What Are the Common Risks of Brain Tumor Surgery?

Brain tumor surgery poses both general and
specific risks. The general risks apply to anyone
going through surgery for any reason and are not
limited to brain tumor surgery. These include:
• Infection
• Bleeding
• Blood clots
• Pneumonia
• Blood pressure instability
Risks specific to brain tumor surgery depend
greatly on the particular location of the tumor.
Particular areas of the brain control functions
such as vision, hearing, smell, movement of the
arms and legs, coordination, memory, language
skills, and other vital functions. The process of
operating on the brain always includes some risk
that nerves or blood vessels serving these areas
will be damaged. This could result in partial or
complete loss of sensation, vision, movement,
hearing or other functions. When a tumor is
located deep within the brain it increases the
risk and range of possible complications.
Additional risks, while generally rare, are also
possible. These brain surgery risks include:
• Seizures
•Weakness
• Balance/coordination difficulties
• Memory or cognitive problems
• Spinal fluid leakage
• Meningitis (infection causing inflammation of
membranes covering the brain and spinal cord)
• Brain swelling
• Stroke
• Hydrocephalus (excessive fluid in the brain)
• Coma
• Death

Frameless Stereotactic Surgery

Instead of using an external frame as a reference
point, frameless stereotactic surgery uses tiny
markers, called fiducial markers, that are taped
or glued to the head before the brain is scanned.
The scan is then loaded into a planning and
navigation computer, producing a 3-dimensional
representation of the head, brain and tumor.
During surgery these markers are touched with
a pointing device, called a “Wand.” Identified
on the scan, the computer “knows” where the
surgical instrument is during the procedure in
relation to the brain and tumor.

Frame-Based Stereotactic Surgery

With frame-based stereotactic surgery, a lightweight
frame is attached to the skull at four points.
Local anesthesia is used to numb the places where
the pins contact the skull. Once the frame is
attached a CT, MRI or dye scan (angiography) is
done. Since the scan images both the tumor and
the frame, it is able to show the exact location of
the tumor in three dimensions in relation to the
head frame. The neurosurgeon takes these
coordinates and precisely inserts a probe through
a small incision in the skull to perform the biopsy
or other procedure.
It also has some limitations. The frame can
sometimes obstruct the neurosurgeon’s view of
the site; it can be time-consuming to manually
set the frame and read the scans; there is a
limited space to work within the radius of the
arc; and the scans and surgery usually need to
be performed the same day.

STEREOTACTIC SURGERY

The use of highly advanced computers to
locate and create a three-dimensional image of
a tumor is called stereotaxy. When used during
surgery, this technique is called stereotactic
surgery. Conventional x-rays can only measure
two dimensions: height and width.
Stereotaxyadds the third dimension of depth, which
enhances the neurosurgeon’s ability to precisely
map the location of the tumor and find the best
and safest pathway for removing it.
Stereotactic techniques may be used to prepare
for a surgery, during biopsy or tumor removal,
while implanting radiation pellets, or to provide
a navigation system during surgery. These
techniques are especially useful in locating and
removing tumors deep within the brain, such as
brain stem and thalamic tumors. Stereotactic
systems are used in operating rooms, enabling
surgeons to view images of the brain as surgery
is being performed.

Brain Surgery

Whether you use the word “surgery,”
“resection,” “operation,” “brain operation”
or “brain surgery,” surgery is usually the
first step in treating most benign and many
malignant tumors. It is often the preferred
treatment when a tumor is accessible – which
means it can be removed without unnecessary
risk of neurological damage.
Surgery might be recommended to:
• remove as much tumor as possible
• provide a tumor tissue sample for an
accurate diagnosis
• remove at least part of the tumor to relieve
pressure inside the skull (intracranial
pressure), or to reduce the amount of tumor
to be treated with radiation or chemotherapy
• enable direct access for chemotherapy,
radiation implants, or genetic treatment
of malignant tumors
• relieve seizures (due to a brain tumor) that
are difficult to control
“Radiosurgery” is a type of intense radiation
delivered to a tumor. It may be used instead of, or
in addition to, conventional surgery.Radiosurgery
is not surgery in the conventional sense, as no
opening is made in the skull. In certain cases,
it may offer similar benefit and lower risk or
discomfort than conventional surgery.