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?

Question

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?

In: 33

Answer 1

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.