Very often a biopsy is used to find out exactly what type of brain tumour you have. The biopsy may also be done as part of an operation to remove the tumour.

A biopsy is the removal of a small piece (sample) of the tumour to find out exactly which type of tumour it is. By examining the sample under a microscope, a pathologist (a doctor who specialises in how disease affects the body's tissue) can tell what kind of cells are present.

Having a biopsy may mean a few days in hospital as it usually involves an operation under a general anaesthetic. An MRI brain scan or CT scan is done (see further tests) to find the position of the tumour to the nearest millimetre. During the operation a small hole, called a burr hole, is made in the skull. A fine needle is then passed down through the burr hole to remove a small piece of the tumour. This is sent to the laboratory and examined by the pathologist.

Stereotactic biopsy

Sometimes, especially if the tumour is deep within the brain, you may be given a specialist type of biopsy called a guided or stereotactic biopsy. After you have been scanned you will be fitted with a head frame. This helps the doctors to guide the biopsy needle to exactly the right part of the brain. Once the frame is in place the doctors will drill a small hole in the skull in much the same way as a normal biopsy. The frame will then guide the needle to the right place. A stereotactic biopsy is usually done under a local anaesthetic, but may involve a general anaesthetic.

Once the type of brain tumour is known, a more extensive operation can be done to remove all or part of it. A craniotomy is an operation that involves opening the skull. You will be given a general anaesthetic. Some of your hair may need to be shaved off in the anaesthetic room before the operation. Some people prefer to have all their hair shaved off, as this makes it easier to wear a wig while waiting for the hair to grow back. The surgeon will cut the scalp and the piece of skull over the tumour, remove the tumour itself, and replace the piece of skull. The flap of scalp is then stitched back in place.

Often it is not possible or advisable to remove the whole tumour. When only part of the tumour is removed, this is called partial resection or debulking.

Sometimes the only way for the surgeon to remove the tumour is to go through a healthy part of the brain, which may risk causing some permanent damage. The effects of this will vary depending on the area of the brain involved. Your surgeon will talk this over with you very carefully beforehand to make sure that you are fully aware of how your surgery may affect you.

In some situations it will be too difficult or dangerous to remove even a small part of the tumour, or the doctors will think that other treatments are more suitable. Your surgeon or doctor will discuss the most appropriate type of operation with you and, if you like, with a close relative or friend. Before any operation, do ask questions so that you know exactly what is involved. No operation or procedure will be done without your agreement.

After your operation

The length of your stay in hospital will depend on the extent of your operation and any treatment you may need afterwards. For about the first 12 hours after your operation, you will be closely observed, probably in the intensive care unit (ICU/ITU). You will probably have frequent observations taken to begin with. These are known as neurological observations, or ‘neuro obs’, and will include checking your pulse, blood pressure, the amount of oxygen in your blood and number of breaths each minute. You may initially be cared for on a machine which maintains your breathing (a ventilator).

Your head may be bandaged and you may have a tube in the site of the operation, which drains into a bottle. This is used to drain excess blood from the head wound and is usually removed within a day or two. Sometimes your face and eyes will be swollen and appear bruised after the operation. The swelling should go down within 48 hours and the bruising within a few days. You may also have a drip of salt water (saline) to replace any fluids you may have lost.

You may have a headache when you wake up after the operation and you will be given pain killers to help relieve this. It is unusual to get a lot of pain after surgery to the brain, but tell your nurse or doctor if you are in pain or the pain starts to get worse.

These descriptions may sound dramatic but the effects of the operation should settle fairly quickly and once staff are confident with your condition you will go back to the ward to recover further.