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Surgery is the first
and most common treatment for most
patients with brain tumors at the
Johns Hopkins Comprehensive Brain
Tumor Center(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope). It is highly
successful for most benign tumors.
Surgery is usually the best
treatment for tumors that
neurosurgeons can reach without
severely damaging normal brain
tissue near the tumor.
Neurosurgeons can surgically remove
some tumors completely (called
resection or complete removal). If
the tumor is near sensitive areas of
the brain, neurosurgeons will only
be able to remove part of it (called
partial removal). Even partial
removals can relieve symptoms and
facilitate or increase the
effectiveness of other treatments.
A biopsy — a surgical procedure to
remove a small sample of a brain
tumor for examination under a
microscope — is usually performed
during surgery to remove the tumor.
This enables doctors to confirm the
diagnosis and recommend the most
appropriate treatment. If the
patient is not a surgical candidate,
a separate biopsy may be done.
The role of surgery in treating
brain tumors (Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope)
Surgery can provide:
- The complete removal of some brain
tumors(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope)
- A sample to enable doctors to
diagnosis the tumor and recommend
the most appropriate treatment
- Better quality of life:
Reduced symptoms and improved
ability to function (e.g., to think,
speak or see better)
Less pressure within the skull from
the tumor
- A longer life
Neurosurgeons at the Johns Hopkins
Comprehensive Brain Tumor Center
perform surgery on hundreds of
patients with brain tumors every
year. To improve the results
(outcomes) of brain surgery, they
use state-of-the-art imaging and
surgical techniques. Advanced
imaging enables neurosurgeons to
precisely plan and perform surgery,(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope)
using the least invasive approach
possible.
They also work closely with
neuroanesthesiologists — doctors who
specialize in using pain-blocking
techniques or medications
(anesthetics) during neurosurgery(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope).
This ensures that the patient will
receive the most appropriate type of
anesthesia for the specific brain
tumor and optimal anesthesia care
during the procedure.
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Brain（cerebral） surgery (Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope) is
only performed by a neurosurgeon
(also known as a neurological
surgeon). No other types of
specialist or surgeon are qualified
to perform brain （cerebral）surgery(Brain
(cerebral) surgery (Operation,surgical,operating)
microscope). The
surgery is extremely delicate and
complex and takes many years to
master. Brain surgery used to be
very dangerous with a high rate of
intra-operative death. Thankfully,
with the advent of modern anesthesia
techniques, the operating
microscope, image guidance (computer
assistance to localization of brain
structures), and other advances,
surgery has become much safer.
Training for brain surgery（Brain
(cerebral) surgery (Operation,surgical,operating)
microscope） is
grueling and extends over 6-8 years
after graduation from medical
school.
At Carilion Clinic our surgeons have
undergone exceptional training in
pediatric and adult (cerebral)brain surgery at
the best programs in the country.
All possess extensive experience and
expertise in （cerebral）brain surgery. Our
surgeons are very professional in
dealing with brain disorders
requiring surgery but are also
compassionate and caring. They
understand that conditions requiring
brain surgery（Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope）, and the surgery
itself, are frightening and highly
stressful for patients and their
families.
Our surgeons use a team approach for
the care of (cerebral)brain operation patients.
Proposed brain operations are
reviewed by the team, essentially
providing the patient with multiple
“second opinions” prior to operation.
Treatment options are discussed
extensively and the team makes every
effort to spare the patient from
operation, if at all possible.
Post-operatively multiple members of
the team participate in the
patient’s care to maximize
practitioner availability to the
patients and their families.
Surprisingly, recovering from brain
operating （Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope）is not very painful.
Nonetheless, patients always spend
at least one night recovering in the
intensive care unit for close
monitoring. Patients often undergo
cat scanning of the brain the day
after operating (or later in their
hospital stay). Patients are
mobilized rapidly after operating to
help prevent blood clots and
pneumonia and to help them get out
of the hospital as rapidly as
possible. If a recovering patient
has difficulty with activities of
daily living they sometimes will
spend further recovery time in a
rehabilitation facility.
At Carilion Clinic hundreds of (cerebral) brain
operations are performed every year.
The operating rooms are supported
with state of the art equipment and
experienced, dedicated support
staff. ICU’s at the Clinic are brand
new and again are supported with
state of the art equipment and
intensive care specialists and
nurses who are second to none. Carilion Clinic therefore offers a
superb setting for those unfortunate
enough to require (cerebral)brain surgery（Brain
(cerebral) surgery (Operation,surgical,operating)
microscope）.
Conditions that might require brain
operating include:
■Arteriovenous malformations: “AVMs”
are tangles of abnormal blood
vessels in the brain (cerebral) that can
hemorrhage and cause death or severe
brain injury. Removal can be
technically challenging and at
times, impossible. Operating may be
combined with other treatments
including stereotactic
radiooperation
and angiographic micro-catheter
treatments.
■Brain biopsy: many brain disorders
cannot be diagnosed by MRI’s and Cat
scans alone. Sometimes the
abnormality requires biopsy but not
removal. High tech computer assisted
systems are used to pass small
cannulas into the brain to safely
obtain small samples of tissue for
pathologic evaluation. Patients
generally suffer no side effects and
can return home on the day following
operating(Brain
(cerebral) surgery (Operation,surgical,operating)
microscope).
