How is an image guided craniotomy performed?

This procedure will be performed either with a general anaesthetic or sedation (see awake craniotomy).

In the operating theatre you will be positioned on an operating table and your head will be supported by a headrest. The neuronavigation system (like a satellite navigation system) will then be used together with your pre-operative scan data to precisely locate the site for the tumour (target) and to determine an entry point, which can then be marked on the scalp. A small incision can then be marked on the scalp and a very small amount of hair shaved along the line of the incision before it is cleaned with antiseptic solutions and then surrounded by surgical drapes. A small injection of local anaesthetic is used: this stings for a few seconds only if you are awake.

The skull is exposed by making an incision in the scalp and then a high-speed drill is used to make a small burr hole through the skull to reveal the underlying dura (the outermost layer of the brain). A special drill (craniotome) is then used to cut a disc of bone, which is removed from the dura. The dura can then be incised to reveal the underlying brain (and tumour). If the tumour lies on the surface of the brain (e.g. a meningioma) it is carefully dissected from the brain and removed. If the tumour lies within the brain substance then it is necessary to incise the surface of the brain and open the brain down onto the surface of the tumour and then the mass can be removed.

For some tumours it is possible to remove the entire tumour and likely produce a cure (e.g. meningioma). This is called a gross total resection. For many intrinsic brain tumours the surgeon aims to remove as much of the tumour as possible (and safely) but there will inevitably be microscopic remnants of the tumour in the surrounding brain (e.g. glioma).

After the tumour has been removed, all bleeding is stopped, the dura is closed with sutures, the bone flap is replaced with 3 mini-plates and the scalp is closed. The skin is closed with staples, the wound is dressed and often a head bandage is applied. It’s all done!

What happens after surgery?

You will be transferred to the recovery area for a short time and then to the neurosurgery ward where observations will be performed regularly. This will include an assessment of your conscious level (asking you to follow simple commands, opening your eyes and answering questions), examination of your pupil responses, tests of your limb strength and checks on your pulse, blood pressure and respirations. You will be discharged from the neurosurgical centre as soon as your condition is stable. You may sometimes have a scan before discharge. Many patients are discharged directly home as soon as they are fully self-caring and comfortable. If you are requiring on-going medical treatment or support you may be transferred back to your local hospital for further care. Occasionally it is necessary to stay in for longer.

It is likely that you will have anti-thrombotic stockings (TEDS) on and a drip in your arm and you may have a head bandage and occasionally a catheter in your bladder. Operations on the head are not particularly painful but you will be given some tablets or injections for the headaches and if you feel nausea you will be given drugs to relieve this symptom. You will often be given steroids to prevent swelling (in a slowly reducing dose) and sometimes anti-epileptic drugs to prevent fits in the early post-operative period. You can eat, drink and move as soon as you feel able to.

What happens after discharge?

Your surgeon will usually arrange an appointment with you to discuss the results of the biopsies sent from your operation, usually 5-7 days after surgery. The staples can be removed from your wound at around 5 days for a first operation or later for a re-do operation. Your surgeon will also explain to you any plans for further treatment and follow-up.

You may have some headaches which will lessen with time and you will feel tired and need to rest at home. If you are taking steroids, the dose will slowly be reduced, as prescribed by your surgeon, and if you have not had any fits your anticonvulsants will be stopped, as directed by your surgeon.

Driving after brain surgery

You will not be able to drive for a time determined by your symptoms, diagnosis and treatment. You should inform the DVLA of your diagnosis. This can be done by completing Form B1 which you can download here.

Because of the small risk of a fit, you should also avoid any other activities that may put you at risk if you were to suffer a brief loss of consciousness, such as climbing ladders, operating certain machinery or swimming unsupervised.

You can find out more about driving when you have a brain tumour diagnosis in our Know How.

What should I tell my doctor about after surgery?

