Surgery is the primary treatment for brain and spinal cord cancer. Surgery is used to:
The type of surgical procedure depends mainly on the:
Side effects of surgery depend on the type of surgical procedure.
A person with a brain or spinal cord tumour is evaluated very carefully before surgery. The neurological examination looks for any changes to normal functions, such as reflexes, speech, hearing, vision, thinking, movement, feeling and body functions.
The location of the tumour is carefully mapped out before surgery with a series of computed tomography (CT) scans or magnetic resonance imaging (MRI) pictures. This will help the surgeon decide if the tumour can be removed by surgery.
Some areas of the brain and spinal cord are difficult to reach or have functions that are too important to be damaged by an attempt to surgically remove the tumour. Tumours that cannot be removed are called inoperable.
A craniotomy is surgery that opens the skull to remove a brain tumour. The goal of surgery is to remove as much of the tumour as possible without destroying important brain tissue or affecting brain functions.
Brain mapping is done during a craniotomy when a tumour is near areas of the brain that control speech or motor function. Mapping is done by a technique called intraoperative cortical stimulation. The technique involves stimulating the surface of the brain with a mild electrical current to determine the function of a particular part of the brain. The procedure is painless. It produces temporary speech disturbance or twitching in the part of the body that is controlled by the area of the brain being stimulated. This information is then “mapped” so that the surgeon can avoid these areas when removing the tumour.
Speech mapping tracks the areas around the tumour that are responsible for speech and understanding speech. After a general anesthetic is given, the surgeon opens the skull and dura mater to expose the brain. The person is then woken up so that they can talk to the surgeon and follow any instructions given during the mapping. When the mapping is finished, the person is given a general anesthetic again and the surgeon continues the operation to remove the tumour.
Motor mapping tracks the areas around the tumour that are responsible for movement and reflexes. The person may remain under general anesthetic if the surgeon does not need direct feedback from the person. The surgeon stimulates the areas around the tumour with an electrical current and watches for any movement of the body. As with speech mapping, the surgeon uses the mapped areas as a guide when removing the brain tumour.
An external ventricular drain (EVD), also called ventriculostomy, is a thin tube inserted through the skin and skull into a ventricle (fluid-filled chamber in the brain). It allows cerebrospinal fluid (CSF) to drain from the brain into a collection system or bag outside the body. An EVD is sometimes placed before or during surgery to remove a brain tumour to relieve a buildup of CSF. The EVD cannot be left in place permanently. It is typically removed when it is no longer needed or it is replaced with a shunt.
A shunt may be needed if the brain tumour is blocking the flow of cerebrospinal fluid (CSF) and causing extra fluid to build up in the brain (hydrocephalus). A shunt is a narrow, soft, flexible piece of tubing. It has a valve system that regulates the pressure of the CSF and prevents fluid from flowing back into the ventricles. Many shunts have reservoirs that may be used to remove CSF samples.
During surgery, the shunt is placed in a ventricle of the brain (an area filled with CSF). It leads from the ventricle to the scalp. From there, it runs under the skin, down the neck and into the abdominal cavity (not the stomach). The CSF that drains into the abdominal cavity is reabsorbed into the bloodstream.
An endoscopic third ventriculostomy (ETV) is a procedure in which the surgeon creates an opening and places a tube in the third ventricle to allow CSF fluid to flow around an obstruction. The surgeon uses an endoscope to navigate within the ventricle and create an internal bypass. ETV is sometimes used to treat a buildup of extra fluid in the brain (hydrocephalus). It can also be used to biopsy or remove tumours within the ventricles of the brain.
An Ommaya reservoir is a small, dome-shaped device with a short tube (catheter) attached to it. The surgeon inserts the reservoir under the scalp and the catheter is threaded into a ventricle or cyst in the brain.
The reservoir may be used to:
Laminectomy is surgery to open a bone of the spine (vertebra), which covers the spinal cord, to remove a spinal tumour.
En bloc resection is a technique in which the surgeon tries to remove the tumour in a single piece. The location of the tumour and how far it extends into surrounding tissues determine the amount of tumour that is removed. En bloc resection is used to remove some spinal cord tumours.
During marginal or wide en bloc vertebral body resection, the entire vertebral body (the solid, central part of the vertebra) is removed. This technique is called a total en bloc spondylectomy (TES). A TES is performed through either a combined anterior-posterior approach (through both the back and the abdomen) or a posterior-only approach (through the back). In the posterior-only approach, the person is placed in a frame and in a prone position (lying face down). During the procedure:
When part or all of a vertebra is removed, the spine is weakened (spinal instability). The spine must be reinforced (stabilized) so it can function properly.
If the vertebrae above and below the removed section are intact, the surgeon can stabilize the spine using fixation devices. These are special pins, plates, rods, hooks or distractible cages (implants that replace a vertebra). The surgeon attaches the fixation device to the bones above and below where the vertebra was removed.
If there is no stable bone that can be used to attach the fixation devices, people with spinal instability will remain in bed until a special brace is made and fitted for them.
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