Brain Tumor Surgery
Brain tumor surgery represents the primary treatment for many brain tumor cases. It aims to remove the tumor while preserving healthy tissue, thus preserving vital brain functions.
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Brain tumor surgery is the first-line treatment for most brain tumors. The goal is to remove the tumor completely or as much as possible while minimizing damage to surrounding healthy tissue. The type of surgery performed varies depending on the tumor type, size, location, grade, patient’s age, and his overall health. This is determined by Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, with his exceptional expertise. Some brain tumors can be removed using minimally invasive techniques, while others may require traditional open surgery. Brain tumor surgery is often performed in conjunction with other treatments, such as radiotherapy and chemotherapy, to shrink the tumor and facilitate its removal, or to reduce recurrence risk.
Goals of brain tumor surgery:
• Removing the entire tumor (total resection), thus treating low-grade or early-stage cancers. The entire tumor is removed if it can be done safely, but this depends on the type and location of the tumor.
• Removing part of the tumor (partial resection or debulking) if complete removal is not possible to help make other cancer treatments more effective. Partial resection may be considered when the tumor covers a larger area or is near major blood vessels or other important parts of the brain or spinal cord. This helps reduce pressure on the brain, relieving symptoms caused by tumor pressure.
• Confirming a cancer diagnosis (biopsy) and providing more information about the tumor type, especially when removal is unsafe due to the tumor’s location near critical structures, as the surgery could result in blindness, loss of speech, paralysis, or other serious complications. A needle biopsy can often still be performed to help guide treatment options.
• Repairing tissues damaged by the tumor by balloon kyphoplasty in case of vertebral fractures caused by tumor pressure, or spinal fixation in cases of instability after tumor removal.
Types of brain tumor surgery:
There are several different types of surgery used by Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, to deal with brain cancer. The choice of surgery depends on the nature of the tumor, its location, and its size. The most common brain tumor surgeries include:
1- Craniotomy (open brain surgery):
• The craniotomy procedure involves removing part of the skull using specialized surgical instruments to create an opening through which Dr. Zeiad Yossry can access the brain tumor and remove it completely or partially. After removing the tumor, the surgeon repositions the bone and secures it with small metal brackets and stitches.
• To achieve maximum tumor removal, a special dye is used. As the dye circulates throughout the body, it accumulates in rapidly dividing cells, such as cancerous brain cells. When viewed under a special light, the cells glow red, helping the surgeon during surgery to visualize and distinguish tumor tissue from normal brain tissue.
• EEG also helps identify areas responsible for vital functions, such as motor skills, language, and sensation.
• Enhanced imaging devices, including image-guided surgery, also help Dr. Zeiad Yossry obtain an accurate map of the tumor's location.
• The person may remain awake during surgery, which is called awake brain surgery. Dr. Zeiad Yossry recommends this procedure if the tumor is close to areas responsible for basic brain functions, such as speech, senses, or movement.
The patient will undergo general anesthesia at the beginning of the procedure, which is reduced until the patient wakes up and remains awake throughout most of the procedure to allow for better monitoring. The surgeon will ask the patient to perform tasks during the surgery to check the functioning of various body parts.
2- Endoscopic Endonasal Surgery for pituitary tumor or skull base tumor:
The endoscopic endonasal technique, a minimally invasive surgical technique, involves using a thin, flexible tube with a light source and a mini camera. After guiding the endoscope through the nostril, the surgeon can navigate the nasal passages and sinuses to remove a pituitary tumor or skull base tumor without making an external incision. Compared to traditional open surgery, endoscopic endonasal surgery is associated with less pain, faster recovery, and a lower risk of complications.
3- Skull base surgery:
Skull base surgery is a specialized procedure that allows the surgeon to access the base of the skull, a complex area that contains many vital structures, including major blood vessels, nerves, and the base of the brain. To minimize damage to surrounding tissue and shorten recovery time, the surgeon may use minimally invasive techniques, such as endoscopes and robotic assistance. Skull base surgery may be performed to remove a brain tumor or relieve pressure on the brain caused by hydrocephalus.
4- Shunt placement:
A brain tumor may sometimes lead to increased production of cerebrospinal fluid (CSF) or interfere with its proper drainage. If CSF accumulates in the brain (hydrocephalus), Dr. Zeiad Yossry may temporarily or permanently place a thin tube (shunt) to drain the excess fluid to another part of the body, such as the abdomen. Often performed along with brain tumor removal surgery, shunt placement can help relieve pressure on the brain caused by hydrocephalus.
5- Neuroendoscopy:
Neuroendoscopy is a minimally invasive surgical technique. After inserting an endoscope through a small incision in the skull or spine, the surgeon can visualize and treat the tumor. Compared to traditional open surgery, neuroendoscopy is associated with smaller incisions, less trauma to surrounding tissue, and a faster recovery.
