Someone with a primary brain tumor, a tumor that has started in the brain, as opposed to cancer traveling to the brain from somewhere else in the body, probably will face surgery.

The surgery could have different goals. Some tumors can be completely taken out; others, because they’ve spread to surrounding tissue, can’t be removed. In this situation, the goal of surgery will be to relieve pressure and ease symptoms caused by the tumor. If the tumor is too deep to remove entirely, the surgeons may only take out part of it.

Brain Tumor: Deciding on Surgery

Besides the tumor’s location, other factors will determine whether your treatment team will recommend surgery for your tumor. Factors include:

  • Number of tumors. In cases where there is more than one tumor, surgery may not be an option.
  • Symptoms. If your tumor is small and is not causing significant problems, you may not need surgery.
  • Tumor's definition. Surgery is most successful when the tumor's borders are well-defined and not mixed with surrounding tissue.
  • Overall health. Surgery to remove a brain tumor is best in people who are in good health.

Brain Tumor Surgery: Craniotomy

"A craniotomy is a general name for an operation [in which] you make an incision in the skin on the head, take the bone out, and do the operation," says Robert Martuza, MD, chief of neurosurgery at Massachusetts General Hospital and professor of neurosurgery at Harvard Medical School in Boston.

In the case of a brain tumor, the neurosurgeon will cut through the scalp and skull and remove as much of the tumor as possible before replacing the piece of skull and stitching the scalp closed.

The success rates of craniotomy for brain tumor treatment vary, depending on your tumor, says Dr. Martuza. "There are a number of tumors we can just take out and cure somebody," he says. In other cases, Martuza says, tumor cells are more likely to be left behind and can infiltrate the brain, requiring further treatment.

Brain Tumor Surgery: Shunt Placement

In some cases, a brain tumor can block fluid pathways and cause swelling. "The brain is constantly making fluid and is bathed in fluid," says Martuza. "If that fluid uptake gets blocked, the pressure can then build up."

If this is the case, a neurosurgeon can place a shunt, which is a tube and valve that drains fluid from the brain and shunts it to another part of the body, in the abdominal cavity.

Martuza says that shunts can result in major improvements. People can go from being sluggish and unable to walk, having urinary incontinence, and vision problems, to back to normal. While shunts can last a lifetime, they may need maintenance due to blockage, infection, or other malfunction.

Brain Tumor Surgery: The Risks

Like any surgery, brain surgery carries its own set of risks, including:

  • Neurological damage
  • Infection
  • Bleeding
  • Blood clots
  • Pneumonia
  • Coma
  • Death

The risks will vary depending on the type of surgery required and where the brain tumor is located. But modern technology now allows neurosurgeons to monitor and minimize potential adverse effects of brain surgery. "We can use intraoperative monitoring, so we can monitor your hearing, facial movements, and more, even when you are asleep," says Martuza.

By weighing the pros against the cons, you and your doctors can decide if surgery is right for you. Before you have surgery to treat your brain tumor, write down any questions you have and go over them with your medical team. The more informed you are about your procedure, the better prepared you will be for the surgery, as well as the recovery care required in the weeks and months following surgery.