Our Summary

This research paper discusses brain metastases, which are the most common type of brain tumors and a leading cause of death and serious illness in cancer patients. The research shows that removal of these tumors through surgical means can improve survival rates, reduce the chance of the tumor returning, and help patients maintain their physical independence. This is particularly true for patients with up to three metastases (spread of cancer) and those who have their cancer under control elsewhere in the body.

Modern medical techniques and technologies allow surgeons to perform these operations with minimal invasiveness. This includes procedures like “keyhole craniotomies” and the use of “tubular retractors”. These methods allow surgeons to operate through small openings, reducing damage to healthy tissue.

The paper also discusses the importance of careful planning before surgery, especially for tumors located in critical areas of the brain (eloquent regions). This involves using advanced imaging technologies like functional MRI and diffusion tensor imaging to map the brain, as well as monitoring brain function during surgery. This helps to preserve normal brain function and reduce the risk of neurological damage. This can be done under general or awake anesthesia.

FAQs

  1. What are the most common intracranial tumors?
  2. How does en bloc surgical resection of brain metastases improve a patient’s condition?
  3. What modern techniques and technologies are used in brain surgery to preserve normal neurologic function?

Doctor’s Tip

One helpful tip a doctor might tell a patient about brain surgery is to follow all pre-operative instructions carefully, including fasting before the surgery and avoiding certain medications that may increase the risk of bleeding. It is also important to discuss any concerns or questions with your healthcare team and to have a support system in place for after the surgery to assist with recovery and rehabilitation. Additionally, following post-operative care instructions and attending all follow-up appointments is crucial for a successful recovery.

Suitable For

Patients who are typically recommended for brain surgery include those with:

  1. Brain metastases from systemic cancer, especially if they have up to three metastases and controlled extracranial disease
  2. Primary brain tumors that are causing symptoms or affecting quality of life
  3. Traumatic brain injuries that require surgical intervention
  4. Vascular abnormalities such as aneurysms or arteriovenous malformations
  5. Epilepsy that is not controlled with medication and can be treated with surgical resection of the seizure focus

It is important for patients to undergo thorough evaluation and consultation with a multidisciplinary team, including neurosurgeons, oncologists, radiologists, and other specialists, to determine the best course of treatment for their specific condition.

Timeline

Before Brain Surgery:

  1. Consultation with a neurosurgeon to discuss treatment options
  2. Preoperative testing such as MRI, CT scans, and blood work
  3. Planning for the surgery, including discussions about risks and benefits
  4. Possible radiation or chemotherapy treatments before surgery

After Brain Surgery:

  1. Recovery in the hospital, which may include monitoring in the intensive care unit
  2. Rehabilitation to regain strength and function
  3. Follow-up appointments with the neurosurgeon to monitor progress and discuss further treatment options
  4. Possible radiation or chemotherapy treatments after surgery to prevent recurrence
  5. Long-term monitoring for any potential complications or recurrence of the tumor.

What to Ask Your Doctor

  1. What are the risks and potential complications associated with brain surgery?

  2. How long is the recovery process expected to be and what can I expect during the recovery period?

  3. Will I need any additional treatments or therapies following the surgery?

  4. How will my quality of life be impacted after the surgery?

  5. What are the chances of the tumor recurring after surgery?

  6. Will I need to undergo any additional imaging or tests to monitor the tumor post-surgery?

  7. Are there any specific lifestyle changes or precautions I should take following the surgery?

  8. What is the expected prognosis for my specific case?

  9. How experienced is the surgical team in performing this type of surgery?

  10. Are there any alternative treatment options to consider before proceeding with surgery?

Reference

Authors: Wang JL, Elder JB. Journal: Neurosurg Clin N Am. 2020 Oct;31(4):527-536. doi: 10.1016/j.nec.2020.06.003. Epub 2020 Aug 14. PMID: 32921349