At Memorial Sloan Kettering, we typically use surgery to diagnose as well as treat gliomas. Often a sample of the tumor is removed during surgery and analyzed by a pathologist to help the surgeon decide how much tumor tissue can safely be removed. New technologies have made brain surgery safer than ever before. It is usually the most effective treatment for people with a glioma.
MSK neurosurgeons have vast experience with glioblastomas. Studies suggest that people who have brain surgery have the best outcome when the doctor has done the procedure many times before. MSK neurosurgeons operate on more than 600 people with brain tumors each year — one of the highest numbers of patients cared for in the world.
Postoperative care at MSK, provided by our expert nursing staff, is second to none. Our nurses received Magnet® recognition in 2016 for their outstanding performance in delivering patient-centered care.
Depending on what’s best for you, we may use one of the following approaches and techniques:
Functional MRI Brain Mapping
A functional MRI (fMRI) can help your neurosurgeon plan the best course for your surgery. This imaging test is done a few days before surgery. An fMRI makes a map of your brain. During the fMRI, you’ll do simple tasks, such as moving your hands and feet or counting in your head. The results show your neurosurgeon which parts of your brain affect such functions as vision, speech, touch, and movement, and whether the tumor may affect those parts. An fMRI can help your surgeon figure out how much of the tumor is safe to remove.
MRI During Surgery
Your neurosurgeon can use MRI technology at any time during a procedure. This helps the team determine whether all the tumor tissue has been removed. If any tumor tissue is left, your surgeon may be able to resume surgery to remove it.
Using MRI to reevaluate the tumor during surgery enables your neurosurgeon to operate with precision and deal skillfully with potential complications if they come up.
Surgical navigation, also called frameless stereotaxy, helps us plan your operation. It functions as a guide during the operation itself. It is like a GPS system for the brain.
With this approach, your surgeon uses MRI images to determine the exact location of the instruments being used during surgery. In the operating room, an image that is synchronized with the MRI is projected on a screen, generating real-time information about the position of your brain and the tumor.
Your surgeon will use a viewing wand to see the tumor’s outermost edges. This increases the likelihood that every part of the tumor is removed, if possible. The benefits of this procedure include better accuracy plus the potential for a smaller incision (cut) and a shorter surgery.
Awake surgery is also called awake craniotomy. It is an advanced surgical procedure used if the tumor is close to a delicate part of your brain. The neuro-anesthesia team gives you a local anesthesia and medication to sedate you while keeping you conscious.
Electrodes stimulate the surface of your brain and help your surgeon identify the delicate areas that must be kept safe. During parts of the procedure, your surgeon wakes you up to have you speak or do movements that can help guide tumor removal.
Depending on where the glioma is located, you may be a candidate for neuroendoscopy. This is a minimally invasive surgery, which uses a smaller incision (cut) than traditional surgery. A thin tube with a powerful lens, a high-resolution video camera, and specialized surgical instruments help the surgeon complete the procedure. Not every tumor can be treated with a neuroendoscopy. It depends on where the tumor is located.
The primary goals of glioblastoma surgery are to relieve pressure in the brain and to safely remove as much of the tumor as possible. This is done before giving other treatments, such as radiation or chemotherapy.
Glioblastoma tumors are typically found in the outermost region of the brain, but they can occur anywhere in the brain or spinal cord. These tumors can be hard to remove completely because they tend to have irregular patterns of growth and a complex shape. They also grow into the brain. Microscopic parts of the tumor may spread over relatively large distances. This makes them very difficult to find and remove, especially if they involve important parts of the brain.
At MSK, we use a range of sophisticated imaging techniques. These include functional MRI and diffusion tensor imaging, which help MSK doctors understand the functions of the areas of the brain affected by the tumor. For example, these imaging techniques can help determine where the movement or speech areas of the brain are located, as well as where the fibers that connect them to the rest of the brain are. Overall, these techniques are combined to provide the safest and most complete tumor removal possible.