Why do we have to break down a brain tumor to remove it?

My father just had surgery for a large pituitary tumor at Tam Anh General Hospital.

The doctor said the tumor was as big as a plum (4x5 cm) but during the surgery, he had to break it down to remove it. Doctor, can you tell me why this had to be done? (Le My, Ho Chi Minh City)

Reply:

Normally, when operating on brain tumors, doctors will consider opening the smallest possible skull to improve treatment effectiveness and ensure aesthetics for the patient. Thanks to modern techniques and machines, doctors will reduce the tumor before removing it in small pieces. The reason for not removing the entire tumor is because it will increase the risk of collision, pulling and damaging the surrounding brain areas.

Your father's pituitary tumor, about 4x5 cm, is quite large. The surgical technique to remove a pituitary tumor is not difficult, but this type of tumor is quite tough, prone to bleeding and is quite difficult to stop. If the doctor does not have experience and does not use modern specialized equipment, the tumor may not be completely removed and can easily tear the arachnoid membrane, causing cerebrospinal fluid to leak from the brain, causing very severe meningitis.

Doctors have used an ultrasonic surgical aspirator (Cusa), also known as an ultrasonic cavitation device, to help break down the tumor so that it can be removed through the smallest possible incision. If the entire tumor is removed, a large incision is needed, and the strong pulling and force will affect the pituitary gland. If the pituitary gland suddenly bleeds, the lack of blood supply will cause total pituitary failure - pituitary stroke, requiring emergency surgery.

The ultrasonic surgical aspirator is a surgical device that uses low-frequency ultrasonic energy (around 23 kHz). This mechanical energy is transmitted through a 3 mm hollow tip that vibrates at a rate of 23,000 cycles per second, which fragments low-fiber tissue. It is essentially an ultrasound probe combined with a suction device. After fragmentation, the device sucks out pieces of the brain tumor without much impact on the surrounding healthy brain tissue.

A brain tumor was operated on by a robot with the help of a Cusa machine to shred the tumor. Photo: Provided by the hospital — A brain tumor was operated on by a robot with the help of a Cusa machine to shred the tumor. Photo: *Provided by the hospital*

Currently, this is a modern device used in tumor surgery at major hospitals specializing in neurosurgery and brain surgery around the world.

At Tam Anh General Hospital in Ho Chi Minh City, in addition to the Cusa machine, we use two modern techniques to help operate on brain tumors, spinal tumors, hemorrhagic strokes and dangerous cranial nerve diseases: the Modus V Synaptive brain surgery robot and the latest generation of microsurgical glasses. The benefit is that after surgery, patients recover quickly, preserve maximum function and return home early.

MSc.MD.CKII Mai Hoang Vu
Department of Neurosurgery, Tam Anh General Hospital, Ho Chi Minh City

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