Malignant Brain Tumour Surgery

Glioblastoma (GBM), also referred to as a grade IV astrocytoma, is a fast-growing and aggressive brain tumor. It invades the nearby brain tissue, but generally does not spread to distant organs. GBM is a devastating brain cancer that can result in death in six months or less, if untreated.

The mainstay of treatment for GBMs is surgery, followed by radiation and chemotherapy. The primary objective of surgery is to remove as much of the tumor as possible without injuring the surrounding normal brain tissue needed for normal neurological function. However, GBMs are surrounded by a zone of migrating, infiltrating tumor cells that invade surrounding tissues, making it impossible to ever remove the tumor entirely. Surgery provides the ability to reduce the amount of solid tumor tissue within the brain, remove those cells in the center of the tumor that may be resistant to radiation and/or chemotherapy and reduce intracranial pressure. Surgery, by providing a debulking of the tumor, carries the ability to prolong the lives of some patients and improve the quality of remaining life.

Before surgery

Tumour in left dominant temporal brain.

After surgery (This patient was operated under awake anaesthesia)

Subtotal removal of tumour

Eloquent Area Tumour

Eloquent cortex is a term that refers to specific brain areas and its associated subcortical structures that directly controls function, thus damage to these areas generally produces major focal neurological deficits. Unlike cancers affecting other solid organs, brain tumors grow within the context of complex neural circuitry. Regardless of location, all intrinsic brain tumors interface with nervous system structures.

Many intrinsic brain tumors arise within eloquent cortical and subcortical regions of the brain. It is therefore critical that surgery for tumor removal balances both the oncological benefits of maximal resection with preservation of functional neural networks. This goal is achieved with various technological advances like MRI, intra-operative Navigation or ultrasound, cortical mapping and awake anaesthesia, to name a few.

The surgery for such tumours require transdisciplinary work of the Neurosurgeon, Neuroanesthesiologist and Neuropsychologist before, during and after the resection of a neoplasm in eloquent areas with the patient conscious under the 3A anesthesia modality (asleep, awake, asleep).
Benefits of awake craniotomy are greater resection of the lesion, with improvement in survival, while the damage to the eloquent cortex, which generates postoperative neurological dysfunction, is minimized. Other advantages include shorter hospitalization times, hence a reduction in care costs, and a decrease in the incidence of postoperative complications.
Intrinsic brain tumour in speech area.

Here the patient is awake, whilst the brain surgery is being done.

MRI Before Surgery

Motor strip glioma resected with cortical mapping and navigation control

Patient Awake During surgery / Neuro-navigation during surgery

Intra-operative cortical stimulation