6- Spinal cord tumor removal (laminectomy):
The most common surgery for spinal cord tumors is a laminectomy. Dr. Zeiad Yossry makes an incision through the skin, muscles, and vertebrae in the spine to remove the tumor. This type of surgery is typically performed under general anesthesia.
7- Diagnostic biopsy:
To obtain a sample for testing, Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, guides a hollow needle into the brain tumor and withdraws a small amount of tissue. The biopsy is performed with the help of a computer-guided imaging system, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), for greater accuracy. A biopsy is necessary to definitively diagnose brain cancer.
8- Surgeries to repair tumor-damaged tissue:
• Balloon kyphoplasty:
Balloon kyphoplasty, a minimally invasive surgical procedure, can be performed to treat a spinal compression fracture caused by a tumor. The surgeon inserts a balloon-like device and inflates it to create a cavity within the vertebra. Once the cavity is created, the surgeon deflates and removes the balloon, then injects a special bone cement into the cavity to stabilize the fracture and restore the original height of the vertebra. Balloon kyphoplasty can help relieve pain, improve mobility, and prevent further collapse of the damaged vertebra.
• Spinal fixation:
Spinal fixation involves surgically placing spinal devices, such as screws or plates, to stabilize the spine and promote fusion of vertebrae damaged by the tumor. The goal is to improve spinal alignment, relieve pressure on the spinal cord and nerves, reduce pain, and restore spinal function.
What are the risks of brain tumor surgery?
Like any cancer treatment, brain tumor surgery is associated with some side effects and complications, which can range from mild to severe. Specific risks can vary depending on the type of tumor, its location, size, grade, type of surgery, the patient's age, and overall health. Before recommending brain tumor surgery, Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, will carefully analyze the potential benefits and risks and help the patient make a fully informed decision.
The risks of brain tumor surgery include:
• Swelling and bleeding in the brain.
• Infection of the surgical site.
• Allergic reaction to anesthetic medications.
• Blood clots.
• Impaired memory or motor skills.
• Seizures.
What factors can affect the outcomes of brain tumor surgery?
The outcomes of brain tumor surgery may be influenced by a range of individual factors, such as:
• Tumor type, location, size, and grade.
• The patient's age and general health.
• The degree of tumor removal.
• The extent of the cancer spread (metastasis).
• Neurosurgeon experience.
• Any treatments performed after surgery.
Dr. Zeiad Yossry, Professor of Neurosurgery and Parkinson's Disease, handles all brain and spinal cord tumor cases with outstanding professionalism. He has treated many brain tumors, even the most challenging ones, using the latest techniques, achieving the highest success rates with minimal complications.
Public FAQs
Thanks to advances in surgical technology and techniques, many have been developed to enhance surgical procedures, helping to minimize complications and achieve highly successful surgical outcomes with exceptional precision.
What is a surgical navigation system for neurosurgery?
The surgical navigation system works by transmitting data and images obtained from the MRI to the operating room computer. The specialized software provides accurate estimates, including depth, to support optimal neurosurgical planning using the fastest and safest pathways. Both relevant locations and images are displayed simultaneously on a screen during surgery. Using infrared tracking, longitude and latitude measurements can be used to pinpoint the precise location of targets and other brain structures, as the brain is a three-dimensional space. Any location in the brain can be measured using the solid landmarks of the skull, allowing precise access to various deep brain regions using the surgical navigation system.
Why is surgical navigation technology important?
Surgical navigation technology allows surgeons to precisely track instrument positions and then plot the exact location of the instruments used on imaging data, such as preoperative CT and MRI scans. This advanced technology is often compared to GPS, which allows travelers to see their location on a map. Accurately locating brain injuries and preventing damage to vital areas is critical in treating brain disorders. Despite the advancements in many technologies, including angiography, MRI, ultrasound, and the use of a stereotactic frame (a metal device placed over a patient's head prior to brain surgery to create a three-coordinate reference system for precise surgical intervention), a need for a more accurate system remained, which led to the creation of surgical navigation.
Advantages of the surgical navigation device:
● The surgical navigation system accurately identifies anatomical structures during open or percutaneous brain and spinal surgeries.
● The surgical navigation system enables preoperative planning of key brain regions, tumor boundaries, and dimensions, as well as the surgical method and pathway, ensuring precise and complete tumor removal.
● It is used in a variety of modern surgical procedures, such as implanting deep brain stimulation devices to treat Parkinson's disease and epilepsy.
● Neurosurgery has become faster, safer, more precise, and less likely to cause damage to other brain tissue during surgery.
● The surgical navigation system is widely used in brain tumor surgeries, cerebral hemorrhage, and cerebrovascular surgeries, as it can accurately identify and remove the damaged area.
● It is used in spinal surgeries, as it can precisely determine the direction of rod and screws placement without injuring the spinal cord.
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