Brain, Cranial & Nerve
Craniotomy for Brain Tumor
Surgical removal of a brain tumor with image guidance, operating microscope, and — when the tumor is near eloquent cortex — awake mapping.
What it is
A craniotomy is a planned opening in the skull to access a brain tumor. The bone removed is temporarily set aside and replaced at the end of the operation, secured with small titanium plates. There is no permanent skull defect.
Modern brain tumor surgery is not just about removing the tumor — it's about removing it without injuring the brain around it. Image-guided navigation tracks where we are in three dimensions. The operating microscope gives us submillimeter visualization. For tumors near speech, motor, or language areas, awake mapping lets us preserve function we can't see on imaging alone.
Why this procedure when surgery is needed
For a brain tumor that is causing or threatens to cause symptoms, that needs a tissue diagnosis, or that has been shown to benefit from maximal safe resection for its tumor type, surgery is the foundation of treatment. For many primary brain tumors, the extent of resection correlates directly with outcomes.
The phrase that matters is maximal safe resection — taking as much tumor as we can take without injuring the functional brain around it. For tumors near critical cortex, that boundary is defined by direct cortical and subcortical mapping during surgery.
What to expect
Surgery duration varies widely by tumor — typically 3–6 hours.
Hospital stay of 2–5 nights for most cases.
Some incisional discomfort and short-term swelling at the surgical site.
Most patients walk and eat within 24 hours of surgery.
Return to most activities in 6–8 weeks; full neurologic recovery may take longer.
Pathology results typically take 5–10 days; we meet to review and plan next steps together.
Approach
- Image-guided neurosurgical navigation throughout
- Operating microscope for detailed visualization
- Awake mapping for tumors near eloquent cortex
- Intraoperative neuromonitoring (motor evoked potentials, EEG)
- Multidisciplinary planning with oncology and radiation oncology
Typical indications
- Symptomatic primary brain tumor in a resectable location
- Solitary brain metastasis with mass effect
- Tumor of unknown pathology requiring tissue diagnosis
- Tumor types for which extent of resection correlates with outcomes
- Refractory seizures from a known epileptogenic lesion
Alternatives we considered
- Stereotactic biopsy alone — for diagnosis without removal
- Stereotactic radiosurgery for small, well-defined lesions
- Observation with serial imaging for stable asymptomatic tumors
- Combined surgery with intraoperative radiation in select cases
- Clinical trial enrollment where appropriate
Last reviewed: 2026-05-10· Author: Chad Tuchek, MD · Cotton O'Neil Neurosurgery and Spine Center, Stormont Vail Health
The information on this page is general patient education and is not a substitute for individualized medical advice. For urgent symptoms, call 911 or go to the nearest emergency department. For non-urgent questions, call (785) 368-0767.