Brain Tumor Surgery via Microsurgical Method
Microsurgery is a technique performed using an operating microscope and high-precision instruments that has become the standard method in brain tumor surgery. It ensures the removal of the tumor as safely as possible while preserving healthy brain tissue.
What is a brain tumor?
A brain tumor is a mass formed as a result of abnormal and uncontrolled proliferation of cells within the brain tissue inside the skull.
There are two main types:
| Type | Description | Examples |
|---|---|---|
| Primary tumor | Originates from the brain tissue itself | Glioma, meningioma, pituitary adenoma, schwannoma |
| Secondary (metastatic) tumor | Occurs when cancer from another organ spreads to the brain | Metastases originating from lung, breast, or melanoma |
Tumors are also classified as benign or malignant. Benign tumors generally grow slowly and do not spread into surrounding tissue; malignant tumors, on the other hand, can grow rapidly and invade surrounding tissue.
What are the causes of a brain tumor?
The exact cause of most brain tumors is unknown. Known risk factors include:
- Genetic predisposition: Hereditary syndromes such as neurofibromatosis or Li-Fraumeni syndrome
- Exposure to ionizing radiation: Particularly a history of previous radiation therapy
- Advanced age: Certain tumor types increase in incidence with age.
- Immunosuppression: Conditions such as immunosuppressive therapy following organ transplantation
- Family history: Familial predisposition can be observed in certain tumor types.
What are the symptoms of a brain tumor?
Symptoms vary depending on the tumor’s location, size, and rate of growth. The most common symptoms are:
- Progressively worsening headache (especially increasing in the morning)
- Nausea and vomiting
- Seizures (epileptic fits)
- Visual disturbances or double vision
- Loss of balance and difficulty walking
- Speech disorders
- Weakness or numbness in the arm or leg
- Personality changes or cognitive decline
Important note: These symptoms are not specific to brain tumors and can occur due to many different reasons. Neurological examination and imaging (MRI/CT) are required for a definitive diagnosis.
Brain Tumor Treatment Methods
The treatment plan is determined jointly by a team of neurosurgery, medical oncology, and radiation oncology specialists according to the tumor’s type, location, stage, and the patient’s general health status.
| Treatment | Intended Use / Purpose |
|---|---|
| Surgery (Resection) | Removing as much of the tumor as safely possible |
| Radiotherapy | Targeting remaining tumor cells post-surgery |
| Chemotherapy | Particularly in high-grade gliomas |
| Targeted Therapies | Personalized treatment based on the molecular characteristics of the tumor |
| Active Surveillance (Observation) | In slow-growing, small benign tumors |
What is microsurgery?
Microsurgery is a surgical technique performed under an operating microscope that requires high magnification and precise instruments. It has revolutionized neurosurgery since the 1960s and has become the standard approach for brain tumor surgeries today.
Its primary goal is to preserve surrounding healthy brain tissue, blood vessels, and nerves as much as possible while removing the tumor.
What are the fundamental principles of microsurgery?
1. Magnification and Illumination of Tissues
The operating microscope magnifies tissues by 3 to 40 times. Thanks to this, the surgeon can:
- Clearly see millimeter-sized blood vessels and nerves
- Better distinguish the boundary between tumor tissue and healthy tissue
- Achieve clear vision through focused illumination on deep-seated structures
2. Precise Instrument Usage
The instruments used in microsurgery are much finer than standard surgical tools:
- Micro-scissors and micro-forceps: Precise cutting and grasping in millimeter-scale tissues.
- Bipolar coagulation forceps: Minimizes thermal damage to surrounding tissue while controlling bleeding.
- Ultrasonic aspirators (CUSA): Can fragment and aspirate tumor tissue while preserving surrounding blood vessels.
How does the microsurgical operation process work?
Planning Phase
- The three-dimensional location of the tumor is determined using MRI and CT images.
- Neuronavigation systems (GPS-like location tracking technology) display the surgeon’s position in real time during the operation.
- Critical brain regions (speech center, motor cortex) can be mapped in advance using functional MRI.
Surgery
- A small window is opened in the skull (craniotomy) to provide the safest access to the tumor.
- The brain membranes (dura mater) are opened under the microscope.
- The surgeon reaches the tumor while preserving healthy tissue.
- The tumor is separated from the surrounding tissue and removed piece by piece or as a whole.
- Intraoperative neuromonitoring (electrical tracking of nerve functions during surgery) can be applied in critical regions.
- In certain cases, awake craniotomy (keeping the patient awake during surgery to perform speech or movement testing) is preferred.
Assistant Technologies
- Intraoperative MRI/Ultrasound: Used to check how much of the tumor has been removed during surgery.
- Fluorescence-guided surgery (5-ALA): Shows tumor tissue in a distinct color, especially in high-grade gliomas, enabling clear visualization of margins.
What are the advantages of microsurgery?
- Less tissue damage: Thanks to a smaller access path and precise manipulation.
