Principal Director & HOD, Neuro and Spine Surgery, Fortis Hospital, Shalimar Bagh, New Delhi
Part 5 of 9 in Diagnosis and Management of Brain Tumour
Brain Tumour Surgery and Radiosurgery: Treatment Options Explained
June 9, 2024
Brain tumour treatment has four broad modalities: surgery, radiotherapy, chemotherapy and radiosurgery, with surgical technology having advanced considerably in recent decades.
From open surgery to neuronavigation-guided keyhole surgery
Open microscopic surgery has been the standard treatment for eight to nine decades. The major advancement since is neuronavigation-guided keyhole microscopic surgery, which uses computer-assisted navigation to locate the tumour precisely during surgery, combined with a surgeon-controlled robotic microscope that allows more complete tumour removal without damaging surrounding brain tissue. Stereotactic biopsy, taken through a small hole, is used for deep-seated tumours.
Radiosurgery and when it's used instead of open surgery
For malignant tumours, radiotherapy and chemotherapy are standard adjuvant treatments. Certain small benign tumours can be treated directly with radiosurgery, delivered as gamma knife, cyber knife, or LINAC-based stereotactic radiosurgery. Radiosurgery's main limitation is that it takes about two years to shrink a tumour, so it is not always appropriate when a tumour carries an immediate risk, such as bleeding.
This article is based on a Jivo Masterclass session conducted by Dr. Sonal Gupta, Principal Director & HOD, Neuro and Spine Surgery, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Sonal Gupta taught doctors across Africa on June 9, 2024.
FROM THE LIVE Q&A
Moderator
Can a brain tumour be detected in a newborn?
Dr. Sonal Gupta
Yes. An ultrasound of the skull can be used as a screening test to check for excess fluid or a tumour, but an MRI is required for a definitive diagnosis even in a newborn.
Frequently Asked Questions
What are the post-operative complications of brain tumour surgery?▼
Complications have come down to under 5% of cases. They include epilepsy, a haematoma (clot) at the surgical site, infection from open surgery, and, if the tumour is very large, the possibility that a portion has to be left behind.
Will children benefit from epilepsy surgery at an early age?▼
Yes. If a child is dependent on multiple anti-epileptic medications, surgery helps by reducing both the number of medications needed and their side effects.
A 19-year-old has been on epilepsy follow-up and medication for 10 years. The MRI is negative, but the EEG shows a slow-wave background. What is the next step?▼
This patient should be referred for a dedicated epilepsy workup.
After a complete resection of a cancerous mass, there is a void left in the brain. How does this void evolve during healing, and are there always neurological sequelae?▼
A cancer tumour can never be removed completely; microscopic cells are always left behind. Because these tumours cause significant surrounding brain swelling, the surgical cavity fills in quickly on its own, so the void itself is not a concern.
A 7-year-old girl presented with a two-week history of headache and vomiting that progressed over the last three days. MRI showed a well-defined left frontal lobe mass with a differential of metastasis versus high-grade glioma, and local doctors are recommending a frontal lobectomy. What would you recommend, and what are the likely outcomes?▼
Rather than an open frontal lobectomy, neuronavigation-guided keyhole tumour surgery using a surgical robotic system allows near-complete removal of high-grade tumours, improving survival, though high-grade tumours cannot be described as fully curable. This is typically followed by stereotactic radiosurgery and chemotherapy or immunotherapy depending on the biopsy, guided by genetic study of the tumour, which few centres worldwide perform routinely.
What is neuronavigation-guided keyhole surgery?▼
A technique combining computer-assisted navigation to precisely locate a tumour with a surgeon-controlled robotic microscope, enabling more complete tumour removal through a smaller opening without damaging surrounding brain tissue.
What is the limitation of radiosurgery?▼
It takes about two years to shrink a tumour, so it may not be appropriate when a tumour poses an immediate risk such as bleeding.
In This Series: Diagnosis and Management of Brain Tumour
- 1.Brain Tumour
- 2.How Brain Tumours Are Classified: Benign, Malignant, Primary and Secondary
- 3.Brain Tumour Symptoms and Which Headaches Are Red Flags
- 4.Diagnosing Brain Tumours: CT, MRI and Beyond
- 5.Brain Tumour Surgery and Radiosurgery: Treatment Options Explained
- 6.Brain Tumour Surgery: Realistic Complication Rates and Recovery
- 7.Epilepsy Surgery: Who Needs It and How It Helps
- 8.Brain Tumours in Children and Newborns: Diagnosis and Management
- 9.Real Brain Tumour Cases: Weighing Surgery Against Radiosurgery