You should tell your doctor about:

  • Headaches that are progressively worsening
  • Fitting
  • Fever
  • Wound problems (increasing pain, swelling, discharge)
  • Development of new or worsening symptoms (weakness, numbness, etc)
  • Increasing drowsiness
  • Rash

If you are at home you could discuss your symptoms with your GP, call your neuro-oncology specialist nurse (if you have one) or contact your surgeon and his team at the hospital.

What are the risks of craniotomy for a brain tumour?

Every operation carries a risk. Overall, complications following a craniotomy are uncommon and the degree of risk depends on a number of factors, for example, the size, location and type of the tumour, your general medical health and age. Your surgeon will explain to you the particular risks associated with your operation and give you an indication of the likely chance of complications occurring. Complications include, but are not exclusive to, the following:

  • Temporary or permanent neurological deficit (stroke e.g. paralysis of limbs or loss of speech)
  • Haematoma (blood clot)
  • Brain swelling
  • Infection
  • Fits
  • CSF leak (leakage of fluid from around the brain)
  • General medical complications
  • Deep vein thrombosis (clot in leg veins)
  • Pulmonary embolism (clot from legs passing to lungs)
  • Pneumonia
  • Heart attack
  • Urinary tract infection

Some of these complications might be serious enough to warrant further surgery and some can be life threatening. Overall, as a general guide, the incidence of serious complications causing permanent neurological deficit (stroke) or death is <5%.

Will my symptoms improve?

This will depend on the tumour and the surgery. If the tumour has been causing headaches, there is a good chance these will improve following surgery. If you had weakness or paralysis in a limb caused by pressure on the brain by a tumour, then this may improve following surgery. However, if you had weakness caused by invasion of the tumour into the brain, then it is unlikely that this will improve following surgery. Seizures are sometimes improved by removal of a tumour but may not change or may occasionally worsen.

Did this information make you feel more resourced, more confident or more in control?

Date published: 17-05-2009
Last edited: 28-02-2018
Due for review: 28-02-2021

sidebar brainbox

Introduction

The Brain Tumour Data Dashboard lets you explore up -to-date, population level data about the brain tumours diagnosed in England between 2013 and 2015. Using the drop down menus on the left you can select different groups of patients to view in the charts below. In these charts the number of patients for every 100 diagnoses is displayed as images of people. Patients have been grouped by date of diagnosis, type of tumour, age, gender, and region in England.

For each group of patients you can explore the different routes to diagnosis, the proportion of those who received chemotherapy or radiotherapy, as well as the survival of the patients within each group. For more information about what these metrics mean please see the glossary.

How to use

  1. Select the year of diagnosis using the drop down menu.
  2. Select your patient group of interest from the four drop down menus in the following order:
    1. Tumour group
    2. Age at diagnosis
    3. Region of England
    4. Gender of patient
  3. To view a second chart to compare different groups of patients, click the ‘compare’ button.The second chart will appear below the first chart.

*Note that the tool is best used on a laptop or tablet rather than a mobile phone*

Unavailable data

Some of the data in these charts is not available.There are two main reasons for this:

  1. How the data has been grouped

If you cannot select a patient group from the drop down menus, the data is unavailable because of how the data has been organised.

Public Health England has grouped the data like a branching tree. The bottom of the tree contains all the patients with brain tumours, and then each branch divides the data by a certain characteristics, like age, or location of tumour. But the data is divided in an order, starting with location of the tumour (endocrine or brain), then by age, region, and gender. Age is at the start because it makes a bigger difference to survival rates and treatment rates than gender or region. Sometimes, after the data has been split by type of tumour and age, there is not enough data to be split again. This is because to protect patient confidentiality groups cannot contain less than 100 patients. Because some groups cannot be split further, you cannot create ‘totals’ for everyone by region or gender. For example, you cannot see results for all ages by region, or all brain tumours by gender. If these totals were calculated and released, it might be possible to identify patients, which is why Public Health England cannot release this data.

