Most of the information in this section pertains to intrinsic brain tumours such as Gliomas or metastases. For tumours such as meningiomas, acoustic neuromas and pituitary adenomas even though general principles of intracranial surgery apply, there will be specific issues pertaining to these tumours that will be detailed in the relevant sections. The first treatment for most brain tumours is either surgery to remove the tumour or a biopsy to obtain a small sample of tumour. The tumour tissue that is removed is used to determine the exact type of tumour. Find out more about surgery for suspected brain tumours here.

There are several types of equipment available to the neurosurgeon. Specialised equipment is used to accurately localise the tumour within the brain and to track the margins of normal and abnormal tissue. This is similar to a satnav while driving, where the position of your car is shown relative to the street map. This is known as Image guidance (or Neuro navigation) and it increases safety and accuracy of tumour resection. Ultrasonic aspirators can be used to break up and suck out the tumour. High-powered microscopes may be used to better see the tumour tissue and surrounding nerves and blood vessels. Because the tentacle-like cells of an astrocytoma grow into the surrounding tissue, complete resection of these tumours is difficult to achieve without also removing normal brain tissue. Therefore a compromise has to be made between removing tumour tissue and preserving normal tissue. At surgery visibly abnormal looking tissue is removed. If the image guidance equipment shows that what looks visibly like normal brain could also represent abnormal tumour, then that area is also removed if it is felt by the surgeon that it will not lead to any compromise in neurological function. If the abnormal looking area on image guidance is an area that is vital for important bodily functions, then it is left intact, and treated non surgically depending on the type of tumour. Partial removal can help decrease symptoms and confirm the type of tumour.