Malignant brain tumors are the most common primary brain tumor, with an estimated incidence in adults of 6.89 cases per 100,000 persons per year in the United States. Although newer treatment modalities such as chemotherapy and immune therapy have emerged as potential adjuvants for management of these tumors, surgery continues to be first-line therapy. Malignant brain tumors (most commonly high-grade astrocytomas such as glioblastoma multiforme) are the most common primary brain tumor, and incidence rates have increased over time. Surgery is considered first-line therapy for these patients, but attempting resection of these tumors carries inherent risks such as neurological deficits and subsequent decreases in overall survival. Most often, the first step in brain or spinal cord tumor treatment is for the neurosurgeon to remove as much of the tumor as is safe without affecting normal brain function. Surgery alone or combined with radiation therapy may control or cure many types of tumors, including some low-grade astrocytomas, ependymomas, craniopharyngiomas, gangliogliomas, and meningiomas.
Tumors that tend to spread widely into nearby brain or spinal cord tissue, such as anaplastic astrocytomas or glioblastomas, typically cannot be cured by surgery. But surgery is often done first to reduce the amount of tumor that needs to be treated by radiation or chemotherapy, which might help these treatments work better. This could help prolong the person’s life, even if all of the tumor can’t be removed.
The importance of this, however, is that newer evidence has supported more aggressive resections as a mode to improve survival. Nonetheless, more aggressive resections carry an increased risk of potentially catastrophic surgical complications, including irreversible neurological deficits. he most common surgical complication was iatrogenic stroke, with an estimated incidence of 16.3 per 1000 cases. Retention of a foreign object and wrong side surgery were relatively rare events, with reported incidences of less than 0.7 per 1000 cases. If your brain tumor or epileptic focus is close to areas of your brain that control vision, speech or movement, your doctor will conduct brain mapping. This provides your neurosurgeon with a map of the brain centers that control each of these functions. Your surgeon also can perform brain mapping deeper in your brain during surgery. Your neurosurgeon uses this map to avoid damaging these areas and preserve these functions. Brain mapping, along with 3-D computer images, allows your surgeon to safely remove as much of your brain tumor or epileptic focus as possible and lower the risks of damaging important body functions. During surgery, your neurosurgeon or a speech-language pathologist may ask you questions or ask you to identify pictures and words on cards or computer that you saw before surgery. Your doctor may ask you to make movements, identify pictures on cards, count numbers or raise a finger. Your responses help your surgeon identify and avoid the functional areas in your brain. Notably, these cases were not found to carry an increased risk of mortality. Postoperative meningitis occurred in 1.1 per 1000 cases, and also did not increase the risk of mortality. Moreover, suffering from an iatrogenic stroke increased the risk of in-hospital mortality by 9-fold. The second most common surgical complication was hemorrhage or hematoma complicating a procedure, with an incidence of 10.3 per 1000 cases. Similar to iatrogenic strokes, having a hemorrhage/hematoma carried a significantly increased risk of in-hospital mortality.
Surgery on the brain or spinal cord is a serious operation, and surgeons are very careful to try to limit any problems either during or after surgery. Complications during or after any type of surgery can include bleeding, infections, or reactions to anesthesia, although these are not common. A major concern after surgery is swelling in the brain. Drugs called corticosteroids are typically given before and for several days after surgery to help lessen this risk. Seizures are also possible after brain surgery. Anti-seizure medicines can help lower this risk, although they might not prevent them completely.
Brain tumors and surgery for brain tumors can cause problems with thoughts, feelings and behaviors. After surgery, the patient may need help recovering. Rehabilitation specialists (physical therapists, occupational therapists and speech language pathologists) will provide assistance:
- Physical therapists will assess the patient’s ability to walk safely and climb stairs before being released from the hospital. They may also help the patient improve strength and balance.
- Occupational therapists will assess the patient’s ability to perform activities of daily living such as getting dressed, using the toilet and getting in and out of the shower. Occupational therapists also test the patient’s vision and thinking skills to determine whether the patient can return to work, driving or other challenging tasks.
- Speech language pathologists: If the patient’s brain tumor affects speech, speech language pathologists will evaluate problems with speech, language or thinking. They may also evaluate the patient for swallowing disorders.
Caring for the wound made during the brain surgery procedure is vital during the recovery time. Inadvertent poking or stretching in the area of the wound may cause a suture to open and involve risk of further brain damage. Rest and lowered stress are two major factors that aid in a speedy recovery after a brain surgery. Check with your doctor to understand what steps would help to ensure a holistic recovery after the procedure. Follow up visits to the clinic to discuss any symptoms and postoperative assessments are suggested even after brain surgery recovery.
If you had awake brain surgery to manage epilepsy, you generally should see improvements in your seizures after surgery. Some people are seizure-free, while others experience fewer seizures than before the surgery. Occasionally, some people have no change in the frequency of their seizures. If you had awake brain surgery to remove a tumor, your neurosurgeon generally should have been able to remove most of the tumor. You may still need other treatments, such as radiation therapy or chemotherapy, to help destroy remaining parts of the tumor.