Surgery

The majority of brain tumors are treated with surgery. First, a part of the skull is removed to get to the brain in a craniotomy. (After the surgeon removes the tumor, the bone is usually put back, or the opening in the skull is covered with a piece of metal or fabric.) The challenge is to remove as much of the tumor as possible without injuring normal brain tissue that controls functions such as speaking, walking, and thinking. A tumor can recur if any tumor cells are left.

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In the past, surgeons looked for subtle differences in the appearance of normal tissue and the tumor to determine how much tissue to remove. This frequently resulted in complications. In the early 1990s, computerized devices called surgical navigation systems were developed that enable the surgeon to study an image of the patient's brain on a computer in the operating room, match it to the patient's head, and more accurately determine the location and size of the tumor. These tools have greatly reduced the risk of complications from surgery and have allowed surgeons to remove some tumors that were once considered inoperable.

One limitation of these systems is that they use CT and MRI scans obtained prior to surgery to guide the surgeon. However, these scans can't account for movements of the brain that occur during surgery. In certain cases, some type of imaging is used during surgery, such as ultrasound, CT scan, or even MRI, to provide surgeons the most accurate information.

Sometimes surgery isn't possible. If the tumor is in the brain stem, for example, a surgeon may not be able to remove it without harming healthy tissue. Also, in some cases, surgery may not be necessary as the tumor is likely to respond to other treatments. In these cases, the patient may receive chemotherapy or radiation.