Brain Tumour Surgery
There are four neurosurgical units in Scotland: Glasgow, Edinburgh, Dundee and Aberdeen. Discussion of cases happens in multidisciplinary team (MDT) meetings with specialists in:
- Brain tumour surgery
- Neuro-oncology (treating tumours of the brain and nervous system)
- Neuro-radiology (imaging)
- Pathology (disease specialists)
Other possible staff in the MDT discussion include neuropsychologists and nurse specialists or key workers.
Every patient with a suspected primary brain tumour should be registered with a neurosurgical service and have their treatment discussed by an MDT.
If you are diagnosed with a brain tumour you should have the opportunity to discuss what the diagnosis is and what the aim of any treatment would be. Often there will be a range of treatment options available at the local centre or at another surgical centre in Scotland. Choice is important and you should be supported in being involved in decisions on your care.
If an operation to remove the tumour is planned this should happen within 4 weeks of being referred to the hospital. If you are having an operation you may benefit from a neuropsychological assessment. Support services will be offered by your team, to help you recover after surgery.
What type of operation is possible?
Brain tumours can be very difficult to remove completely by an operation. There is a risk in separating the tumour from the brain.
Sometimes an operation may be considered too unsafe to do or it may only be possible to do a biopsy (taking a small sample of the tumour to make the diagnosis).
If you are well enough, with a tumour that is possible to remove, then the aim of treatment is to do a maximal safe resection. This means removing as much of the tumour as possible without causing damage to the brain.
Specialist Surgery
If your surgeon is aiming for maximal safe resection they will use specialised techniques. This can include using fluorescence guiding with drugs and imaging that helps to show them what is tumour and what is normal brain tissue. Fluorescent dyes help surgeons visualize structures and tissue to work out where to operate.
Some of these brain tumour operations are done while you are awake. This requires highly technical skills and equipment. This may include tracking and monitoring systems which guide how the operation is done.
It is important that your surgeon:
- Attends the MDT routinely
- Is skilled in the state-of-the-art techniques
- Ensures that your post-operative care and ongoing review is within a specialist clinic that can best support you
For some cancers in Scotland there are defined standards of care. These cover how many patients per year an individual surgeon or a surgical unit should operate on to maintain expertise. There is no agreement in place for brain tumour surgery in Scotland and case numbers do vary between surgeons. This may be due in some areas to challenges in providing a full service with a smaller number of staff.
Low Grade Gliomas
These are a slow-growing type of brain tumour. Ideally you should be cared for in a dedicated low-grade glioma clinic with both a surgeon and oncologist to explain treatment.
It is important that you have a full explanation of the options available to you so that you can make choices on your treatment.
Treatment can range from a biopsy of the brain (taking a sample at operation), to attempting to cut out as much of the tumour as possible. Sometimes not operating may be an option but keeping it under review with further scans in a few months.
Having surgery early (within six months of the first diagnosis) will:
- Provide detail on the pathology of the tumour
- Provide detail on the extent of the tumour
- Allow testing for ‘biomarkers’ in the tumour, which may indicate the treatment options which would be most helpful
Having this information might also help predict what the outlook from the tumour will be over time.
If you have an operation for your low-grade glioma and not all of the tumour is resected then your case should be discussed back at the MDT. This is to consider whether a further operation might be useful..