The neurosurgical revolution: how modern surgical techniques are transforming brain cancer treatment

The vital role of surgery in brain cancer treatment 

For many people, the idea of brain surgery can be daunting, but Mr Bhangoo is keen to emphasise its importance. “Brain surgery remains the safest, most effective primary intervention for most tumours. Many patients are surprised to learn that”, Mr Bhangoo explains. “The brain is also what’s known as a ‘haven site’—many medications can’t penetrate it effectively, so approaching it with surgery initially, wherever possible, is important.”

The true age of personalised medicine 

Personalised medicine provides more precise, tailored therapies following surgery. 

“After surgery there can be microscopic deposits left in the surrounding brain tissue that we can’t see. This is when systemic therapies come into play, to reduce the chance of recurrence, or time to recurrence”, says Mr Bhangoo. 

“We produce a ‘fingerprint’ of each tumour by analysing its genes, RNA, and proteins. This helps our oncology colleagues understand which systemic treatments, such as chemotherapy or immunotherapy, will work best, what the tumour might be resistant to, how it might behave in the future, and whether the patient could be eligible for a clinical trial.”

Extensive surgical removal is crucial for this level of analysis. “Brain tumours are heterogeneous—which means one part of the tumour can be genetically different from another. A small biopsy might not give us the full picture. By removing the tumour completely, we can send it for a full analysis.” 

The advancements transforming surgery 

Advanced surgical and imaging techniques are enabling greater precision and personalisation, minimising disruption to the brain, improving recovery times and maintaining that essential quality of life. “We now focus on what we call an ‘onco-functional balance’, which means removing as much of the tumour as we can, as safely as possible, while ensuring the patient can still do the things they need to do, and that they love to do,” explains Mr Bhangoo.

• Advanced brain mapping: “Through our extensive research, we’re continually advancing our understanding of the structure, anatomy and physiology of the brain. Using advanced 3D imaging techniques, we can reconstruct the brain’s wiring and better understand certain functions,” says Mr Bhangoo. “This helps us navigate safely, avoiding critical areas during surgery.”
• Awake surgery for function preservation: In some cases, patients can be kept awake during surgery to monitor key abilities—such as speech, cognitive and psychological function, and even artistic and vocational skills. “I’ve operated on patients while they were knitting, writing poetry, even architects identifying straight lines versus curvy ones,” he shares. “By keeping the patient awake, we can monitor their cognitive and motor functions in real time, ensuring they keep those essential skills after surgery.”
• Minimally invasive techniques: “Certain techniques are leaving a smaller and smaller surgical footprint, allowing us to access the tumour with minimal impact on surrounding areas of the brain. I was the first surgeon outside the USA to use BrainPath – a minimally invasive tool that allows us to reach tumours that are deep in the brain through a tiny opening,” Mr Bhangoo explains. “Another method we use here at The Harley Street Clinic is laser interstitial thermal therapy (LITT). Through a small opening in the skull, and guided by an MRI scan, we place a fibre-optic catheter into the tumour. Once in place we apply heat to the tumour, destroying it from within. We then remove the catheter, leaving a single stitch and no visible scar.”
• Florescence-guided surgery: “For high-grade gliomas, we give patients a special medicine before surgery that makes their tumour cells glow under blue light,” he explains. “During the operation, this allows us to differentiate tumour from healthy brain tissue, which enables us to be much more precise.”

The approaches shaping the future  

The next big step in brain cancer treatment could be delivering systemic therapies during surgery.

“There’s hope that in the future we’ll be giving chemotherapy, radiotherapy, and even gene therapy at the time of surgery – right at the tumour site,” says Mr Bhangoo. “This could ensure maximum effectiveness when the tumour bed is exposed. That's never been done before, it's one of the things that we want to start doing.”

Another promising area is personalised cancer vaccines. “By using extensive tumour samples to create bespoke vaccines, we can train the immune system to recognise and attack the cancer,” he says. “This could revolutionise long-term brain cancer management.”

A new era for brain cancer patients 

“The reality is that the last ten to fifteen has seen a sea change. For fifty years, survival rates for brain tumours didn’t change,” Mr Bhangoo notes. “Now, thanks to new treatments and surgical techniques, patients are living longer—and with a much better quality of life.”

With ongoing advancements Mr Bhangoo hopes to see brain cancer survival improve further in the coming years, “Bringing all the surgical and medical knowledge together, with enhanced imaging, precision surgery, personalised medicines, and intraoperative therapies, over the next decade I would like to see brain cancer increasingly being managed as a chronic condition.”

“At HCA UK, we are committed to providing the best medical teams, the best technology, and truly personalised patient care,” concludes Mr Bhangoo. “That’s what makes the real difference.”

Find out more about cancer treatment and care at HCA Healthcare UK