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planning."}},{"purpose":"assessment","requirement":"routine","after":{"min":60,"max":120,"unit":"days","qualifier":"Typical first surveillance MRI and neurological review, often after chemoradiation; schedule varies by tumor grade."}}],"indications":["Resectable glioma (any grade) needing tissue diagnosis and molecular profiling","Maximal safe cytoreduction to improve symptoms and enable adjuvant therapy","Relief of mass effect, raised intracranial pressure or tumor-related seizures"],"main_risks":["New or worsened neurological deficit (weakness, speech, vision, cognition)","Bleeding or hematoma","Infection (wound, meningitis)","Seizures","Cerebral edema","Cerebrospinal fluid leak or hydrocephalus","Venous thromboembolism","Anesthesia-related complications"],"pain":"Moderate scalp and headache pain for the first days, usually controlled with standard analgesia; the brain itself has no pain receptors.","preparation":["Multidisciplinary tumor board review","Preoperative MRI, often with functional or tractography mapping","Neurological and anesthesia assessment with blood tests","Fasting before general anesthesia","Review of regular medications with the surgical team","Discussion of risks and informed consent"],"recovery_timeline":[{"phase":"Hospital stay","description":"Neuro-monitoring, early MRI, mobilization and steroid or antiseizure management as needed.","restrictions":["Assisted mobilization only until neurologically stable","Neurological observation"]},{"phase":"Early home recovery (weeks 1-6)","description":"Wound healing, fatigue and gradual increase in activity; adjuvant therapy planning.","restrictions":["No driving until physician clears, especially with seizure history","Avoid heavy lifting and straining"]},{"phase":"Later recovery (months)","description":"Gradual recovery of function, rehabilitation as required, and ongoing oncological surveillance.","restrictions":["Individualized by neurological status and adjuvant treatment"]}],"rehabilitation_days":{"min":14,"max":90,"unit":"days","qualifier":"Ordinary functional recovery; longer with speech, motor or cognitive deficits needing physiotherapy or therapy."},"result_longevity":"Resection is one-time, but glioma may recur. Low-grade tumors often stay controlled for years; high-grade tumors usually recur within months to a few years despite adjuvant therapy.","revision_rate_pct":{"min":2,"max":6,"unit":"percent","qualifier":"Unplanned early reoperation for hematoma, infection, CSF leak or wound problems within 30 days."},"scars":"A scalp incision within the hairline in most cases; a linear or curved scar that is usually well hidden by hair, with a small area of hair removed or shaved.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single craniotomy operation; staged or repeat surgery is exceptional or for recurrence."},"stages":[{"code":"craniotomy_resection","label":"Craniotomy and glioma resection","after":{"min":0,"max":0,"unit":"days","qualifier":"Performed on the day of surgery."}}],"qualifier":"Adjuvant radiotherapy or chemotherapy is separate from the resection."},"success":{"metric":"Gross total resection achieved on postoperative MRI","value":60,"unit":"percent of patients","horizon":"Within 72 hours after surgery","population":"Adults with resectable supratentorial glioma, standard neuronavigated craniotomy","evidence_status":"limited"},"techniques":[{"name":"Craniotomy with microsurgical resection and neuronavigation","suits_whom":"Most accessible gliomas; maximal safe resection with image guidance.","recovery":"Hospital stay of several days, then gradual recovery over weeks."},{"name":"Awake craniotomy with cortical mapping","suits_whom":"Tumors near speech or motor areas in selected cooperative patients.","recovery":"Similar to standard craniotomy; aims to preserve function."},{"name":"Fluorescence-guided resection (5-ALA)","suits_whom":"Suspected high-grade glioma.","recovery":"Similar to standard craniotomy; temporary light sensitivity precautions."}],"treatment_conditions":["inpatient"],"treatment_duration_hours":{"min":3,"max":6,"unit":"hours","qualifier":"Typical operative time for an uncomplicated primary craniotomy; varies with location and monitoring or mapping."},"initial_assessment_documents":["Brain MRI with and without contrast (DICOM)","MRI report","Biopsy or pathology report (if available)","Neurosurgery discharge summaries (if available)","List of blood thinners"],"travel_trips":{"min":1,"max":1,"one_trip_possible":true,"qualifier":"Single craniotomy; 7-14 day stay including hospital and early MRI. Wound check and adjuvant therapy possible at home."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check whether follow-up care is scheduled at the same facility","scope":"treatment_abroad","source":{"url":"https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html","host":"cdc.gov","quote":"Medical tourists should also know whether follow-up care is scheduled to occur at the same facility as the procedure.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403}},{"id":"C2","text":"Check whether brain mapping is performed before and during surgery to identify functional brain areas","scope":"procedure","source":{"url":"https://departments.med.upenn.edu/academic-departments/department-of-neurosurgery/divisions/neuro-oncology-division/treatment-options","host":"departments.med.upenn.edu","quote":"The brain is mapped both before and during the surgery.