Craniotomy for Tumor
Craniotomy is a surgical procedure in which part of the skull is removed in order to view the brain. The piece of skull removed is called a “bone flap.” After the surgery is performed to remove the brain tumor, the bone flap is fitted back into the skull.
Surgery is often the most effective way to treat many brain tumors, whether they are benign or malignant. Craniotomies, which are performed by neurosurgeons, are designated in different ways. A frontotemporal, parietal, temporal or suboccipital craniotomy is named after the bone that is removed.
In order to accurately access the tumor and reduce the risk of damage to healthy brain tissue, imaging devices may be used to help guide the surgeon. Known as a stereotactic craniotomy, scans are taken that create a three-dimensional image of the brain. A computer provides a navigation system to safely route the surgeon to the precise location of the tumor.
The Craniotomy Procedure
A craniotomy is performed, sometimes under general anesthesia, in a hospital. An incision is made in the scalp (which is shaved at the incision site), and the bone flap is removed to allow access to the treatment area. There are cases in which patients remain awake during surgery, and are asked to move their legs, recite the alphabet or tell stories to ascertain whether brain functioning has been affected.
The location of the incision will depend upon the area being treated. A medical drill may be used to create small holes, or a special saw may be used to cut the bone flap. An incision is then made in the dura matter, which is the covering of the brain. The tumor is located and removed in its entirety if possible. Once the procedure is complete, any tissue that has been cut into is stitched together, and the bone flap is reattached using plates, sutures or wires.
Depending on the location of the tumor, complete removal may be difficult. However, even if the entire tumor cannot be removed, surgery can relieve symptoms and help reduce pressure within the brain. If the tumor has been only partially removed, additional treatment, such as radiation therapy, may be required to destroy any remaining tissue.
Ommaya Reservoir Placement
An Ommaya reservoir is a synthetic dome that is surgically placed beneath the scalp and attached to a catheter that is inserted within the brain. The catheter is directed into a ventricle, which is an open space in the brain where cerebrospinal fluid flows. Cerebrospinal fluid travels around the brain and spinal cord. The purpose of the Ommaya reservoir is to collect samples of cerebrospinal fluid that can then be tested for the presence of infection or cancerous cells and to administer medication such as antibiotics or chemotherapy drugs directly into the cerebrospinal fluid.
The Ommaya reservoir can be a particularly effective method of treatment for certain types of brain cancer. It delivers the chemotherapy directly to the cerebrospinal fluid to attack the malignant cells in the area. This enables the medication to bypass the blood-brain barrier-a system of blood vessels that surround the brain in order to keep foreign substances from penetrating brain tissue. Due to the efficiency of the blood-brain barrier, it has traditionally been very difficult to successfully administer chemotherapy to fully treat some forms of brain cancer.
The Ommaya Reservoir Placement Procedure
This procedure is performed with the patient under general anesthesia. The patient’s head is properly positioned, then a small area of the scalp is shaved. The surgeon will make a small, rounded incision and insert the Ommaya reservoir securely between the skull bones and the scalp. The catheter is carefully guided through the head until it reaches a ventricle in the brain. Once the reservoir and catheter have been correctly placed, the surgeon will close the scalp incision using sutures or staples. The placement procedure typically lasts for one hour.
Recovery from Ommaya Reservoir Placement
A procedure for the placement of an Ommaya reservoir generally requires a hospital stay of one night to ensure that the catheter is correctly positioned and that the incision is beginning to heal well. The sutures or staples in the scalp are removed approximately 10 to 14 days after the surgery. A small bump will remain at the treatment site, but normal activities can be resumed as soon as the incision is completed healed.