What happens during brain surgery for glioma?

Gliomas are tumours that start in the glial cells, which are the supportive tissues of the brain. Treatment for the disease may include surgery, radiation therapy and/ or chemotherapy. We’ve asked one of our top neurosurgeons Mr Richard Gullan about the different types of glioma and what happens during craniotomy, the surgical procedure to remove a brain tumour.
 

What are the different types of glioma?

The three main types of glioma include:
 

• Astrocytoma – these are the commonest types of glioma brain tumour to occur in adults and children. They appear in any part of the brain and nervous system, including the spinal cord. From astrocyte cells, they regulate electrical impulses in the brain.
• Oligodendroglioma – they develop from oligodendrocyte cells, which insulate nerve cells to help send nerve signals.
• Ependymoma – from ependymal cells that line the cavities of the brain (ventricles).
   

What is the surgical procedure for glioma?

The most common surgical procedure to remove gliomas is a craniotomy where part of the bone of the skull is removed to expose the brain. The cut-out area of bone is called a ‘flap’.

Prior to the operation, the surgeon uses scans to accurately locate and remove as much of the tumour as possible as to avoid removing any healthy tissue.

The ‘flap’ is then replaced and secured with small permanent metal brackets. The scalp is stitched back into places and in most cases is covered by the patient’s hair.
 

Will I be asleep during brain surgery?

It depends on the location of the brain tumour as the surgeon may suggest an ‘awake craniotomy’. This enables the surgeon to check the function of the brain if the tumour is close to the part of the brain that controls speech, for example, they make ask the patient to speak.

The patient can discuss with the surgeon if they are able to have general aesthetic for part of the operation. A local anaesthetic will be used for any parts of the surgery when the patient is awake so that they will not feel pain.

The brain does not feel pain, therefore although an awake craniotomy sounds daunting, the team around you will ensure you that you are not in any pain.
 

What is a neuroendoscopy?

Neuroendoscopy (or keyhole surgery) is a minimally invasive technique, which requires a much smaller opening in the skull. A long tube with a camera and small surgical instruments is passed through the small opening. The camera projects the image from inside the brain onto a TV screen and the surgeon will use this as a guide in removing the tumour.

Keyhole surgery allows for faster recovery. Neuroendoscopy is particularly useful for removing the fluid-filled spaces of the brain (ependymomas in the ventricles).


If you are researching your options for brain surgery to remove a glioma, do not hesitate to book an appointment here with Mr Gullan for expert advice.