What is the success rate of craniotomies (surgical removal of part of the skull) with tumor resection in adults and children with benign or malignant brain tumors?

Success Rates for Craniotomy with Tumor Resection

Craniotomy with tumor resection achieves successful same-day or early discharge in approximately 90.6% of carefully selected patients, with gross total resection (GTR) rates of 70-72% for intra-axial tumors and higher rates (83-100%) for certain meningiomas, though success varies significantly by tumor type, location, and patient age. 1, 2, 3

Overall Surgical Success Metrics

Resection Completeness

• Gross total resection is achieved in 70-72% of intra-axial brain tumors across modern surgical series, representing the primary measure of technical success 2, 4
• For meningiomas specifically, Simpson grade I resection (complete removal including dural attachment) is achievable in 83-100% of cases in experienced centers 3
• Complete resection rates for pediatric meningiomas range from 55-79%, with one series reporting 86% achieving complete remission 5

Mortality Rates

• Operative mortality for adult craniotomy with tumor resection is 1.7% in contemporary series 2
• Pediatric 30-day mortality ranges from 1.16-1.72% for children aged 1-21 years undergoing diagnostic neurosurgical procedures for brain tumors 6
• Infants under 1 year have substantially higher mortality of 5.66-7.23% within 30 days, largely due to more aggressive tumor biology 6

Morbidity and Functional Outcomes

Neurological Complications

• Major neurological morbidity occurs in 8.5% of patients, with overall morbidity of 32% when all complications are considered 2
• Major complication incidence is 13% in modern surgical series 2
• Tumor location in eloquent brain regions (Grade III) significantly increases neurological deficit risk compared to non-eloquent areas (Grade I), though GTR can still be performed safely 2

Functional Status Changes

• 32% of patients improve functionally, 58% remain stable, and only 9% deteriorate based on Karnofsky Performance Scale scores at 4 weeks post-surgery 2
• Approximately 80-100% of patients preserve neurological functions in long-term follow-up series for certain tumor types 5

Success Rates by Tumor Type

Meningiomas

• 5-year local tumor control rates of 99% and 10-year rates of 93% for cavernous sinus meningiomas treated with stereotactic radiosurgery 5
• 5-year progression-free survival of 94% and 10-year rates of 86% for surgically treated meningiomas 5
• Up to 20% of completely resected benign meningiomas recur within 25 years, necessitating lifelong surveillance 5, 3

Chordomas

• Gross total removal achieved in 72% of skull base chordomas, resulting in 50% local control rates 5
• Margin-free en bloc resection provides continuous disease-free survival with 12 of 18 patients (67%) remaining disease-free at 8 years average follow-up 5
• Local recurrence rate of only 17% after wide surgical margins compared to 81% after incomplete resection 5

Ependymomas

• 7-year local control of 83.7%, event-free survival of 69%, and overall survival of 81% for pediatric intracranial ependymomas after GTR and radiotherapy 5
• Overall survival around 70% at 5 years with GTR, but much lower with incomplete resection 5

Metastatic Brain Tumors

• Gross total resection improves overall survival and prolongs time to recurrence in RPA class I patients compared to subtotal resection 5
• Surgery plus whole-brain radiotherapy is superior to radiotherapy alone for single brain metastases based on Class I evidence 5

Factors Affecting Success Rates

Patient-Related Factors

• Age >60 years with preoperative Karnofsky Performance Scale ≤50 increases both regional and systemic complications 2
• Posterior fossa tumor location increases complication rates 2
• Younger age, female sex, and better preoperative functional status predict improved outcomes 5

Surgical Factors

• High-volume centers (>27 craniotomies/year) reduce patient safety indicator events by 55% and mortality by 73% compared to low-volume centers 7
• Mini-craniotomy approaches achieve equivalent GTR rates (70.9% vs 70.5%) compared to conventional craniotomy but with shorter operative time (165 vs 205 minutes) and lower complication rates 4
• En bloc resection decreases leptomeningeal disease risk compared to piecemeal resection for metastases 5

Tumor-Related Factors

• Small to medium-sized tumors, WHO grade I histology, and upfront surgery without prior resection predict improved local control 5
• Tumor functional grade (proximity to eloquent cortex) is the most important variable affecting neurological deficit incidence 2

Hospital Course and Recovery

• Median postoperative hospital stay is 5 days for standard craniotomy 2
• Successful same-day discharge occurs in 90.6% of carefully selected patients in specialized programs 1
• Readmission within 24 hours occurs in only 1.4% of same-day discharge patients, primarily for headache, seizure, or neurological deficit 1

Critical Pitfalls to Avoid

• Incomplete dural resection for meningiomas increases recurrence risk; the dural attachment must be completely excised when feasible 3
• Prior microsurgery significantly reduces improvement rates of pre-existing cranial neuropathies compared to upfront radiosurgery alone 5
• Infants require special consideration given their 3-4 times higher mortality risk and tendency to harbor more aggressive lesions 6
• Extent of resection matters more than repeat surgery status; neither repeat surgery for recurrent disease nor surgical approach (mini vs conventional craniotomy) significantly affects neurological outcomes when GTR is achieved 2, 4