BRAIN TUMOUR RESECTION

As a Neurosurgeon with a super-specialist focus on brain tumour surgery, Dr Christos Profyris, in Johannesburg, South Africa, will work-up and resect your brain tumour according to the most current international standards.

WHEN IS BRAIN TUMOUR RESECTION SURGERY NECESSARY?

Brain tumours are an abnormal growth of cells in the brain. Be it benign or malignant; a brain tumour can cause serious health problems as it compresses vital parts of the brain. This is especially true when brain tumours continue to grow.

Surgery is usually the first step in treating most benign and many malignant brain tumours and is generally the preferred treatment.  As every tumour is unique Dr Christos Profyris and his team will devise a tailored surgical plan to your specific tumour with the aim of minimising surgical risk while maximising surgical resection. Depending on your tumour and your situation, the benefits of tumour surgery can include achieving a diagnosis, potential cure, improvement in quality of life, prolongation of life and/or increasing the effectiveness of other treatments used to manage your tumour.  

HOW IS BRAIN TUMOUR RESECTION SURGERY DONE?

In Johannesburg, Dr Christos Profyris and his team will assess you in clinic where a comprehensive history will be taken and clinical examination will be performed.  Depending on your specific tumour and presentation, a detailed workup will be undertaken.  This will be tailored to your tumour and may include a combination of blood tests, visual field testing and further imaging such as magnetic resonance imaging (MRI), MR tractography (DTI), Functional MRI (fMRI), MR Navigation, MRA/MRV and Digital subtraction angiography.  Other tests may also be ordered as deemed necessary.  

Ultimately this testing, will allow Dr Christos Profyris to appreciate the three-dimensional architecture of your tumour and will also alert him to potential risks and dangerous areas in relation to your tumour.  This is essential as all brain surgery is potentially risky and can lead to severe consequences.  This workup will allow for appreciation of these risks and will help minimise risk as much as possible.  Furthermore, this workup will also allow Dr Christos Profyris to devise a plan for minimal access and keyhole surgery. 

In Johannesburg, Dr Christos Profyris will employ a range of intra-operative technologies that will be aimed to decrease the risk of your surgery and achieve maximal resection.  These technologies include navigation, Neurosurgical microscope, 2D and 3D endoscopy, exoscope, awake craniotomy (brain mapping), intra-operative neurophysiological monitoring and intraoperative angiography. 

As there are more than 120 different types of brain tumour and brain tumours can arise in any location within the brain or spinal cord the techniques vary drastically.  As this is vastly complex, the following section will only emphasise basic principles involved in brain tumour surgery.

PRINCIPLES OF BRAIN TUMOUR SURGERY

In general, brain tumour surgery involves a skin incision on the scalp to expose the skull.  The exact site of the incision will be selected with the use of image mapping technology which will allow for the planning of a keyhole.  An opening is made in the skull and a piece of skull bone removed and is set aside so that it may be used to close the opening later. The dura mater, a membranous layer that covers the brain is then exposed and gently opened to expose the brain. Based on the pre-operative plan, critical structures such as nerves and blood vessels will be identified and protected and the tumour will be identified. The tumour is then carefully resected away from the healthy brain tissue which is protected at all times with the aim of causing minimal disruption to the healthy tissues.  Following resection, the dura mater is closed, the skull bone is replaced and secured with a type of rivet, and the scalp is sutured.

Other types of procedures may differ drastically depending on the location of the tumour.  For instance, removal of a pituitary tumour or anterior skull base tumour may be done through a transnasal approach. This is another type of keyhole technique that is performed by operating through the nose.  A thin tube-like tool known as an endoscope is passed through the nostril and an incision is made in the sphenoid sinus at the back of the nasal cavity. Once the sphenoid sinus is opened, access to tumour is obtained and with the use of endoscopic tools, tumour can be removed through the nose.  

AFTER BRAIN TUMOUR SURGERY

Following your surgery you will remain in hospital for a few days to recover and sutures will be removed at 7 to 10 days after the operation.  As soon as a diagnosis is obtained from our pathologists, the results will be communicated to you.  You will get a post-operative MRI following your surgery to assess tumour resection and you will be seen again in clinic following the operation.  For many cases, surgery is only the first step in the treatment pathway.  Once a diagnosis is established, further treatment in the form of Stereotactic Radiotherapy (Gamma Knife), Radiotherapy or Chemotherapy may be required.  In Johannesburg, Dr Christos Profyris works with a team of expert oncologists who will be consulted and will aid in planning further treatment.

Importantly, as brain tumour care is our passion you will always be our patient and we will keep in close communication with you throughout the post-operative period.

COLLOID CYST

This is a case of a large colloid cyst operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the colloid cyst which has been removed as can be seen by the images on the right. This opened up the brains water system and led to resolution of the patients symptoms.  The patient made an uneventful recovery.

The video below shows and endoscopic colloid cyst resection performed by Dr Profyris.

GLIOBLASTOMA

This is a case of a large Glioblastoma operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the Glioblastoma which has been removed as can be seen by the images on the right. The patient made an uneventful recovery with resolution of their symptoms.

This is another case of Glioblastoma operated on by Dr Profyris through a keyhole approach.  .  The green arrows on the left hand images demonstrate the Glioblastoma which has been removed as can be seen by the images on the right.

HAEMANGIOBLASTOMA

This is a case of a haemangioblastoma operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the haemangioblastoma which has been removed, as can be seen by the images on the right. The patient made an uneventful recovery with resolution of their symptoms.

INTRAVENTRICULAR TUMOUR

This is a case of an Intraventricular tumour operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the intraventricular tumour which has been removed, as can be seen by the images on the right. The patient made an uneventful recovery with resolution of their symptoms.

LOW GRADE GLIOMA

This is a case of a Low Grade Glioma tumour operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the intraventricular tumour which has been removed, as can be seen by the images on the right.  The patient made an uneventful recovery.

Another Low Grade Glioma tumour operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the intraventricular tumour which has been removed, as can be seen by the images on the right.  The patient made an uneventful recovery. Below the scans there is an animation of this patients individual brain tracts demonstrating the tumour in red and the critical tracts in the other colours.  Specifically in this case the tumour was opposed to  a very important tract (Frontal Aslant Tract), seen in purple, which is responsible for speech fluidity.  The blue tract (Corticospinal) is responsible for movement on the right side of the body.    This type of analysis permits careful preoperative study of the tumour and the tracts, which allows for personalisation of the pre-operative plan to make resection as safe as possible by avoiding critical tracts.  Because of the relation of this tumour to the critical speech tract an awake craniotomy was performed.

This is a case of a giant meningioma (position: Parafalx) operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the meningioma which has been removed, as can be seen by the images on the right.  The patient made an uneventful recovery.

METASTASIS

This is a case of a brain metastasis operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the metastasis which has been removed, as can be seen by the images on the right.

Above we can see an animation of this patients individual brain tracts demonstrating the tumour in red and the critical tracts in the other colour.  This permits careful preoperative study of the tumour and the tracts, which allows for personalisation of the pre-operative plan to make resection as safe as possible by avoiding critical tracts.

OLIGODENDROGLIOMA

This is a case of oligodendroglioma operated on by Dr Profyris through a keyhole approach.  The green arrows on the left hand images demonstrate the oligodendroglioma which has been removed, as can be seen by the images on the right.

PINEAL TUMOUR

This is a case of a pineal tumour operated on by Dr Profyris through an endoscopic assisted approach.  The green arrows on the left hand images demonstrate the pineal tumour which has been removed, as can be seen by the images on the right.  Recovery was uneventful.  Endoscopic footage of the procedure can be seen in this video.