Brain and Spinal Cord Tumor Surgery

What are Brain and Spinal Cord Tumor Surgeries?

Brain and spinal cord tumor surgeries are surgical procedures commonly used to treat tumors located in the brain or spinal cord. The type of surgery performed depends primarily on the location and size of the tumor. When planning surgery, the neurosurgeon also considers other factors, such as the patient’s age, the extent of neurological function impairment, and overall health.

Indications for Brain and Spinal Cord Tumor Surgery

Brain and spinal cord tumor surgeries can be performed for various reasons such as:

1. Removing all or as much of the tumor as possible.
2. Taking a sample of the tumor to determine its type.
3. Placing a tube (shunt) to drain cerebrospinal fluid in cases of hydrocephalus to relieve pressure on the brain.
4. Placing a device called an Ommaya reservoir to remove cerebrospinal fluid or administer chemotherapy.
5. Preventing or treating potential complications from the tumor.
6. Reducing pain or alleviating symptoms.

These surgical procedures aim to improve the patient’s quality of life, relieve pressure on nerves, reduce pain, improve symptoms, examine the tumor to determine its type, and guide subsequent treatment based on laboratory results.

First: Brain Tumor Surgery

Brain tumor surgery is an important part of tumor treatment. Although the idea of brain surgery may seem frightening, it is a very safe procedure. Prof. Dr. Yousry Anwar El-Hemyly and his medical team possess highly specialized skills, and you can discuss any concerns with them for reassurance.

Not all cases are suitable for brain surgery, as it is a major operation, so the patient must be in good condition. Additionally, there are some tumors that grow in areas of the brain that are difficult to access, such as the brainstem.

The surgery is performed by a specialized team of neurosurgeons, led by neurosurgery consultant Prof. Dr. Yousry Anwar El-Hemyly – Professor of Brain, Neurosurgery, and Spine Surgery Department at Cairo University Faculty of Medicine – and there may be other specialized doctors working with the team, for example, an ENT surgeon.

There are two main types of brain tumor surgery:

1. Craniotomy
2. Neuroendoscopy

• Craniotomy

Craniotomy is the most common surgical procedure for treating brain tumors. It is performed with the following steps:

1. Pre-operative examinations are first performed to accurately determine the tumor location, and examinations may also be performed during surgery to help the surgeon accurately locate the tumor.
2. The patient is placed under general anesthesia, where the patient is asleep and feels nothing during the operation.
3. The neurosurgeon cuts a section of the skull bone to create an opening that allows access to the area where the tumor is located in the brain.
4. The surgeon uses special tools to remove the tumor, an ultrasonic device to fragment the tumor, and a suction device to gently remove it. A microscope can be used to see tissues precisely during the operation.
5. After removing the tumor, the bone piece that was cut is placed back in its position and secured with small metal plates. The skin is sutured over the bone to close the opening, and in most cases, the scar disappears under the hair.

What is Awake Craniotomy?

Awake craniotomy may be suggested by the surgeon if the tumor is close to a part of the brain that controls important functions, such as speech, movement, or sensation. It is performed with the following steps:

1. The patient is given local anesthesia to numb the skin and muscles in the skull and brain area.
2. The surgeon makes an opening in the skull to create an access point to the brain.
3. Awake brain surgery is performed in different ways: either the patient is conscious throughout the entire operation, or the patient is awake for part of the operation. In this case, the patient receives general anesthesia at the beginning of the operation, then the anesthesia is reduced so the patient wakes up for the main part. After that, the patient is given another general anesthesia for the final part of the operation.
4. During awake brain surgery, the surgeon asks the patient to perform certain tasks and checks the function of different parts of the brain, such as asking them to speak, move a part of their body, or asking what they feel.
5. The surgeon uses various tools to remove the tumor from the brain while preserving healthy tissue as much as possible.
6. Once the tumor is removed, the skull pieces are placed back in position and secured, then the wound is closed with sutures.

Awake brain surgery allows the surgeon to know the precise boundaries of the tumor and avoid damaging healthy parts of the brain. Although the idea of surgery while awake may seem frightening, this procedure is considered safe and common and helps improve treatment outcomes and reduce potential side effects. During the operation, any areas that feel pain, such as skin and muscles, are anesthetized. The brain itself does not contain pain receptors, so it does not feel pain.

2. Neuroendoscopy

Neuroendoscopy is a surgical procedure used to remove part or all of a tumor in the fluid-filled spaces in the brain (ventricles). You may also undergo neuroendoscopy to remove fluid accumulation in the brain (hydrocephalus). The steps are as follows:

1. The patient is anesthetized and positioned appropriately on the operating table.
2. The surgeon makes a small opening in the skull using a drill.
3. The endoscope is inserted through the opening in the skull and directed toward the location of the tumor.
4. Using the endoscope that contains a camera that sends images to a screen visible to the surgeon, there are small forceps and scissors at the tip of the endoscope. The surgeon visualizes the tumor and uses the tools at the tip of the endoscope to remove it precisely.
5. After removing the tumor, the opening in the skull is closed and secured tightly.
6. After the operation, the patient is transferred to the recovery room for monitoring and follow-up for a short period.

These are the general steps for endoscopic brain surgery, and the procedure varies slightly according to the location and size of the tumor and the patient’s condition. This type of surgery is considered less invasive and is believed to help in rapid patient recovery compared to traditional surgery.