■Adult and Pediatric Brain Tumors:
Carilion Clinic neurosurgerons
routinely confront a barrage of
various brain tumors. Type and
complexity varies tremendously.
Operating is very technically
demanding. Some tumors can be
completely removed, some can be
removed but have invasive root
systems that must be left in place,
some can only be biopsied. Brain(cerebral)
tumors may require further treatment
including chemotherapy, radiation
operation or radiooperating(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope). Sometimes
re-operation is required to
recurring tumor or to administer
chemotherapy directly into the
tumor.
■Hydrocephalus and Brain Cysts:
Small sections of the brain contain
pockets of crystal clear spinal
fluid. Sometimes the passage ways
for the fluid becomes blocked up.
The pocket expands and pushes on the
surrounding brain(cerebral). This is called
hydrocephalus or “water on the
brain.” This is treated by diverting
the fluid through thin silastic
tubes under the skin to other areas
of the body (abdomen, heart, chest).
Sometimes “shunting” can be avoided
by using a television scope to open
a window between the fluid filled
pocket and free fluid passages at
the base of the brain(cerebral).
■Tic Dolareaux and Hemifacial Spasm:
some conditions of severe facial
pain or constant facial twitching
can be stopped by a brain operation
where a small blood vessel is
separated from a very fine nerve in
the back of the brain. This takes
very fine microscopic(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope) work. The
operating is generally very
successful. Other treatments for
these conditions can include
procedures through needles passed
through the face and the base of the
skull, and specialized radiation
called Cyberknife.
■Intractable Epilepsy: Some patients
with persistent poorly controlled
seizures can have the location of
seizure generation identified by
extensive testing (years of multiple
EEGs, surgical electrode placement
etc). In these patients seizures can
often be stopped or better
controlled by removal of this
section of the brain (as long as it
is a safe region for removal).
■Cranial fractures: most skull
fractures will heal well. Some are
so bad, however, that they require
repair with small metal plates or
complete artificial bone material
reconstruction.
■Head Injury: Some patients have
sustained severe brain(cerebral) injuries. The
brain swells, and because the head
is a closed box, pressure in the
head rises causing further damage to
the brain(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope). This can be followed and
responded to by placement of
monitoring devices into the brain
through small holes in the skull.
Sometimes the pressure will not
respond to medical management and
surgeons are forced to remove a
large section of the patient’s skull
to allow the brain(cerebral) to swell. The
removed bone is replaced weeks or
months later once the brain injuries
have settled down.
■Parkinson’s Disease and tremors:
Some symptoms of Parkinson’s
disease, and potentially many other
brain conditions can sometimes be
improved (not cured) by placement of
thin wires deep into the brain and
connecting them to pacemaker-like
devices.
■Cerebral Aneurysms: patients who
survive the rupture of an aneurysm
have a 50% chance of re-rupture
within a year- usually with
devastating consequences. Aneurysms
can often be obliterated by placing
a small metal clip across their base
through microscopic brain surgery(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope).
Of late, many aneurysms can be
treated through catheters passed
through the vascular system into the
brain（Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope）. The best approach to the
treatment of cerebral aneurysms is a
multi-disciplinary team assessment
and treatment combining all the best
technologies.
■Cerebral hemorrhages: Intracranial
hemorrhages (bleeding within the
brain) is unfortunately fairly
common. Patients on blood thinners,
those with weakened arteries, and/or
uncontrolled high blood pressure,
and trauma patients are particularly
vulnerable. When a hemorrhage occurs
it presents like a stroke, with
sudden onset of neurological
dysfunction as bad as coma or death.
Many patients unfortunately are too
far gone for to help, and
many on the other hand can recover
with supportive care. A sizable
number however may survive and
potentially recover if the
collection of clotted blood is
removed from their brain(cerebral).
■Pituitary Tumors: The pituitary
gland (located just above a sinus at
the back of the nose) is a common
location for the development of
benign tumors. These tumors can
cause problems by secreting too much
of harmful hormones (such as growth
hormone), or by suppressing all
hormone production from the gland,
or by growing large enough to press
on eye nerves and other structures.
These tumors can be effectively
treated with operating, generally
through the nose supported by
operating microscope
(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope)or tv
endoscopes. Sometimes other
additional treatments such as
stereotactic radiosur-gery are
required.
■■Synostosis: some children are born
with severely disfigured skulls and
facial bones. This can often be
significantly improved by
reconstructive surgery(Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope). Sometimes
teams of neurosurgeons, plastic
surgeons, and oromaxillofacial
surgeons combine their expertise for
the surgery.
■Stroke: A stroke occurs when a
portion of the brain loses its blood
supply. The section dies but it also
swells. If the swelling is bad
enough it can push on and damage
surrounding good brain tissue. In
very select cases surgeons will
remove a large section of skull to
allow swelling and take pressure of
the (cerebral)brain surrounding the stroke.
This wont return function to the
dead portions of brain (Brain
(cerebral) surgery
(Operation,surgical,operating)
microscope) but may save
a patient’s life or function in the
areas surrounding the stroke..
■Infections: The brain can develop
severe infections and abcesses that
require extensive clean-up or “debridement.”
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