Neuro-oncology · London
Craniotomy for glioblastoma, by a specialist neuro-oncology team.
Maximal safe resection with awake mapping, 5-ALA and intraoperative imaging — followed by the Stupp protocol, Optune where eligible, and MRI surveillance. Every case discussed at a dedicated neuro-oncology MDT.
Why patients choose us
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A dedicated neuro-oncology MDT
Every glioblastoma case is discussed at a specialist neuro-oncology MDT — neurosurgery, neuro-oncology, neuroradiology, neuropathology and clinical oncology round the same table.
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A fellowship-trained tumour neurosurgeon
Not a general neurosurgeon covering a list. A named consultant whose practice is brain-tumour surgery — awake mapping, 5-ALA, intraoperative imaging.
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Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pricing
What glioblastoma surgery and treatment costs in London.
Indicative ranges across our partner neuro-oncology units. Send the diagnosis and we quote firm figures across two or three options.
In short
A craniotomy and resection in our network: £28,000–£55,000, with the Stupp protocol at £25,000–£45,000.
| Step | Indicative range | Typical duration | Inpatient stay |
|---|---|---|---|
| Consultant neurosurgery opinion | £300–£500 | 45 min | Same visit |
| MRI brain with contrast (with spectroscopy) | £800–£1,400 | 45–60 min | 24–48 h |
| Stereotactic brain biopsy | £8,000–£14,000 | Half-day | 1–2 nights |
| Craniotomy and resection of GBM | £28,000–£55,000 | 4–6 hours | 5–7 nights |
| Awake craniotomy with cortical mapping | £35,000–£65,000 | 5–7 hours | 5–7 nights |
| Stupp chemoradiation package (6 weeks) | £25,000–£45,000 | 6 weeks | Outpatient |
Prices vary by hospital, by which neurosurgeon and clinical oncologist take the case, by whether awake mapping and intraoperative MRI are used, and by inpatient stay. We come back with a firm quote within one working day.
The problem
The right team, the right resection, the right adjuvant plan.
Glioblastoma is unforgiving of a generalist pathway. The margin between a maximal safe resection and a life-limiting deficit is millimetres, and the adjuvant plan starts the day surgery ends.
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Not sure it is a GBM?
Ring-enhancing lesions have a differential. MR spectroscopy, perfusion and biopsy narrow it — before any resection is committed to.
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Tumour near eloquent brain?
Awake craniotomy with cortical and subcortical mapping is the safest way to remove tumour and keep language, movement and vision intact.
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Life after surgery?
The Stupp protocol, Optune eligibility, rehabilitation and clinical trials are planned in parallel with theatre, not afterwards.
The journey
From diagnosis to chemoradiation and follow-up — what happens, in order.
One coordinated pathway from the first MRI to Stupp completion and long-term surveillance.
Phase 1 · Diagnosis and planning
MRI, MDT, work-up
Phase 2 · Surgery
Craniotomy and neuro HDU
Phase 3 · Adjuvant and follow-up
Stupp, Optune, surveillance
- 01
Diagnosis
The MRI and the diagnosis
MRI with contrast, and where useful MR spectroscopy and MR perfusion, to characterise the lesion. Biopsy or surgery provides tissue for molecular profiling.
- 02
Diagnosis
Neuro-oncology MDT review
The scans, the clinical picture and any tissue are reviewed at the MDT. A plan comes back: biopsy only, subtotal or gross-total resection.
- 03
Diagnosis
Pre-operative work-up
Bloods, steroids to settle oedema, anti-epileptics if indicated, and functional MRI or DTI if the tumour sits near eloquent cortex.
- 04
Surgery
The craniotomy
Neuronavigation-guided craniotomy, 5-ALA fluorescence, intraoperative ultrasound or MRI, and awake mapping if the tumour is near language or motor cortex.
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Surgery
Neuro high-dependency recovery
A night on the neuro HDU, a post-operative MRI within 72 hours to document extent of resection, and early mobilisation.
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Adjuvant
Molecular results and Stupp
IDH, MGMT methylation, EGFR and TERT results guide the plan. The Stupp protocol — chemoradiation with temozolomide, then six adjuvant TMZ cycles — usually starts four to six weeks after surgery.
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Adjuvant
Surveillance and Optune
Three-monthly MRI surveillance, Tumour Treating Fields (Optune) if eligible, and early access to clinical trials for progression.
Typical timeline: 1–2 weeks from diagnosis to surgery. Stupp protocol runs ~6 months. Surveillance continues thereafter.