  1. Statistical reasons and data availability

If you can select a patient group from the chart menus, but the chart does not display, the data is unavailable for one of several reasons:

  1. Data is not yet available for the selected year from Public Health England.
  2. Data is not available because the data quality is too poor to release this statistic.
  3. Data is not available as the statistic is not appropriate for this group.
  4. Data is not available because the standard error of the estimate was greater than 20% and so the estimate has been supressed.

Up to date brain tumour data

Brain tumour data may influence the decisions you make about your care. Data also helps you understand the bigger picture, or landscape, in which you find yourself.

Brain tumour data and statistics influence the focus, and work of organisations like brainstrust. The information helps us to understand the scale and impact of the problems we are setting out to solve.

This tool helps you understand the landscape in which you find yourself having been diagnosed with a brain tumour. This landscape can be particularly tricky to navigate as there are many different types of brain tumour, all of which have a different impact.

The information you see represents the most up-to-date, official, population level brain tumour data available for England. Over time we will be adding to the brain tumour data available and publishing reports, with recommendations, as a result of what we learn from this data.

The data behind this content has come from Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and is a direct result of the ‘Get Data Out’ project.

This project provides anonymised population level brain tumour data for public use in the form of standard output tables, accessible here: http://cancerdata.nhs.uk/standardoutput

Incidence

The number or rate (per head of population) of new cases of a disease diagnosed in a given population during a specified time period (usually a calendar year). The crude rate is the total number of cases divided by the mid-year population, usually expressed per 100,000 population.

Malignant

Malignant tumours which grow by invasion into surrounding tissues and have the ability to metastasise to distant sites

Mortality

The number or rate (per head of population) of deaths in a given population during a specified time period (usually a calendar year). The crude rate is the total number of deaths divided by the mid-year population, usually expressed per 100,000 population.

Non-malignant

Not cancerousNon-malignant tumours may grow larger but do not spread to other parts of the body.

Survival

The length of time from the date of diagnosis for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the survival is one way to see how well a new treatment works. Also called ‘overall survival’ or ‘OS’.

Routes to Diagnosis

Under the ‘Routes to Diagnosis’ tab in the Brain Tumour Data Dashboard, you can explore the ways patients have been diagnosed with brain tumours. There are many ways, or routes, for cancers to be diagnosed in the NHS. A ‘route to diagnosis’ is the series of events between a patient and the healthcare system that leads to a diagnosis of cancer. The routes include:

  1. Two Week Wait

Patients are urgently referred by their GP for suspected cancer via the Two Week Wait system and are seen by a specialist within 2 weeks where they are diagnosed.

  1. GP referral

Diagnosis via a GP referral includes routine and urgent referrals where the patient was not referred under the Two Week Wait system.

  1. Emergency Presentation

Cancers can be diagnosed via emergency situations such as via A&E, emergency GP referral, emergency transfer or emergency admission.

  1. Outpatient

Outpatient cancer diagnoses include diagnoses via an elective route which started with an outpatient appointment that is either a self-referral or consultant to consultant referral. (It does not include those under the Two Week Wait referral system).

  1. Inpatient elective

Diagnosis via an inpatient elective route is where diagnosis occurs after the patient has been admitted into secondary care from a waiting list, or where the admission is booked or planned.

  1. Death Certificate Only

Diagnoses made by Death Certificate Only are made where there is no more information about the cancer diagnosis other than the cancer related death notifications. The date of diagnosis is the same as that of the date of death.

  1. Unknown

For some patients with a cancer diagnosis, there is no relevant data available to understand the route to diagnosis.

 

More information

If any of the statistical terms in this section of the brainstrust website are hard to understand, we recommend looking them up here:

Cancer Research UK’s Cancer Statistics Explained

http://www.cancerresearchuk.org/health-professional/cancer-statistics/cancer-stats-explained/statistics-terminology-explained#heading-Seven

If you are looking for help understanding terms relating specifically to brain tumours, and treatment, then the brainstrust glossary is available here:

https://www.brainstrust.org.uk/advice-glossary.php