Surgery Decisions: Why Tumor Location Matters

Basically, some areas of the brain can recover or adapt after surgery while others cannot, making tumor removal in these regions significantly riskier.

Am I a Candidate for Surgery?

If you have been diagnosed with a brain tumor, one of the first discussions you will have with your medical team is whether surgical removal is an option.

Several factors determine whether surgery is recommended, including:

1. Tumor Location: If the tumor is in a surgically accessible area and does not involve critical brain structures, surgery may be a viable treatment option.
2. Tumor Type: Some tumors are more amenable to surgical removal than others. For example, slow-growing, well-defined tumors are often easier to remove completely than diffuse, infiltrative tumors.
3. Overall Health: Your overall medical condition and ability to tolerate anesthesia and surgery play a role in determining your eligibility for the procedure.
4. Neurological Symptoms: If the tumor is causing significant symptoms, such as seizures, weakness, or vision loss, surgery may be considered to alleviate these issues and improve quality of life.
5. Potential for Recovery: Your medical team will assess how well your brain may compensate for any changes caused by surgery.

If you are deemed a candidate, your neurosurgeon will discuss the risks and benefits of the procedure in detail, helping you make an informed decision about your care.

What Areas of the Brain Are Inoperable?

Some areas of the brain are considered “eloquent” — meaning they control critical functions with little to no redundancy. Removing or damaging these areas can lead to severe neurological deficits.

“There are tumors that — because of where they’re growing — we can’t make a big difference,” Dr. Ormond explains. “Those tumors, we would often just biopsy and then send the patient on [to other therapies] regardless of grade.”

Regions that may be inoperable include:

1. Brainstem: This area controls vital functions like breathing, heart rate, and consciousness. Surgery in this region is highly risky.
2. Primary Motor Cortex: Responsible for voluntary movement, damage to this area can result in permanent paralysis.
3. Speech Center (Broca’s and Wernicke’s Areas): Located in the left hemisphere for most people, these areas control language comprehension and speech production.
4. Internal Capsule: This is a deep brain structure that carries critical motor and sensory signals between the brain and spinal cord.
5. Thalamus: This is a relay center for sensory and motor signals. Damage can lead to sensory loss and movement disorders.
6. Visual Cortex: Located in the occipital lobe, this area processes vision. Surgical damage can cause partial or complete blindness.
7. Somatosensory Cortex: Responsible for processing sensory information, damage can result in loss of sensation.

When a tumor is located in these areas, surgeons must weigh the benefits of removing it against the likelihood of causing severe impairments. In some cases, alternative treatments like chemotherapy or radiation may be recommended instead of surgery.

Potential Complications of Brain Surgery

Like any major surgical procedure, brain tumor removal carries risks.

Some possible complications include:

• Neurological Deficits: Depending on the tumor’s location, surgery may lead to weakness, numbness, speech difficulties, or vision problems.
• Seizures: Some patients experience seizures after surgery, which may require long-term medication management.
• Infection: There is a small risk of infection at the surgical site, which can lead to serious complications if not treated promptly.
• Swelling and Bleeding: Postoperative swelling (edema) or bleeding in the brain can cause additional neurological problems.
• Cognitive Changes: Some patients report memory problems, difficulty concentrating, or mood changes after surgery.
• Hydrocephalus: In some cases, brain surgery can disrupt normal cerebrospinal fluid drainage, leading to fluid buildup and pressure on the brain.

Your neurosurgeon will discuss these risks with you and explain what measures will be taken to minimize them. Additionally, post-surgical rehabilitation, including physical therapy, occupational therapy, and speech therapy, may be necessary to aid recovery.

Do I Need a Second Opinion?

If you have been told that your tumor is inoperable, seeking a second opinion is a reasonable and often recommended course of action. Different neurosurgeons may have varying levels of experience, access to advanced surgical techniques, or different perspectives on treatment options.

When seeking a second opinion, make sure you seek out a brain tumor specialist. Some neurosurgeons specialize in complex or high-risk brain tumors and may offer additional insights.

It’s also wise to consider seeking care at a major medical center or academic hospital. These institutions often have cutting-edge technology and access to clinical trials. Advanced techniques like awake brain surgery, laser ablation, or intraoperative mapping may allow for safe tumor removal in cases previously thought inoperable.

Even when surgery is not an option, other treatments such as targeted therapy, immunotherapy, or experimental clinical trials may be available.

Your health and quality of life matter. If you feel uncertain about your diagnosis or treatment plan, do not hesitate to seek additional expert opinions.

Questions to Ask Your Doctor

• Where is my tumor located?
• Am I a good candidate for surgery?
• What are the potential side effects of this tumor?
• Do you think full surgical resection is likely?

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