Tumor Debulking

Tumor debulking is a surgical technique that involves partial removal of a tumor mass to reduce intracranial pressure, relieve symptoms, or facilitate further treatment (e.g., radiotherapy, chemotherapy). It is typically employed when complete resection is unsafe or impossible due to tumor infiltration of critical neurovascular structures.

• Reduce tumor volume
• Improve neurological function
• Facilitate adjuvant therapies
• Minimize mass effect and edema
• Allow better access for future staged resections

• Exposure of tumor via appropriate surgical approach (e.g., pterional_craniotomy, midline_suboccipital).
• Capsulotomy: opening the tumor capsule with sharp or bipolar dissection.
• Internal decompression:
  • Debulking begins at the tumor center.
  • Use of ultrasonic aspirator (e.g., CUSA), suction, and microdissectors.
• Subcapsular or subpial dissection at the margins if safe.
• Preservation of adjacent eloquent cortex, cranial nerves, and vessels.

• High-grade gliomas (e.g., glioblastoma multiforme)
• Large meningiomas with dural sinus involvement
• Vestibular schwannomas encasing the facial nerve
• Craniopharyngiomas with hypothalamic adherence
• Any tumor in eloquent areas where gross-total resection is unsafe

• Debulking must be strategic, avoiding uncontrolled collapse of residual capsule (risk of vascular injury)
• Beware of infiltrative margins (e.g., gliomas)
• Hemostasis should be meticulous, especially in vascular tumors (e.g., hemangioblastomas)
• Consider preoperative embolization in hypervascular tumors

• Symptom relief without high morbidity
• Shortens postoperative recovery
• Preserves neurological function
• Enables multimodal treatment planning

• Residual tumor may regrow
• Requires accurate intraoperative judgment
• May lead to overestimation of resection on imaging if cavity collapses

• Yasargil MG. Microneurosurgery. Volumes I–IV. Thieme.
• Berger MS. Surgical management of gliomas in eloquent cortex. Clin Neurosurg, 2001.
• Duffau H. Surgery of low-grade gliomas: towards a ‘functional neurooncology’. Curr Opin Oncol. 2009.