About Craniotomy for Brain Tumor Resection
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What is Craniotomy for Brain Tumor Resection?
guidance is used in every case, skin and the bone incision as planned as a
minimum invasive procedure, usually less than 5 cm. Brain is exposed always
under the microscope, and the tumor is gently separated from the normal tissue,
preserving normal arteries and veins. Monitoring of brain eloquent areas used
is Craniotomy for Brain Tumor Resection performed?
procedure is done for tumor inside the brain, like gliomas or brain metastasis,
and tumors in the covering layers, like meningioma and schwannoma. Some cases
are benign tumors, and the surgery can be curative, but other are aggressive
and need adjuvant treatments as radiotherapy and chemotherapy. It is done in
adults and also in children, for some brain tumors in children, surgery is the
cornerstone of treatment.
safe resection of the tumors is the goal: complete resection without
neurological deficit gives patients the biggest benefit in survival and quality
Most brain tumors are resected under general anesthesia. In some cases, we
need to check the integrity of neurological functions during the surgery. Neurophysiological
monitoring techniques are able to provide that information, usually with the
patient slept. For checking certain functions, like language, patients need to
be awake during all or part of the surgery, this can also be done in our
center, while keeping the patient with good comfort.
Resection of brain tumors is an open surgery, no robotic surgery nor
lasers are routinely in use. However, we
do surgery in a minimally invasive way using always microscope for
magnification and navigation to target the tumor through the smallest approach
possible. With experience, proper technology, and careful planning of every case,
most of the brain tumors can be reached and resected through by natural,
anatomic corridors, with minimal distortion of the normal tissue. The
microscope is the main tool in every case, and it has different fluorescent
filters. The characteristics of some
tumors allow to identify them better under fluorescent light in the surgical
field, is a kind of augmented reality. We have extensive experience with
fluorescence guided resection. Endoscope can be used in some cases, to see
around the corners, and help with the resection.
Author: Dr.Ricardo Díez Valle
Posted: 28 October 2019 2019 at 10:21
Last Updated: 07 November 2019 at 09:33 UTC
Duration of procedure/surgery : Surgery for brain tumors can be quite variable in duration, as there are very simple and very complex cases.
Most cases are between 3h and 8h.
Days admitted : 3-4 days for around of 80% of the cases, without any complications and good general condition. Around 7- days for those cases with some complication, other general disease or a neurological deficit that requires starting of neurorehabilitation and planning the continuation of care after discharge.
Regular cases, more than 80%, without any complication or special circumstances, they will be able to travel around 6-7 days after surgery. If the travel is a long flight, we advise to wait at least 10 days.
Recovery : For most patients, the procedure requires one night in intensive care after the surgery. Next morning, they go back to the regular hospital room, start walking and eating again. Wound pain is not too bad, and can be managed with routine painkillers, no morphine is usually needed. Patients are ambulatory and in a similar condition as previous one after 3-4 days. The head can be washed with regular soap two days after surgery. Shaving part the head is not necessary, is restricted to 1cm around the wound. Stiches can be removed in 7 days, or left alone, as we use a resorbable material.
Some patients could have a neurological problem, like weakness in right or left side, before the surgery, or after the surgery. These patients can expect an improvement within days, weeks or months after the surgery, they should start neurorehabilitation in our center on the first day after surgery, and continue that process at home until recovery.
Risks : Variability of the risks in brain tumor resection is huge, as every case is different, total risk of serious complication can be from 1 to 20%, it depends on size and location of the tumor, and general condition of the patient.
Some risks are general, like infection, deep vein thrombosis, and bleeding needing transfusion, we have been able to keep the rate of this three complications, under 1%.
The risk of neurological deficit can include impairment of strength or sensation in arms or legs, impairment of visual field, memory loss, or language alteration, to name just the more relevant. The kind of risk present and their magnitude will always be characterized for each case and explained in detail to the patient before surgery.
After care : There are too many parameters to measure this, depending on the kind of tumor.
Mortality is well under 1% in our series, 0.3% in our last review for malignant brain tumors resection. Infection, deep vein thrombosis and transfusions are all under 1%.
For glioblastoma, the more common malignant tumor, resection is 100% of the tumor volume in more than 80% of cases and more than 98% of tumor volume in 95%.
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