Surgery for Brain and Spinal Cord Tumors

SURGERY SPOTLIGHT

Removing Brain Tumors Through the Nose

Endoscopic surgery through the nose is a minimally invasive technique that's particularly useful for removing tumors located at the base of the brain.

For example, one of our specialties is endoscopic pituitary surgery, a highly sophisticated procedure. Here's how it works.

Your neurosurgeon will insert an endoscope — a very small high-definition camera attached to a thin tube — into your nostril. Guided by computerized mapping of the brain and skull base, the surgeon can safely navigate to the tumor.

Working alongside your neurosurgeon, an ear, nose and throat surgeon can then use tiny surgical instruments through your other nostril to remove the tumor at the pituitary gland.

Our philosophy at Scott & White is to explore every treatment option. Because there are inherent risks to operating on brain tissue and the spinal cord, we view surgery as the last resort. Your quality of life is paramount.

However, if surgery is considered the best course of treatment for you, our approach at Scott & White is to use minimally invasive techniques whenever possible and appropriate, based on your condition, and to remove as much of the tumor as possible while sparing normal tissue.

Image-Guided Surgery is Safer and More Accurate

Scott & White uses advanced imaging technology that makes brain and spinal cord tumor surgery safer and with more accurate results. This image-guided approach is particularly helpful for brain cancer surgery because of the amount of healthy tissue that normally surrounds the tumor.

Your Surgical Options

There are a number of surgical options for the removal, or partial removal, of brain and spinal cord tumors. Sometimes your neurosurgeon will be able to remove only part of your tumor; other times, surgery may be able to relieve only some of your symptoms, such as headaches, blurred vision or seizures. Often surgery can reduce the amount of other treatments — such as radiation therapy or chemotherapy — that you will need.

The following surgical options are available at Scott & White. Your neurosurgeon will discuss which one is best for you.

Minimally Invasive Surgery

At Scott & White, we’re on the cutting edge of advanced techniques, performing minimally invasive surgery wherever reasonable. Minimally invasive surgery is also referred to as laparoscopic or endoscopic surgery. It's a surgical technique in which short, narrow tubes (trochars) are inserted into the body through very small incisions or a natural body opening such as the nose (see sidebar). Long, narrow surgical instruments and a camera are inserted through the trochars and into your body.

The camera, called an endoscope, gives the surgeon highly magnified three-dimensional images of your body in real time. The surgeon can then use the surgical instruments to manipulate, cut and sew tissue.

The minimally invasive technique differs from standard "open surgery" in which a large incision is used.

In addition, we use the most advanced imaging equipment available. It enables us to accurately identify the location of your tumor before surgery. And during surgery, this image-guided approach allows us at any point to know where we are during your surgery. So instead of searching for the tumor, we can go straight to it."

Minimally invasive techniques can be used with the following tumors:

  • Some pituitary tumors
  • Some skull base tumors
  • Some spinal cord tumors

Advantages of minimally invasive surgery include:

  • Less pain
  • Better cosmetic results
  • Shorter hospital stay (sometimes only two days)
  • Less blood loss
  • Lower risk of infection
  • Quicker recovery times

Not every patient or every tumor is a candidate for minimally invasive procedures. Your physician will guide you in what type of surgery is best for you.

Craniotomy

Your neurosurgeon may recommend that you have a craniotomy to remove your brain tumor. Your neurosurgeon will cut into your skull, setting aside a small piece of bone. Then your neurosurgeon, guided by computed tomography (CT) or magnetic resonance imaging (MRI) scans, will remove as much of your tumor or tumors as possible, and the piece of bone will be replaced.

Craniectomy

A craniectomy is similar to a craniotomy, with one significant difference: The piece of bone removed to allow your neurosurgeon access to your tumor is not immediately replaced. Sometimes your neurosurgeon expects swelling to occur post-surgery or the bone is not reusable. The piece of bone may be stored at the hospital for replacement at a later date.

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Benefits of Surgery

The surgical removal of tumors from the brain and spinal cord is a highly complex process. Our four neurosurgeons are specialists in neurosurgery; together, they have decades of experience performing these complex procedures. Individually and as part of a surgical team, they have developed the expertise you can trust with your care.

If you elect to have surgery to remove your brain or spinal cord tumor, here are some of the potential benefits:

  • You’ll get a definite diagnosis. When tissue is removed during surgery, it’s always evaluated in the laboratory. Your future treatment rests on these results.
  • Surgery often relieves pressure in the brain.
  • Surgery may reduce or remove symptoms resulting from your tumor.
  • Surgery generally improves the effectiveness of other therapies (chemotherapy or radiation therapy, for example) by reducing the size of the tumor load.

Sometimes your physician team may recommend additional treatments, such as radiation therapy, chemotherapy or immunotherapy, following surgery.

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Potential Risks and Complications of Surgery

As with all operations, there are potential risks and complications. 

With brain surgery, there are distinctive concerns because your brain controls your thoughts, vision, memory, movement and many other vital functions. Your neurosurgeon will discuss potential risks and complications with you.

Surgery can cause swelling inside the spinal cord. You may be prescribed drugs to reduce the swelling. With or without surgery, spinal cord tumors can cause permanent damage to nerves, disability from nerve damage, a loss of sensation or paralysis.

Your neurosurgeon will discuss potential risks and complications with you.

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When Surgery is Not Recommended

There are cases where surgery is not recommended for brain and spinal cord tumors, including:

  • Your tumor is located too deep within the brain
  • Your tumor is in a dangerous location, such as on the brain stem
  • Your health is not good
  • Your type of tumor does not respond well to surgery (such as lymphoma)

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