How neurosurgeons safely reach a brain tumour

Every craniotomy starts with a plan built on the MRI: the shortest safe corridor from the surface of the brain to the tumour, avoiding critical structures like the speech area, motor pathways and major blood vessels.

Neuronavigation — think GPS for the brain — is loaded with the pre-operative MRI and tracks the position of the instruments in real time. It tells us exactly where we are inside the head.

The scalp is opened, a section of bone is temporarily removed, and the dura (the tough covering of the brain) is opened. Under the operating microscope, we then work through natural spaces between brain structures wherever possible, following the planned corridor.

For tumours near the speech or motor areas, we may wake the patient up during the operation to test speech and movement in real time. Awake craniotomy sounds dramatic but is safe and lets us remove more tumour without causing a deficit.

At the end, the dura is closed, the bone is replaced with tiny plates and screws, and the scalp is closed in layers. Most patients are moving all four limbs and talking normally within hours of coming out of theatre.