What can I Expect During Astrocytoma Surgery?

Astrocytoma surgery is the preferred treatment for patients with an astrocytoma. An astrocytoma is a tumor, or accumulation of abnormal cells, in the spinal cord. Though it may be advisable to wait and monitor the tumor, or try radiotherapy or chemotherapy, doctors tend to recommend astrocytoma surgery whenever possible. The surgery serves to remove or reduce the tumor and provide a tissue sample so that doctors can make better decisions about future treatments.

An astrocytoma is a tumor that grows in the brain and spinal cord, usually in the chest or neck region, and derives from cells called astrocytes. The characteristics of the tumor depend on the location and grading of the astrocytoma. Though there are several grading systems, the World Health Organization (WHO) grading system is the most commonly used. This system classifies astrocytomas from one to four, or least aggressive to most aggressive. Grade one is the slowest growing and least infiltrating, or invasive, tumor as well as the type most likely to be survived. Grade four, which includes the glioblastoma multiforme (GBM), is the most common and aggressive class of astrocytoma and few people are able to survive it.

Symptoms of a low grade astrocytoma may be missed for several years because it is so slow-growing, but advanced grade tumors grow swiftly and produce symptoms within weeks or months. These symptoms often include seizure, visual disturbance, cognitive impairment, personality change, and vomiting. Doctors will do a full neurological examination, with computed tomography (CT) scans, magnetic resonance imaging (MRI), nerve tests, and biopsy. This helps the doctor find out whether there is a tumor, the location of the tumor, and the grade of the tumor, so the doctor can then decide to pursue astrocytoma surgery, chemotherapy, radiation, or waiting and monitoring for treatment.

If possible, a multidisciplinary team of doctors will recommend astrocytoma surgery, but tumors often cannot be reached without causing brain damage. Grade one tumors have the highest success rate, and astrocytomas grades two through four are more difficult to resect, or cut out, because of the more diffuse infiltration of the abnormal cells. These tumors cannot be completely resected, so astrocytoma surgery on higher grade tumors is thought of as a measure to extend to survival, rather than a cure.

Stereotactic surgery, a minimally invasive surgery that targets the tumor from different coordinates, is the most common form of astrocytoma surgery. This surgery, also called neuronavigation, first uses imaging techniques to determine the exact location of the tumor. Then the neurosurgeon aims beams of radiation at the tumor from different points outside the body. These beams are not strong enough to cause damage on their own but kill cells where they are combined, so they leave the body unharmed on their path to the tumor, but kill the cells in the tumor where they meet. Open surgery may also be possible, but stereotactic astrocytoma surgery is much preferred.

The amount of tumor that can be removed in surgery depends on where the tumor is and how it has grown, and astrocytoma surgery almost never succeeds in removing the entire mass. Many times, especially in higher grade tumors, having the surgery poses more risk to the patient than not having the surgery, so the doctor may recommend radiation therapy or chemotherapy instead. After the surgery, the patient can expect to undergo radiotherapy to continue killing the abnormal cells and take medications to cope with the symptoms of the tumor. Patients must continue meeting with their neuro-oncologist to monitor their condition, as the tumors are likely to re-grow, or worsen.