How does neurosurgery work? How does the surgeon identify which parts of the brain are okay to cut and which one’s arent’t? Isn’t everyone’s brain structured differently?


With other surgeries I guess it’s possible for the surgeon to identify the different tissues, nerves, and blood vessels through an X-ray or CT scan and plan the surgery accordingly

But with the brain, doesn’t everything look like a big blob of brain tissue? How can the surgeon tell what part of the brain performs what function and what’s safe to cut so that he can access the tumor? How would he avoid a Phineas Gage type outcome?

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Doctors will take pictures of the person’s brain with a big machine that’s made of magnets while they do things that are important to them. That’s known as a Functional MRI. That allows the doctors to build up a map of how all of their brain cells work together and they can do this before the surgery even starts.

For some people they even wake them up during surgery and have them do something like solve math problems while they operate to make sure those parts of the brain still work. There was even a lady who [played the violin during her surgery](!

When a doctor needs to do neurosurgery, they first look at pictures of your brain to see where the problem is. These pictures help the doctor understand how your brain is structured and where important parts are located.

The doctor then carefully plans where to make a cut in your brain. They use special tools to make the cut, and they work very slowly and carefully to avoid hurting any important parts of the brain.

Even though everyone’s brain is different, neurosurgeons have studied the brain and know a lot about how it works. They use this knowledge to make sure they only cut the parts of the brain that need to be fixed and leave the other parts alone.

Sometimes, they might even wake you up during the surgery so they can ask you to do things like move your fingers or speak. This helps them make sure they are not cutting any important parts of the brain.

No, brains generally aren’t structured differently. There will be minor variations, like any other body part, but people have the same parts of the brain in the same places, and the same places do the same things. This website has useful info [](

Researchers, doctors and surgeons have studied the brains of cadavers for centuries so there is understanding of the basic structure and locations of blood vessels etc, and then for each individual patient there will be Xrays, CT scans and MRIs to show their precise details.

For some surgeries, patients will need to be awake during the surgery.

If they’re going in to fix a bleed, or take out something, they just get in and out where they need to and that’s that. They use imaging to know where to look and what’s going on before going in.

I saw a surgery on tv (surgery channel or whatever it was) where a person had seizures and so they had to be awake for the surgery. The dr would stimulate a part of the brain with a tiny electric lead, and ask questions or have the patient talk, and if that part effected the patients talking or responses, they knew that was the problem area and cut it out.

It was fascinating.

The brain has areas that can safely be removed without major deficits. Approaches will stay away from motor strip, supplemental motor and vision areas.

Many different ways can be used to identify brain vs abnormal tissue. Some can be done with the naked eye. Then using brain lab or stealth image guidance helps remove margins and ensure as much has been removed safely. 5ala (gleolan) is an oral drug that gets taken up by tumors differently from normal cells and stains the tissue that can be seen under the microscope and newer headlights.

As others have said you can do awake cranis but it’s more rare. Using a probe and Neuromonitoring can help guide you away from high risk structures but it’s not 100%.

It’s all a balance between the type of tumor with different recurrence and growth rates, where it is, patient wishes and how terminal the disease is. I.E. a high grade glioma vs a stable meningioma vs a metastasis in an advanced cancer patient.