Surgery for Glioma

Surgery is one of the most common and initial treatment options for patients diagnosed with glioma. Choosing to undergo surgery is a major life decision. While complications are rare, it is critical for patients and caregivers to have the information they need to make informed decisions about how to prepare and recover from brain tumor surgery.

It is important that you find an experienced neurosurgeon with a track record of excellence. The surgeon should be part of a multidisciplinary team of specialists (neuro-oncologists, etc.) that are nationally known for their proven outcomes. Brain tumor care is truly a team approach.

Please do your research thoroughly through inquiries from other physicians you are familiar with to make sure the neurosurgeon has special expertise in brain tumor surgery. You must be able to establish a great and trusting relationship with your surgeon and importantly be very familiar with your options and surgical risks/benefits. This relationship is one of the most important components of your care and should not be underestimated.

Surgeries to remove gliomas are organized and routine processes which begin far before the day of your surgery. By then, your neurosurgeon will have developed a surgical plan using a combination of your symptoms and advanced imaging.

On the day of surgery, you will typically arrive early to the surgical center or hospital. Expect to be greeted by team members from multiple specialties (neurosurgery, anesthesia, nursing, hospital services, etc.) as they prepare you for your surgery. Glioma surgery can take anywhere from one to 6 hours or more based on the complexity of the case.

For patients under anesthesia, this time will pass quickly. For patient family members, this can feel like an eternity. Many factors contribute to the time in the operating room, and this should not be used as a measure of how the surgery is going. Routine updates are often available from nurse circulators throughout the case.

If you are deemed to be a candidate for an awake craniotomy so that the location of vital functions of the brain can be localized before the tumor is removed, additional instructions will be provided to you before the day of your surgery to make the experience more comfortable for you.

A biopsy procedure is a much simpler surgery where only a small piece of the tumor is removed for diagnostic purposes.

For more information about the technical aspects of the surgery and extensive experience of Dr. Cohen, please refer to the chapter on Low-Grade Glioma in the Neurosurgical Atlas.

Surgical complications are not common; however, it is important to be familiar with the potential risks and what can go wrong before, during, and after surgery.

• Before surgery, risks of anesthesia (the process of putting you to sleep and preventing pain) include minor symptoms, such as a sore throat or nausea and vomiting, to more serious complications involving the heart or lungs.
• During surgery, in addition to the ongoing risks of anesthesia, your surgeon may encounter blood loss, swelling, or unforeseen disease progression since the date of your last imaging. Fortunately, neurosurgeons receive nearly a decade of extensive training to handle these issues when they arise.
• After surgery, your care team will be on the lookout for signs of swelling within the brain, infection of incision sites, and blood clots in your legs from reduced activity after surgery.

A patient can often return home several days to a week after surgery. Patients are encouraged to resume walking and personal care while more strenuous activities like working out are discouraged for 4 to 6 weeks. Ability to return to work depends on the nature of the work. People with less strenuous jobs, such as office work, can make their own determination when to return to work. Jobs that require more stamina should be avoided for 4-6 weeks. Driving may not be permitted for up to 1-2 months and clearance from your surgeon for driving is important. Patients suffering from seizures have to be at least 6-12 months seizure free before driving is considered.

Brain tumors can unfortunately recur and tend to grow back near the site of the original tumor. Tumors are more likely to return if they were only partially removed. The same symptoms, such as headache, feelings of being sick, drowsiness, seizures and vision problems, may be similar or more pronounced than your initial presenting symptoms.

Surgery for some recurring tumors is an option.

For some patients, life after brain surgery is relatively normal. Other patients may need to adjust their lifestyle and return to work later than desired. Some who do recover fully may do so in a few weeks to several months. Recovery is very individualized. Rehabilitation is an important part of recovery for some patients.

Long-term side effects from glioma surgery largely depend on the extent and location of the tumor that needs to be removed. Healing at the site of the incision is often routine. With proper care, this typically occurs within the first few weeks after surgery. During this time, it is not unusual for patients to experience emotional and personality changes.

Patients have reported experiencing anger and sadness while others are overwhelmed. Patients can also be seen as aggressive and confused. These symptoms often occur because of several factors, including isolation during post-operative hospitalization, natural disease progression, loss of independence, and coming to terms with a life-altering diagnosis.

Besides behavioral and personality changes, side effects may include memory loss, vision changes, loss of balance and coordination, arm or leg weakness, and impaired speech if the tumor is near parts of the brain or spine that control these functions.  

Physical therapy and even rehabilitation in special facilities is an important post-operative treatment strategy to help patients regain physical function. Similar techniques can be used to regain cognitive function after brain surgery, such as memory loss. It is important to modify your living environment to fit your needs such as having a notepad by the phone to record messages. Have a special place to keep important items you use daily like keys and cell phones.

Label cupboards to know where items are placed. Use external memory aids such as a smart phone with a calendar or diary. Use pill boxes or organizers for medication. Follow a set routine. Changes in routine should be introduced carefully with many spoken and written reminders to prepare the individual. Understanding that these long-term side effects may occur and how to minimize them is an important part in restoring function after glioma surgery.

• Perimutter Cancer Center
• Mayo Clinic