spine conditions. 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.

Although traditional neurosurgery for oligodendrogliomas in the brain relied heavily on open surgery such as craniotomies and craniectomies (in which a portion of the skull is removed to allow the neurosurgeon access to the brain), today’s neurosurgeons are more likely to use whisper-thin tools that require smaller incisions and less trauma and that allow for faster recovery times.

Modern neurosurgery includes:

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.

Stereotactic radiosurgery: Neurosurgeons use stereotactic radiosurgery for precise delivery of highly focused radiation that can pinpoint an oligodendroglioma 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. Stereotactic radiosurgery is not part of the initial treatment strategy for most oligodendrogliomas. Rather, fractionated radiation therapy with a radiation oncologist is most often used.

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.

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.

After the Surgery
Close follow-up with regular MRI scans is recommended following the successful removal of low-grade oligodendrogliomas. Complete removal of the tumor 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 tumor remains (also called residual tumor), chemotherapy or radiation treatment will likely follow surgery. The timing of additional therapies may vary from immediately following surgery to waiting until the tumor appears to be growing again. Anaplastic oligodendrogliomas that recur may need additional surgery, radiation, and chemotherapy.

Even if it appears an oligodendroglioma has been completely removed, further therapies are often recommended following surgery for these brain tumors.

• Radiation therapy allows doctors to precisely target radiation to the brain tissue while reducing damage to surrounding tissue. Radiation oncology includes radiation therapy, stereotactic radiotherapy, hypofractionated radiotherapy, brachytherapy, stereotactic body radiotherapy, and intraoperative radiation techniques, with the intent of reducing toxicity to normal tissues and improving treatment outcomes.
• Chemotherapy can be used in combination with surgery, radiation, or immunotherapy. When chemotherapy medications are being used, they act directly on cancerous tumors. Chemotherapy and radiotherapy are the first-line treatments in low-grade oligodendrogliomas following surgery.
• Immunotherapy can activate a strong immune response and teach the immune system how to recognize and remember what cancer cells look like and then destroy them, providing long-term protection. Immunotherapy research is ongoing as a tool for oligodendrogliomas, but chemotherapy will likely remain an important tool in treatment.