Brain tumors are removed through surgery, focused radiation, or heat-based techniques, depending on the tumor’s size, type, and location. The most common approach is open surgery called a craniotomy, but several less invasive options exist for tumors that are small, deep, or positioned near critical brain structures. Here’s how each method works and what recovery looks like.
Open Surgery: Craniotomy
A craniotomy is the most direct way to remove a brain tumor. The surgeon uses a medical drill to make small holes in the skull, then uses a specialized saw to cut and lift away a section of bone called a bone flap. This flap is saved and replaced at the end of the procedure. Beneath the bone, the thick outer membrane covering the brain is carefully separated and opened to expose the tumor.
The goal is what surgeons call “maximal safe resection,” removing as much tumor as possible without damaging brain tissue that controls movement, speech, vision, or other functions. Complete removal generally offers the best long-term outcomes. But when a tumor wraps around blood vessels or sits deep in areas that control essential functions, the surgeon may remove only a portion of it (sometimes called debulking) and follow up with radiation or chemotherapy to treat what’s left behind. The surgeon’s experience is one of the biggest factors in how much tumor can be safely taken out.
Staying Awake During Surgery
For tumors near brain regions that control speech or movement, surgeons sometimes keep the patient awake during part of the operation. The scalp is numbed with local anesthetic, and the brain itself has no pain receptors, so the procedure isn’t painful. While the surgeon works, the patient performs simple tasks like speaking, naming objects, or moving their fingers. This real-time feedback helps the surgical team identify exactly which tissue is safe to remove and which must be preserved. These awake procedures are typically used for tumors on the outer surface of the brain and for surgeries expected to last under four hours.
Tools That Improve Precision
Modern brain surgery relies on technology that would have been unimaginable a few decades ago. Before and during the operation, several tools help the surgeon distinguish tumor from healthy tissue and navigate the brain’s complex anatomy.
Fluorescence-guided surgery uses a special dye that the patient takes by mouth or through an IV a few hours before surgery. During the operation, the surgeon shines a particular wavelength of light on the brain. Tumor cells that have absorbed the dye glow pink, red, or green, while healthy tissue stays dark. This visual contrast helps the surgeon find tumor margins that would otherwise be invisible to the naked eye.
Intraoperative MRI takes real-time images of the brain while surgery is underway. This matters because the brain physically shifts as tumor tissue is removed, which can throw off the pre-surgical maps the team is working from. Studies show that real-time MRI leads to more complete tumor removal: in about 29% of cases, surgeons identified and removed additional tumor tissue they would have missed using conventional navigation alone. Neuronavigation systems work like GPS for the brain, using those updated images to track instruments in three-dimensional space relative to the tumor.
Through the Nose: Endoscopic Surgery
Some tumors at the base of the skull, particularly pituitary tumors, can be reached through the nasal passages instead of cutting through the skull. This approach uses a thin tube with a camera and light on the end, inserted through the nostril and guided through the sinuses to reach the tumor. Specialized instruments work alongside the camera to dissect and remove the growth. Because the nose and sinuses act as natural corridors to the skull base, this technique avoids a traditional incision entirely and typically means a shorter hospital stay and faster recovery.
Laser Ablation: Heat Without Open Surgery
For tumors that are small or located deep in the brain where open surgery would be risky, laser interstitial thermal therapy offers an alternative. The surgeon drills a small hole in the skull and threads a thin, needle-like probe through it, guided by stereotactic navigation (a grid-like mapping system) and confirmed by MRI imaging. Once the probe tip reaches the tumor, a laser heats it to between 113 and 138 degrees Fahrenheit, destroying tumor cells.
The entire process is monitored by special MRI sequences that measure the temperature of surrounding brain tissue in real time, helping prevent damage to nearby healthy structures. The probe tip is cooled with saline or carbon dioxide to keep the heat focused. This technique leaves only a small hole rather than a large surgical opening, which shortens recovery considerably.
Focused Radiation: No Incision at All
Stereotactic radiosurgery isn’t surgery in the traditional sense. It involves no cuts or openings in the skull. Instead, the treatment delivers hundreds of individually weak radiation beams from different angles. Each beam passes harmlessly through healthy tissue, but where all the beams converge at the tumor, they deliver a concentrated dose powerful enough to damage the DNA of tumor cells. Without functional DNA, those cells can no longer divide and eventually die.
This approach works best for small tumors or tumors in locations that are difficult or dangerous to reach surgically. The radiation is mapped using detailed brain imaging and computer software to ensure the beams hit only the target area. Patients are typically treated in one to five sessions, and because there’s no incision, recovery is minimal compared to open surgery.
What Happens After the Tumor Is Removed
Hospital stays vary widely depending on the approach. Minimally invasive procedures like endoscopic surgery or laser ablation may require only one to two days in the hospital. After an open craniotomy, a stay of up to 10 days is more typical.
Recovery at home follows a similar pattern. Less invasive procedures may take a few weeks of healing. Open brain surgery recovery ranges from six weeks to several months, depending on the size and location of the tumor, how much tissue was removed, and whether any brain functions were temporarily disrupted during surgery. Physical therapy, speech therapy, or occupational therapy may be part of the recovery plan if the surgery affected movement, language, or coordination.
Even after a successful operation, many patients need follow-up treatment. Radiation therapy or chemotherapy is commonly used to target residual tumor cells, especially when complete removal wasn’t possible or when the tumor type is known to recur. Regular MRI scans in the months and years after surgery monitor for regrowth.