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Brain and Spine Tumors – Procedures/Treatments

Brain Tumors

The most common types of surgery performed for brain tumors are:

Biopsy:

Biopsy is the removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsies.

The most common types:

  • Incisional biopsy, in which only a sample of tissue is removed.
  • Excisional biopsy, in which an entire lump or suspicious area is removed.
  • Needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

Stereotactical Biopsy:

Stereotactical Biopsy maps the brain in a three-dimensional coordinate system. In conjunction with MRI and CT scans, the neurosurgeon is better equipped to accurately target the area of the brain in question.

Debulking:

Debulking is the surgical removal of the portion of a cancerous tumor that can be excised to reduce the effect of the mass on surrounding structures. This technique is often performed in brain surgery when the entire tumor cannot be removed without serious damage to the surrounding structures.

Gross Total Resection (GTR):

Gross Total Resection (GTR) is removal of all visible tumorous tissue, after which follow-up scans show no apparent tumor. GTR is considered when the surgeon believes the entire tumor can be safely removed without substantial risk of unacceptable injury.


Spine Tumors

Reasons surgery would be a good option for spine tumors:

  • Control of tumor growth by surgical removal, sometimes accompanied by radiation and/or chemotherapy.
  • Improving symptoms by reducing pressure on nerves and stabilizing spine to prevent deformities, collapse or paralysis.

The goal is usually to reduce the severity of symptoms, including:

  • Lessen pain
  • Restore spine stability to improve mobility
  • Preserve neurological function
  • Alter or change outcomes

The type of spine surgery will depend on the type of tumor, its location, and the patient’s symptoms.

Types of procedures:

Open Procedures

Open procedures may be done with a surgical incision on the anterior or posterior.

  • Decompression: A procedure to remove the bone that has the tumor and to increase the space around the spinal cord and nerves.
  • Stabilization: An application of screws, rods or cement to stabilize the spinal column.
  • Combination: A combination of the above procedures; may be staged one or more days apart.

Minimally Invasive Procedure

A number of small incisions are made during this procedure, into which a tube or tubes are inserted. The number of incisions depends on the type of surgery. The tube or tubes let the doctor insert tiny video cameras and specially designed surgical instruments to perform the procedure.

Complete En Bloc Resection

Primary spinal tumors may be removed through complete en bloc resection – resection of a large bulky tumor without dissection – for a possible cure. In patients with metastatic tumors, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine and alleviating pain. For cases in which surgical resection is possible, preoperative embolization may be used to enable an easier resection. This procedure involves the insertion of a catheter or tube through an artery in the groin. The catheter is guided through the blood vessels to the tumor, where it delivers a glue – like liquid embolic agent that blocks the vessels that feed the tumor. When the blood vessels that feed the tumor are blocked off, bleeding can often be controlled better during surgery, helping to decrease surgical risks.