Pituitary Gland Surgery Through the Nose

Pituitary gland surgery through the nose, or what is known as transsphenoidal surgery for pituitary tumor removal, is usually performed as follows:

1. The patient is anesthetized and positioned appropriately on the operating table.
2. The surgeon makes a small incision in the nasal septum, which is the thin wall of bone and cartilage that separates the nostrils.
3. Surgical instruments are inserted through this opening to reach the pituitary gland for tumor removal.
4. The surgeon can use an endoscope, which is a long instrument containing a camera and lens, to visualize and operate surgical instruments and remove the tumor precisely.
5. After reaching the pituitary gland, the surgeon removes the tumor using appropriate surgical instruments while preserving the integrity of surrounding tissues.
6. The opening in the nasal septum is closed and secured tightly after completing the operation.

These are the general steps for pituitary tumor removal surgery through the nose, and the procedure varies slightly according to the size and location of the tumor and the patient’s condition.

This type of surgery is often considered one of the less invasive and safer surgical procedures for removing pituitary tumors, and can help restore pituitary gland functions and reduce symptoms associated with tumors.

Surgery for Chemotherapy

During brain surgery, chemotherapy can be implanted in the tumor area to deliver chemotherapy directly to the tumor without affecting the rest of the body.

The device known as the Ommaya reservoir can be placed during surgery. This device allows chemotherapy to be delivered directly to the fluid-filled spaces in the brain chambers. This device is used to deliver chemotherapy to the spaces without the need for repeated surgery.

Surgery to Drain Excess Fluid in the Brain

Surgery is performed to drain fluid accumulation in the brain, in cases of hydrocephalus, during surgery to remove the tumor, or as a separate operation. This procedure aims to relieve pressure on the brain and prevent potential complications associated with fluid accumulation in the brain.

Second: Spinal Cord Tumor Surgery

Spinal cord tumor surgeries are not common for spinal tumors, but generally the surgeon removes as much of the tumor as possible while taking all precautions to protect the spinal cord and other major nerves.

Spinal cord tumor surgeries are usually used in the following cases:

• In case of pressure on the spine.
• If the tumor will not respond to conventional radiation therapy.
• In case of spinal instability that cannot be repaired with minimally invasive surgery.

Among Prof. Dr. Yousry El-Hemyly’s team, there are surgeons who are among the most experienced experts in their field under Dr. Yousry’s leadership, and they have developed techniques that have made spinal surgery a much safer and more effective option.

Neurologists work alongside the surgical team to identify any changes in the patient’s neurological functions that may occur during surgery, where they stimulate the nerves responsible for movement and other basic functions. They then measure and record how the nerves respond. This helps the surgeon maintain nerve integrity.

Here are some types of advanced spinal cord tumor surgeries we offer:

Posterolateral Resection

Neurosurgeons use this procedure to remove spinal cord tumors and straighten the spine through an incision in the middle of the back. This procedure reduces surgical risks and shortens recovery time, helping to receive radiation therapy or other treatments more quickly.

En Bloc Resection

This surgical technique is used to remove the tumor in one piece. En bloc resection is often used to completely eliminate primary tumors, such as giant cell tumors, low-grade chondrosarcoma, and chordomas located in or adjacent to the spinal bones.

Metastatic Spine Tumor Surgery

If there is a metastatic tumor in the spine (a tumor in the spine that started elsewhere in the body), some surgical procedures can help stabilize the spine, reduce pain, prevent paralysis, and increase mobility.

There are two most common surgical procedures for metastatic spinal tumors:

• Spinal Cord Decompression

This technique relieves pressure on the spinal cord and nerve roots. The decompression procedure also allows sufficient space so that high-dose radiation can be received without risk of spinal cord injury.

• Spinal Instrumentation

The surgeon secures vertebral screws and rods to the spine to redistribute pressure and determine bone alignment. This technique is usually used if there is significant pressure on the spinal cord, a collapsed vertebra, or a burst fracture that cannot be repaired. In certain cases, surgeons will use specially designed screws, which is a less invasive technique.

Spinal Angiography

If the tumor contains an unusually large number of blood cells, there may be a risk of losing more blood during surgery. Spinal angiography can help reduce the amount of blood lost.

This procedure involves injecting dye and then performing X-rays. This helps identify blood vessels. During embolization, an interventional radiologist injects small beads into these blood vessels to prevent them from bleeding.

Best Surgeon for Brain and Spinal Cord Tumors

Brain and spinal cord tumor surgeries are among the most difficult and complex surgical procedures, so the correct choice of surgeon plays a crucial role in the success of the operation and the patient’s health. Professor Dr. Yousry Anwar El-Hemyly and his medical team are at the pinnacle of excellence and professionalism in this field for the following reasons:

1. Professor Dr. Yousry El-Hemyly and his team have many years of experience in the field of brain and spinal cord tumor surgery.
2. The team adopts the latest surgical techniques and follows best clinical practices to ensure the best outcomes for patients.
3. Prof. Dr. Yousry and his team work together in perfect coordination to ensure optimal healthcare delivery for each case.
4. The surgical team enjoys a prestigious position in the field of brain and spinal cord tumor surgery, ensuring optimal and most specialized treatment.
5. The medical team prioritizes patient comfort and safety above all else, working with dedication and complete understanding of patient needs.
6. The success rates of operations performed by the medical team are outstanding, reflecting their exceptional skill and precision in performing surgeries.

To book a consultation with Professor Dr. Yousry Anwar El-Hemyly and learn more about the brain and spinal cord tumor surgeries he performs, we invite you to contact us today. Do not hesitate to call us to get an appointment or to ask any questions you may have. Be safe with the expert team specialized in tumor surgery and book your consultation today.