Surgery for a brain tumour

Surgery is often the main treatment for a brain tumour. The operation you have depends on the size of the tumour and its position. Only highly specialised surgeons called neurosurgeons do brain surgery. It is done in specialist centres or hospitals. They use technology that makes operations safer and easier to do

You can have surgery to:

• take a sample of the tumour (a biopsy) for further tests or to diagnose the type of brain tumour
• remove all of the tumour (complete resection)
• remove as much of the tumour as is safe and possible (partial resection or debulking)
• reduce pressure in the skull.

To remove part or all of the tumour, you have an operation called a craniotomy. We have more information about having a craniotomy and how it is done.

Occasionally, some people may also have chemotherapy given directly into the brain during surgery. If this would be helpful in your situation, your doctor will explain this to you.

Some tumours cannot be removed with surgery. A tumour may be too difficult to reach, or the risk of damaging some healthy parts of the brain could be too high. Your surgeon will talk to you about other treatment options.

You will have tests before surgery to make sure you are well enough to cope with it. These are usually done a few days before your operation at a pre-assessment clinic. They may include blood tests, heart and lung tests.

If you smoke, try to stop or cut down. This will help reduce your risk of problems, such as a chest infection. It will also help your wound to heal after the operation. Your GP can give you advice and support to help you stop smoking. We have more information about stopping smoking.

If you are not already taking them, you may be given steroids. They help to reduce swelling caused by the tumour. Always take steroids exactly as your doctor or nurse has prescribed. You usually take them for a while before and after surgery.

Talk to your doctor before your surgery if you take the following drugs:

• aspirin
• clopidogrel
• non-steroid anti-inflammatory drugs such as ibuprofen.

These drugs can thin the blood and increase the risk of bleeding after surgery. If you are on any blood-thinning medication, talk to your doctor before your surgery. They will give you advice about when you can take them.

You are usually admitted to hospital on the morning of your operation. Sometimes you will be admitted the day before.

You will meet a doctor from the surgical team and a specialist nurse who will talk to you about the operation. You will also meet the doctor who gives you the anaesthetic (anaesthetist).

When you wake up, you will be in the recovery unit. After this you usually go back to your ward. Sometimes you may go to the intensive care ward or high-dependency unit for about 24 hours.

The doctors and nurses will monitor you carefully. They will:

• do checks, such as testing your reflexes and seeing how your eyes react to light
• ask questions and ask you to do things, to check you understand what is happening and can follow instructions
• take your temperature and blood pressure.

Your face and eyes may be swollen and bruised. This swelling and bruising should improve within a few days. Sometimes a swelling filled with fluid develops under the operation scar. This is called a meningocele. This may take week or months to go down, but it will get better over time.

You may have some tubes in place when you wake up. These are used to give you fluid and drugs, or to drain body fluids. They are not usually painful. Tell your nurse if you are uncomfortable. Your nurse will remove each drip or drain when you no longer need it.

You may have some of the following:

• A drip going into a vein to give you fluids until you can eat and drink again.
• A drain from your wound to drain blood or fluid into a bottle. It is usually removed 1 to 2 days after the surgery.
• A fine tube that passes down the nose and into the stomach. This is called a nasogastric tube. It removes fluids from the stomach, to stop you being sick.
• A catheter. This is a tube that drains urine from your bladder. It is usually taken out when you can move around more.

You may have a headache when you wake up after the operation. The nurses will give you regular painkillers. Headaches usually get better after a few days. Always tell your nurse or doctor if you have pain, or if the pain gets worse.

You will be encouraged to get out of bed as soon as you feel able. This is important to help prevent chest infections and blood clots. It also helps with your recovery. Your nurse can check that you are ready to get up. A physiotherapist or nurse will help you to start moving around if needed. You will usually be given special stockings to reduce the risk of developing a clot.

The wound on your head may be covered with a dressing or bandage for the first few days. The nurses will check it regularly to make sure it is healing well. After about 7 to 10 days, they will remove your staples or stitches. This can be done at the hospital, at your GP practice or at home by a district nurse. If you have dissolving stitches, these will not need to be removed.

You can usually wash your hair around 3 days after your surgery with the medicated shampoo they give you. But try to keep the wound dry.

Once your stitches have been removed you can usually wash with your normal shampoo. Do not scrub the wound. Some people may find their wound feels tight. This is a normal feeling. It is important not to pick or pull the scab off, even weeks after the surgery.

Your doctor or nurse will explain how to look after the wound once you go home.