This particular tumour was a low grade glioma that was deep within the brain. Nevertheless, it was removed through a burr hole type incision and the postoperative scan showed no residual disease.

At the CMIN most craniotomies are performed by shaving very little hair, through very small openings and with minimal tissue trauma.

Brain tumours can be primary, like this one, or secondary. They can grow from the brain itself, like this one, or other structures within the cranium or skull. Sometimes their borders are obvious, but unfortunately, often they are not readily distinguishable from the normal brain.

Unfortunately, there are some tumours that cannot be removed through a limited opening. Indeed, at the CMIN, although a minimally invasive approach is encouraged, surgery needs to be maximally effective. This particular tumour is a meningioma, which grows from the lining of the brain. For best results, the lining from which they arise needs to be removed along with the tumour, hence the need to expose the entire origin of the tumour.

This surgery obviously requires a large incision and an equally large skull opening.

This post-op scan shows the meningioma completely removed. This particular patient had temporary weakness of both legs but within 3 months had made a complete recovery.

This is the pre-op scan of a 64 year old man who had a malignant glioma partially removed. He was not able to tolerate the postoperative radiotherapy because of raised pressure within his head and was therefore given palliative treatment only. He then approached The Centre asking for a second opinion and was offered radical resection.

After a minimally invasive craniotomy and radical resection he tolerated radiotherapy and is now alive and free of recurrence 18 months after treatment. There were no operative complications.

This is the post-op scan 14 months after his surgery at the Centre.

This patient presented with visual deterioration from pressure of the tumour on the overlying visual pathways (optic chiasm).

This is the MRI of the same patient after removal of the tumour. The patient was discharged from hospital the day after surgery with no complications and no post-operative pain or discomfort.

This is the scan of a 30 year old surgeon who presented with unilateral hearing loss.

This is the same patient's scan after total resection of the tumour. He was discharged from hospital 3 days after surgery and had NO facial nerve weakness. He returned to full-time work 2 weeks later.

Small third vent tumour pre-op. This scan shows a small third ventricular tumour. Although the appearance is similar to a colloid cyst, pathology proved it was a ganglioglioma .

Small third vent tumour post-op. This scan shows the tumour has been totally removed. It was done through an endoscopic approach and the patient was discharged from hospital 1 day after surgery in a perfect neurological state

Large third vent tumour pre-op. This scan shows a tumour in the third ventricle of considerable size. It was called "inoperable" by previous surgeons.

Large third vent tumour post-op. This scan shows the tumour was completely removed. Analysis of the tumour demonstrated a low grade astrocytoma. Although the tumour could not be removed through endoscopic techniques, the principles of minimally invasive surgery were applied and the patient still left the hospital 1 day after surgery in excellent condition and without complications.

Fig 1.      Pre-op MRI that was mistaken as a diffuse brainstem glioma. This patient decided to get a second opinion and agreed to our suggestion of surgery

Fig 2.      Post-op MRI showing a complete resection. The patient has done very well with no recurrence after several years.

Fig 3.      Pre-op MRI of a focal brainstem/low grade glioma. She had several operations at another hospital but the tumour was never removed. She eventually came to the Centre for a second opinion and we suggested attempt at total resection

Fig 4.      Post-op MRI showing complete resection. The patient did very well and is now living a normal life free of tumour 9 years later

Fig 5.      Pre-op MRI showing a focal malignant tumour

Fig 6.      Post-op MRI showing complete removal. The patient was better after surgery but died from tumour recurrence 8 months later

Fig 7.      Pre-op MRI showing the typical appearance of a diffuse pontine glioma. The patient was not offered surgery and died 6 months after this scan

Fig 8.      Pre-op MRI showing a focal brainstem glioma. Despite advise from many other doctors, the parents chose to take the advice given at the Centre to have an attempt at resection

Fig 9       Post-op scan showing an excellent resection but the patient suffered many neurological complications and has never regained independent status