Surgery is often the first step in treating adult brain and spine cancers. Even for the fastest growing brain cancers, surgery is the first step toward complete treatment. Surgery is done for several reasons:
• To biopsy the cancer to find out the type of cancer, especially if complete removal is not possible to due the location in the brain or spine. In this procedure, a small amount of the cancer is removed and viewed under a microscope by a neuropathologist in order to diagnosis the type of cancer.
• To safely remove the entire visible cancer.
• Whenever possible, to reduce pressure on the brain or spine caused by the cancer. This may also relieve symptoms caused by the cancer.
For some brain and spine cancers, surgery cures the cancer when it is removed completely. Sometimes it is not possible to remove all of the cancer. Regardless of how much cancer is removed by surgery, radiation therapy and/or chemotherapy treatments may be needed to get rid of invading cancer cells.
Minimally invasive techniques refers to doing surgery through smaller incisions. Endoscopy is a minimally invasive technique that may be used for certain types of brain and spinal cord cancers. The surgeon uses an endoscope for these procedures (a thin flexible tube with an internal light source). Looking through the endoscope, the surgeon can see and remove part(s) of the cancer. There is often less injury to other surrounding tissue with the minimally invasive technique and recovery times are often faster and less painful than with traditional surgery.
There are other types of procedures that may be performed before or during surgery for brain and spinal cord cancers.
• Embolization involves selectively blocking the flow of arterial blood by using pellets or glue to reduce the blood supply to the cancer and permit a safer surgery. After the embolization, surgery is done as soon as possible to avoid re-growth of cancer blood vessels.
• Functional Brain Mapping refers to mapping the parts of the brain to identify important areas such as motor areas, which control movement, somatosensory areas, which control sensation, and language areas, which control speech and understanding verbal communication. The removal of brain cancer is a delicate operation that often needs functional brain mapping. By mapping the brain, the neurosurgeon can find a safe balance between cancer removal and avoiding damage to areas of the brain that affect the patient's quality of life. UW Medicine’s brain mapping program is the largest and busiest program in the Pacific Northwest.
• Lasers (Light amplification by stimulated emission of radiation) release a beam of concentrated light energy that can destroy cancerous tissues and are used as a surgical tool.
• Polymer wafer implants are biodegradable wafers containing a chemotherapy drug are placed in the surgical cavity left after a cancer is removed. The wafer dissolves over time. For 4-6 weeks there is a slow release of the chemotherapy directly into the surgical cavity and surrounded brain containing cancer.
• Shunt refers to a piece of flexible tubing that is inserted into a ventricle in the brain and is used to drain excess or blocked cerebrospinal fluid in patients with intracranial pressure.
• Ultrasonic aspiration refers to ultrasound waves that cause vibration which can fragment, or break apart, cancer. The cancer fragments are then removed with suction (aspiration).