Craniotomy is a brain operation during which a neurosurgeon makes an opening in the skull bone to remove a brain tumor. The incision is made over the area of the brain tumor. It can be performed under local or general anesthesia. The maximal tumor removal (if possible) is the best treatment for prolonging survival and, in case of benign tumors, may be curative.
Minimal Access Neurosurgical Techniques, in conjunction with advanced intraoperative image-guidance technology, are used to reduce incision and craniotomy sizes to the smallest possible and to optimize the accuracy and safety of neurosurgery. These techniques allow surgeons to navigate as safely as possible to the tumor or lesion. The use of intraoperative MRI allows neurosurgeons to assess tumor resection in a real-time during surgery and increase safety and the potential to maximize resection of the tumor.
Minimal access surgical approaches allow for safer surgery, earlier and optimal recoveries, and shorter hospital stays. BNA neurosurgeons utilize a “minimal shave” technique for scalp incisions where possible. Despite being able to remove a tumor entirely, it is important to understand that, except in highly unusual circumstances, malignant tumors cannot be cured through surgery, chemotherapy or radiation; the growth can only be stabilized or controlled. A decision for the most appropriate treatment option(s) is made depending on the tumor location, imaging characteristics, patient’s health, age, and wishes.
This type of surgery is performed using an endoscope to visualize the tumor in the brain or spine to allow minimally invasive access to some lesions. The entire operation is performed through a tiny hole usually in combination with a surgical microscope. This combination allows neurosurgeons to perform an operation deep within the brain and skull base. A small incision site and minimal trauma to the surrounding tissues results in a shorter hospital stay and quicker return to normal activities for patients. These are just a few of the advantages of this type of minimally invasive surgery. Click this link to read a case report on pituitary tumor resection.
For selected patients with tumors or other pathological conditions in highly functional parts of the brain (also known as ‘eloquent’ regions of the brain, such as motor, sensory, and speech areas), Boulder Neurosurgical Associate (BNA) surgeons and their team perform a specialized type of surgery called awake craniotomy. Patients are lightly sedated during the initial portion of surgery, and awakened when the brain is exposed. Depending on the region of the brain and the lesion, different electrical or cognitive tests are performed to allow the surgeon to carefully ‘map’ the selected region of the brain, thus ideally identify the safest possible route and region of resection. As the brain has no pain receptors, this is a pain-free and comfortable procedure that adds safety to certain craniotomies if necessary. A patient is kept asleep for all other parts of the operation. It is important to understand that a majority of cases do not require awake craniotomy and only your surgeon will identify if you may benefit from this specialized procedure.
Click here to download a PDF with more information about the principles of awake craniotomy that were established more than 50 years ago.