- Better tumor margin differentiation: Healthy tissue is preserved to the maximum extent.
- Lower risk of bleeding: Controlled hemostasis through clear visualization of blood vessels.
- Functional preservation: The probability of preserving critical functions such as speech, movement, and vision increases.
- Faster recovery process: Less surgical trauma generally leads to a shorter hospital stay.
What are the limitations of microsurgery?
- Complete removal may not always be possible in deep-seated tumors or those close to critical regions such as the motor cortex or speech center.
- Complete resection can become technically challenging in tumors without clear margins, such as infiltrative gliomas.
- Outcomes depend heavily on the experience of the surgical team and the technological equipment of the center.
Frequently Asked Questions About Brain Tumor Surgery via Microsurgical Method
Can microsurgery be applied to all types of brain tumors?
Microsurgery can be applied to most types of brain tumors; however, suitability is evaluated based on the tumor’s location, size, and type. For certain deep-seated tumors or those located in highly critical regions, different approaches (such as radiosurgery) may be preferred.
Why is an awake craniotomy performed?
In tumors located close to brain regions responsible for speech or movement, keeping the patient awake during surgery aims to test functions in real time and preserve these critical functions.
How long does the recovery process take after microsurgery?
The recovery duration varies according to the size and location of the tumor, the patient’s general health status, and the scope of the surgery. For precise timeline information, consult the treating neurosurgery team.
Can the entire tumor always be completely removed?
No. Complete removal may not always be possible, especially in tumors that are close to critical brain regions or are infiltrative (tend to spread); in such cases, additional treatments such as post-surgical radiotherapy or chemotherapy may be applied.
What are the risks of microsurgical surgery?
As with any surgical intervention, there are general risks associated with infection, bleeding, and anesthesia. Although the risk of temporary or permanent neurological deficits (loss of vision, speech, or motor strength, etc.) exists depending on the tumor’s location, microsurgery and advanced imaging methods aim to minimize these risks.
How long does a brain tumor surgery via microsurgery take?
The duration of the surgery varies depending on the tumor’s location, size, and type. Although it generally takes between 3 to 8 hours, this duration may extend in complex and deep-seated cases.
Is all the hair shaved for the operation?
With the development of modern microsurgical techniques and surgical planning, shaving the entire head is generally not necessary. In most cases, only a small strip of hair in the region where the surgical incision will be made is shaved locally.
Which technologies are used during microsurgery to prevent brain damage?
In addition to the operating microscope; neuronavigation, which calculates the tumor’s location with millimeter precision; neuromonitoring, which instantaneously tracks nerve functions throughout the operation; and specialized intraoperative ultrasonography systems that facilitate tissue differentiation are used to maximize the preservation of healthy tissues.
How long is the intensive care unit stay after brain tumor surgery?
Patients typically spend the first 24 to 48 hours in the intensive care unit so that their neurological status can be closely monitored following surgery. Patients whose conditions are stable are subsequently transferred to the standard inpatient ward.
Is a severe headache normal after surgery?
Feeling a headache during the first few days post-surgery is an expected situation due to the surgical incision and intervention performed on the skull. These headaches are usually managed effectively with pain relievers prescribed under physician control and gradually subside within days.
Does a tumor recur after surgery (Is there a risk of relapse)?
The risk of recurrence depends on whether the tumor is benign or malignant, its pathological subtype, and how much of it was removed during surgery. While the risk of recurrence is higher in malignant tumors, benign tumors generally do not recur when completely removed. Therefore, regular post-operative MRI follow-ups are mandatory.
Is radiotherapy or chemotherapy absolutely necessary after brain tumor surgery?
This situation depends on the pathological examination result (biopsy report) of the tumor removed during surgery. While additional oncological treatment is usually not needed for benign and completely resected tumors, oncological treatments are planned for malignant tumors or cases where residual tumor tissue is left in critical regions.
When can one return to work and normal life after surgery?
The time to return to work varies depending on the scope of the surgery, the patient’s neurological condition, and the physical/mental effort required by their profession. Generally, patients working desk jobs can return to work within 4 to 6 weeks, whereas this period is longer for professions requiring physical labor.
Is physical therapy or rehabilitation necessary after surgery?
If the tumor was located near centers of movement, balance, or coordination, and if a loss occurred in these functions before or after surgery, rehabilitation is required. Initiating physical therapy programs early in the post-operative period is recommended to regain neurological functions as quickly as possible.
Sources
- Mayo Clinic – mayoclinic.org
- Johns Hopkins Medicine – hopkinsmedicine.org
- Cleveland Clinic – clevelandclinic.org
- MD Anderson Cancer Center – mdanderson.org
- American Association of Neurological Surgeons (AANS) – aans.org
- National Brain Tumor Society – braintumor.org
- UCSF Health – ucsfhealth.org
- Memorial Sloan Kettering Cancer Center (MSKCC) – mskcc.org
- Stanford Health Care – stanfordhealthcare.org
- National Cancer Institute (NCI) – cancer.gov