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C3","text":"Check whether intraoperative neuromonitoring is available to help protect nearby brain function","scope":"procedure","source":{"url":"https://braintumorcenter.ucsf.edu/treatment/surgery/surgical-techniques","host":"braintumorcenter.ucsf.edu","quote":"During an operation, a neurophysiologist monitors electrical signals in the patient’s brain, cranial nerves, and spinal cord to make the tumor removal as safe as possible.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C4","text":"Check the surgeon’s specialist training and experience with complex brain surgery","scope":"treatment_type","source":{"url":"https://my.clevelandclinic.org/florida/departments/neurological/depts/neurosurgery","host":"my.clevelandclinic.org","quote":"Our neurosurgeons have fellowship training and years of experience in brain, spine and skull base surgeries.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C5","text":"Ask for certification information and the name of the body that certified the surgical setting","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Ask for certification information and the name of the certifying body when assessing a surgical setting.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"red_flags":{"status":"ok","items":[{"id":"F1","text":"The surgeon who will perform the procedure is unavailable for a prebooking discussion","scope":"treatment_abroad","source":{"url":"https://travelhealthpro.org.uk/factsheets/travelling-for-treatment-medical-tourism","host":"travelhealthpro.org.uk","quote":"The health professional carrying procedures abroad should be available to talk to the traveller (via telephone or video call).","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"F2","text":"The offer provides no clear explanation of risks or possible post-procedure problems","scope":"treatment_abroad","source":{"url":"https://travelhealthpro.org.uk/factsheets/travelling-for-treatment-medical-tourism","host":"travelhealthpro.org.uk","quote":"This consultation should provide a clear explanation of the planned treatment, including success/complication rates, potential risks and possible post-procedure problems.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"F3","text":"The clinic will not provide a written treatment contract before booking","scope":"treatment_abroad","source":{"url":"https://travelhealthpro.org.uk/factsheets/travelling-for-treatment-medical-tourism","host":"travelhealthpro.org.uk","quote":"A written contract from the clinic or hospital should be provided.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Blurry or double vision or vision loss","urgency":"contact_clinic","general":false,"source":{"url":"https://www.mayoclinic.org/tests-procedures/about/pac-20584295","host":"mayoclinic.org","quote":"Blurry or double vision or vision loss.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403}},{"id":"W2","text":"Weakness or paralysis in face, legs, or arms","urgency":"emergency","general":false,"source":{"url":"https://www.mayoclinic.org/tests-procedures/about/pac-20584295","host":"mayoclinic.org","quote":"Weakness or paralysis in the face, legs or arms.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403}},{"id":"W3","text":"Leaking cerebrospinal 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the first treatment","name":"Radiation therapy","source":{"url":"https://www.mayoclinic.org/diseases-conditions/glioma/diagnosis-treatment/drc-20350255","host":"mayoclinic.org","quote":"Other treatments, such as radiation therapy and chemotherapy, might be recommended as the first treatment.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403},"operation_id":null},{"id":"A2","text":"Chemotherapy may be recommended as the first treatment","name":"Chemotherapy","source":{"url":"https://www.mayoclinic.org/diseases-conditions/glioma/diagnosis-treatment/drc-20350255","host":"mayoclinic.org","quote":"Other treatments, such as radiation therapy and chemotherapy, might be recommended as the first treatment.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403},"operation_id":37}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"technique_details":{"status":"ok","items":[{"id":"craniotomy","name":"Craniotomy with microsurgical resection and neuronavigation","how_it_works":{"text":"The skull is opened so the surgeon can reach the brain tumor","source":{"url":"https://www.mayoclinic.org/diseases-conditions/benign-brain-tumor/diagnosis-treatment/drc-20605258","host":"mayoclinic.org","quote":"A craniotomy is surgery that removes a section of skull bone so the surgeon can reach the brain tumor.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403}},"recovery_daily":{"status":"missing","reason":"no_official_source"}},{"id":"awake-craniotomy","name":"Awake craniotomy with cortical mapping","how_it_works":{"text":"The patient stays awake while medicines prevent pain during craniotomy","source":{"url":"https://www.mayoclinic.org/tests-procedures/about/pac-20584295","host":"mayoclinic.org","quote":"In this type of craniotomy, you remain awake but take medicines so that you don't feel any pain.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":403}},"recovery_daily":{"status":"missing","reason":"no_official_source"}},{"id":"fluorescence-guided-resection","name":"Fluorescence-guided resection (5-ALA)","how_it_works":{"text":"Malignant tissue glows under blue light while healthy tissue stays dark","source":{"url":"https://chicago.medicine.uic.edu/neurosurgery/news-stories/seeing-whats-invisible-how-5-ala-is-changing-brain-tumor-surgery/","host":"chicago.medicine.uic.edu","quote":"Under blue light, the malignant tissue glows pink while healthy brain tissue remains 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