Glioma Surgery
2024/10/02
Glioma is a type of tumour that originates in the supportive cells in the brain and spinal cord (glial cells). Symptoms of glioma can vary depending on the size and location of the tumour. They may include headaches, seizures, vision problems, speech difficulties, weakness or numbness on one side of the body, and personality changes. Surgery remains the standard approach to glioma. Advancements in intraoperative techniques, such as neuronavigation and stimulation mapping, have enabled early diagnosis and safe glioma removal.
Brain surgery, or craniotomy is typically performed under general anaesthesia with the balance of maximal tumour resection and maximal preservation of critical brain functions. Often, a sample of the tumour is removed and examined by a pathologist to help with further diagnosis and treatment planning.
At NUH, we specialise in the resection of gliomas through Awake Brain Surgery, or awake craniotomy where the patient is awake for a portion of the procedure. The primary goal is to preserve various complex neurological functions, such as memory, speech, language and movement and to maintain a good quality of life by maximising tumour resection and reducing postoperative complications. Achieving this goal requires a thorough pre- and intra-surgical assessment of the patient's abilities, functionalities and overall quality of life.
Following surgery, patients undergo individually tailored rehabilitation programme involving neurosurgeons, neuropsychologists, physiotherapists, speech therapists and rehabilitation doctors. Additional treatment options, such as radiosurgery and chemotherapy, may be offered for any remaining cancerous cells or tissues after the surgery.
Gliomas can occur in various regions of the brain or spinal cord and are classified based on the specific type of glial cells from which they originate. There exist different types of gliomas that are typically addressed through surgical management:
Astrocytomas (low-grade glioma): These gliomas stem from astrocytes, the star-shaped cells.
Glioblastoma (high-grade astrocytomas): This is the most prevalent type of malignant brain tumour among adults.
Ependymomas: They develop from cells responsible for producing cerebrospinal fluid, known as ependymal cells.
Oligodendrogliomas: Seizures are the most frequently encountered symptom associated with these tumours.
At your first appointment, you will be assessed by our neurosurgeons specialising in brain surgery and/or awake surgery. Your MRI scan will be reviewed and discussed to determine whether brain surgery or awake surgery is recommended. The neurosurgeons will assess all potential benefits, possible risks, and complications associated with the surgery to create a treatment plan tailored to your medical needs.
For patients undergoing an awake surgery, you will be clinically and functionally assessed by our neuropsychologist and anaesthesiologist prior to the surgery. You will also be provided with the relevant information and training to prepare for the surgery.
During the first phase of the awake surgery, you will be deeply sedated and asleep. Subsequently, the anaesthesiologist will stop the sedation and allow you to wake up for a series of tests which you will perform under the guidance of a neuropsychologist. You will be able to communicate with the surgery team during the awake phase. Once the tumour has been removed, you will be placed under anaesthesia again to complete the remaining phase of the surgery. Depending on your condition, you may require an inpatient stay for up to a few weeks.
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