Common Brain Surgery Procedures and Their Purposes

Brain surgery is one of the most complex fields in modern medicine. It deals with the prevention, diagnosis, and surgical treatment of conditions that affect the brain, spinal cord, and nervous system. Over the years, advancements in technology, imaging, and surgical techniques have made these procedures safer and more effective, offering patients better outcomes and improved quality of life.

This article explains the most common brain surgery procedures, their purposes, and how they help patients manage or overcome serious neurological problems.

1. Craniotomy

A craniotomy is one of the most widely performed brain surgeries. In this procedure, a portion of the skull is temporarily removed to give the surgeon access to the brain. Once the surgery is completed, the bone flap is replaced.

Purposes:

• Tumor removal: Craniotomy is the primary approach for removing brain tumors, both benign and malignant.
• Aneurysm repair: Surgeons may perform a craniotomy to clip an aneurysm and prevent it from rupturing.
• Traumatic brain injury: It can relieve pressure caused by swelling or bleeding.
• Epilepsy surgery: In some cases, it is used to remove the portion of the brain responsible for seizures.

Craniotomies can be large or small, depending on the location and complexity of the condition. The introduction of minimally invasive techniques has made many craniotomies less risky than in the past.

2. Craniectomy

A craniectomy is similar to a craniotomy, but in this case, the bone flap is not immediately replaced. It is often done to relieve severe swelling in the brain when replacing the bone could increase pressure and worsen the condition.

Purposes:

• Stroke management: Decompressive craniectomy is used when brain swelling from a stroke becomes life-threatening.
• Severe traumatic brain injury: It reduces intracranial pressure caused by bleeding or edema.
• Infections or abscesses: In some cases, the bone may not be put back right away to prevent infection.

This procedure is usually followed by a second surgery called cranioplasty, in which the bone flap or an artificial replacement is put back once swelling subsides.

3. Biopsy

A brain biopsy is performed to take a small sample of abnormal tissue for laboratory analysis. It is usually done using a minimally invasive technique.

Purposes:

• Diagnosing brain tumors: Determines whether a tumor is benign, malignant, or metastatic.
• Identifying infections: Helps confirm cases of encephalitis, abscess, or other infections.
• Investigating inflammatory or degenerative conditions: Provides insight into diseases like multiple sclerosis when diagnosis is uncertain.

Biopsies can be done as open procedures during a craniotomy or as a stereotactic biopsy, where advanced imaging guides a needle precisely to the target area.

4. Endoscopic Brain Surgery

Endoscopic brain surgery uses a small camera (endoscope) inserted through a tiny incision or a natural opening like the nose. The surgeon navigates inside the brain using the live video feed.

Purposes:

• Pituitary tumors: Endoscopic transsphenoidal surgery is commonly used to remove tumors from the pituitary gland.
• Hydrocephalus: An endoscopic third ventriculostomy (ETV) creates a new pathway for cerebrospinal fluid to drain.
• Colloid cyst removal: These cysts in the brain’s ventricles can be treated using endoscopic approaches.

Endoscopic methods are less invasive than open surgeries, resulting in smaller scars, faster recovery, and lower risks of infection.

5. Deep Brain Stimulation (DBS)

DBS is a modern neurosurgical procedure that involves implanting electrodes into specific areas of the brain. These electrodes are connected to a small device (similar to a pacemaker) implanted in the chest, which sends controlled electrical impulses to regulate abnormal brain activity.

Purposes:

• Parkinson’s disease: Helps reduce tremors, stiffness, and movement problems.
• Essential tremor: Provides relief when medications fail.
• Dystonia: Improves muscle contractions and posture.
• Obsessive-compulsive disorder (OCD): In select cases, DBS can help manage severe symptoms.

DBS does not cure these conditions but significantly improves quality of life for patients with chronic neurological disorders.

6. Aneurysm Clipping and Coiling

Brain aneurysms are weak spots in blood vessels that can balloon and rupture, causing life-threatening bleeding. Surgery aims to prevent rupture or stop ongoing bleeding.

Clipping:

A metal clip is placed across the neck of the aneurysm through a craniotomy, preventing blood from entering it.

Coiling (Endovascular Surgery):

In this minimally invasive method, coils are inserted into the aneurysm through a catheter guided from the groin or wrist. The coils promote clotting, sealing off the aneurysm.

Purposes:

• Preventing rupture of unruptured aneurysms
• Treating ruptured aneurysms to prevent further bleeding
• Reducing the risk of stroke or death

Both methods have their place, with the choice depending on the aneurysm’s size, location, and the patient’s overall health.

7. Epilepsy Surgery

For patients with epilepsy that does not respond to medication, surgery can reduce or eliminate seizures.

Types of Epilepsy Surgeries:

• Resective surgery: Removing the brain tissue where seizures originate, often in the temporal lobe.
• Laser ablation: Using focused energy to destroy seizure-causing tissue.
• Corpus callosotomy: Cutting the connection between the two brain hemispheres to prevent seizure spread.
• Neurostimulators (like VNS or RNS): Devices implanted to regulate abnormal brain signals.

The purpose is not always to completely cure epilepsy but to reduce seizure frequency and severity, improving safety and daily functioning.

8. Ventriculoperitoneal (VP) Shunt Surgery

A VP shunt is a device implanted to treat hydrocephalus, a condition where excess cerebrospinal fluid (CSF) builds up in the brain.

Purposes:

• Diverts excess fluid from the brain ventricles into the abdominal cavity, where it can be absorbed.
• Reduces symptoms like headaches, nausea, blurred vision, and cognitive problems.
• Prevents long-term damage from increased intracranial pressure.

Though shunts can occasionally get blocked or infected, they remain one of the most effective treatments for hydrocephalus.

9. Tumor Resection (Microsurgery)

Brain tumor surgery often involves the use of high-powered microscopes to remove tumors with maximum precision while sparing healthy tissue.

Purposes:

• Removing as much of the tumor as possible
• Reducing pressure on the brain
• Improving neurological function
• Allowing for additional therapies such as radiation or chemotherapy

Advanced tools like intraoperative MRI and fluorescent dyes help surgeons distinguish tumor tissue from normal brain tissue, making surgeries more effective.

10. Skull Base Surgery

The base of the skull is a challenging area with vital structures like blood vessels, cranial nerves, and the brainstem. Skull base surgery can be performed using open or endoscopic techniques.

Purposes:

• Removing tumors such as meningiomas, pituitary tumors, and acoustic neuromas
• Treating vascular malformations
• Repairing cerebrospinal fluid leaks
• Managing congenital abnormalities

This subspecialty requires a multidisciplinary approach, often involving neurosurgeons and ENT (ear, nose, and throat) specialists.

Conclusion

Brain surgery encompasses a wide range of procedures, each designed for specific conditions and patient needs. From life-saving interventions like craniectomy for brain swelling to highly sophisticated treatments such as deep brain stimulation, the field of neurosurgery continues to evolve rapidly.

While the idea of brain surgery can be daunting, these procedures have transformed countless lives by reducing symptoms, preventing catastrophic events, and restoring normal function. Thanks to technological innovations and growing surgical expertise, patients today face better chances of recovery and long-term wellness than ever before.