After the Biopsy

• Patients are expected to have same level of alertness as before procedure. They are not expected to be more awake or more drowsy
• The scalp incision is covered with a small dressing
• Histology results takes a week or longer to be ready

What are the alternatives?

• Observation i.e. non intervention – proper treatment cannot be given as type of tumour is unknown. Repeat MRI/CT then biopsy if tumour has grown bigger
• Radiation therapy / chemotherapy – given usually when nature of tumour is known, because of risks

Craniotomy and Excision of Brain Tumour

• This is a brain operation wherein the surgeon makes an opening in the skull bone and removes the brain tumour
• It may be done under General or Local anaesthesia
• A scalp incision is made over the area of the brain tumour
• An opening will be made in the skull bone
• The outer covering of the brain is opened to expose the brain and the tumour
• Symptomatic relief from mass effect
• Improve neurological condition
• Decrease tumour size of the tumour to improve results of adjuvant therapy (radiation therapy, chemotherapy)
• Histological diagnosis – no sampling error
• Complete cure (benign) or improved survival (malignant)
• The tumour is separated from normal brain and other important structures such as blood vessels and nerves, then removed.
• In cancerous tumours, tumour cells often spreads beyond tumour boundaries into adjacent “normal” brain, so it would not be possible to remove all of it.
• The aim is to remove as much tumour as is safely possible, without injuring the normal brain and other important structures.
• Tumour may be left
  • If stuck to important brain structures, blood vessels, or nerves,
  • If there is excessive bleeding or brain swelling during the operation
• Second operation or other measures e.g. Radiotherapy / chemotherapy may be required to treat the remnant tumour

Risk Factors

Risks of Craniotomy & Excision of Brain Tumour

• Overall risk: 5-10%
• Bleeding - may need second operation to evacuate the blood clot
• Infection
• Seizures
• Stroke
• Brain swelling
• Weakness on one side of the body
• Inability to speak / understand speech
• Inability to take care of oneself
• Visual impairment
• Hormonal and fluid & electrolyte problems (hypothalamic/ pituitary tumours)
• Risks of Craniotomy & Excision of Brain Tumour
• Non-neurological risks:
  • risks of general anaesthesia: heart attack,
  • lung problems, allergy to anaesthetic drugs
  • inability to pass urine
  • blockage of leg veins
  • chest infection
  • urinary tract infection

Risks of Craniotomy & Excision of Brain Tumour (Infratentorial)

• Injury to the brainstem
  • impaired consciousness
  • possible need for ventilator support
• Injury to cranial nerves
  • double vision
  • facial numbness, facial asymmetry
  • loss of hearing
  • difficulty swallowing
  • slurring of speech
• Hydrocephalus
  • may need to undergo a ventriculo-peritoneal shunt operation
• Inability to speak (cerebellar mutism)
• Involuntary head movements (titubation)
• Difficulty with walking and balance