Brain resection is a specialized neurosurgical procedure involving the removal of a portion of brain tissue. It addresses specific neurological conditions where a localized brain area causes symptoms or disease, aiming to alleviate symptoms and improve prognosis.
Conditions Treated by Brain Resection
Brain resection is a treatment option for several neurological conditions, with brain tumors being a primary indication. Surgeons aim to remove or reduce the size of these growths, whether benign or malignant, to relieve pressure, lessen symptoms, and improve the patient’s outlook. The objective is often maximal safe resection, removing as much of the tumor as possible without causing unacceptable neurological deficits.
Drug-resistant epilepsy is another condition treated by brain resection, especially when seizures originate from a specific, identifiable brain area. For individuals whose seizures are not adequately controlled by medication, removing this “seizure focus” can significantly reduce or eliminate seizure activity. This approach is effective for focal epilepsies associated with structural brain lesions like hippocampal sclerosis or malformations of cortical development.
Vascular malformations, such as arteriovenous malformations (AVMs) or cavernous malformations (CMs), are also treated. These abnormal clusters of blood vessels can cause symptoms like bleeding, headaches, or seizures. Surgical removal of these malformations aims to prevent further complications and improve neurological function.
The Surgical Procedure
Pre-operative planning utilizes advanced imaging techniques to precisely map the brain, identifying the target area for removal and safeguarding crucial functional regions. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans provide detailed anatomical views, while functional MRI (fMRI) helps pinpoint areas responsible for language or motor control. Diffusion Tensor Imaging (DTI) is also used to visualize white matter tracts, which are bundles of nerve fibers connecting different brain regions.
During surgery, neuro-navigation systems guide the surgeon with precision, acting like a GPS for the brain. Intraoperative neuromonitoring techniques assess brain activity and function. This includes electroencephalography (EEG) to monitor electrical activity, and evoked potentials such as somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP) to check nerve pathway integrity.
In some cases, especially when the problematic area is near eloquent regions controlling speech or movement, an awake craniotomy may be performed. This technique allows the patient to remain conscious during portions of the surgery, enabling real-time functional mapping through direct electrical stimulation (DES) of the brain. The surgeon can then identify and avoid areas that, if removed, would cause permanent neurological deficits.
Surgery involves a craniotomy, creating a temporary opening in the skull to access the brain. The size of this opening depends on the location and size of the tissue to be removed. Specialized instruments are then used to carefully resect the targeted brain tissue, which can involve techniques like scalpel, laser ablation, suction, or ultrasonic aspirator. Once the resection is complete, the bone flap is typically replaced and secured, and the scalp is closed.
Recovery and Long-Term Considerations
Immediately after surgery, patients are closely monitored, often in an intensive care unit (ICU) or high dependency unit (HDU) for a few days to a week. Initial recovery involves managing pain, particularly headaches, and addressing potential nausea with medication. Swelling around the face or eyes is common and typically resolves gradually.
The neurological impacts after surgery vary widely depending on the resected brain area. Patients may experience temporary or, in some instances, long-term changes in motor function, sensation, speech, memory, or other cognitive abilities. For example, a study found that 41% of adults experienced neurological difficulties after brain tumor surgery, though this persisted in only 6% after three months.
Rehabilitation plays a significant role in helping patients regain function and adapt to changes. Physical therapy helps improve motor skills and balance, occupational therapy assists with daily activities, and speech therapy addresses communication difficulties. Neuropsychological rehabilitation can support cognitive recovery.
Patients are encouraged to engage in movements and exercises as soon as medically appropriate to prevent complications like blood clots. General surgical risks include infection, bleeding, and swelling, which are closely monitored by the healthcare team. Ongoing medical follow-up includes regular neurological check-ups, imaging scans like MRI, and medication management to monitor recovery and address any residual or new symptoms.