When it helps
When craniotomy for glioblastoma is the right step.
The presentations that lead to a craniotomy, plus the red flag that means an emergency rather than an appointment.
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Enhancing lesion on MRI
A ring-enhancing mass with central necrosis and surrounding oedema — the classic MRI appearance of a glioblastoma.
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New-onset focal seizures
A first seizure in adulthood, especially focal, warrants urgent brain imaging to exclude a tumour.
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Progressive neurological deficit
Weakness, dysphasia, visual field loss or personality change over weeks — not months — needs same-week MRI.
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Raised intracranial pressure
Morning headache, vomiting, papilloedema or reduced consciousness — a neurosurgical emergency, not a clinic booking.
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Recurrence on surveillance MRI
New enhancement at the resection margin, usually six to twelve months after initial surgery — the moment the plan is redrawn.
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Tumour in eloquent cortex
A lesion near language, motor or visual cortex — the case for awake craniotomy with cortical mapping rather than blind resection.
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Molecular profiling needed
IDH status, MGMT methylation, EGFR and TERT drive prognosis and treatment — a biopsy or resection is the only way to know.
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Red flag: rapid deterioration
Sudden drop in consciousness, new severe headache with vomiting or a first-ever seizure is an emergency — 999 or A&E, not a clinic.
Treatment options
Not every glioblastoma is treated the same way.
The surgical and adjuvant options an MDT considers — and which fits which tumour and which patient.
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Stereotactic biopsy only
When resection is unsafe — deep-seated, multifocal or eloquent-cortex tumours — a needle biopsy gives tissue for molecular profiling.
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Subtotal (partial) resection
Debulking to relieve mass effect and provide tissue, when gross-total resection would cost function that matters.
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Gross-total resection
Removal of all contrast-enhancing tumour on post-operative MRI — the extent of resection that correlates most strongly with survival.
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Supra-maximal resection
Resection beyond the enhancing margin into FLAIR-abnormal tissue, when it can be done safely — selected cases only.
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Awake craniotomy with mapping
You are woken during surgery so the team can map language and motor cortex with direct stimulation — the safest way to resect eloquent-area tumours.
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5-ALA fluorescence-guided resection
An oral dye taken before surgery makes tumour cells glow pink under blue light, improving the extent of resection.
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Adjuvant Stupp protocol
Concurrent chemoradiation with temozolomide, then six cycles of adjuvant TMZ — the international standard of care after surgery.
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Tumour Treating Fields (Optune)
A wearable device delivering alternating electric fields to the scalp — added to adjuvant TMZ in eligible patients, shown to extend survival.
Our vetted London network
A small panel of neuro-oncology teams, we picked them.
Fellowship-trained tumour neurosurgeons and neuro-oncologists across central London. Not listed publicly — introductions are made privately, once we understand the case.
Selection criteria
How we choose every neuro-oncology team in our network.
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Consultant neurosurgeons with a dedicated brain-tumour practice, not general neurosurgery
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Access to intraoperative MRI, 5-ALA fluorescence and awake craniotomy
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A specialist neuro-oncology MDT that meets weekly, with neuropathology on the call
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A named clinical oncologist who delivers the Stupp protocol and manages Optune
Risks and what to watch for
What to expect afterwards — honestly.
Glioblastoma treatment is intensive and the disease is unforgiving. The team’s job is to name the risks up front and manage them actively.
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Recurrence is expected, not a failure
Glioblastoma recurs in almost every case, most often at six to twelve months. The plan is written with recurrence in mind from day one.
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Pseudo-progression on MRI
New enhancement three months after radiotherapy can look like tumour but be treatment-related. MR perfusion and repeat imaging tell them apart.
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Radionecrosis
Delayed radiation injury months to years after treatment — mimics recurrence on MRI. Managed with steroids, bevacizumab or, rarely, surgery.
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Cognitive change and fatigue
Concentration, memory and fatigue are affected by both the tumour and the treatment. Neuropsychology input is part of the pathway.
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Seizures
Around a third of patients have seizures at some point. Anti-epileptics are started when clinically needed, not by default.
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VTE risk
Glioblastoma raises the risk of deep-vein thrombosis and pulmonary embolism. Mechanical prophylaxis is routine; anticoagulation is added when the risk profile warrants it.
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Corticosteroid side effects
Dexamethasone controls oedema but costs sleep, mood, blood sugar and, over time, muscle. The dose is tapered as soon as it safely can be.
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MGMT-unmethylated tumours
Around 60% of GBMs are MGMT-unmethylated and respond poorly to temozolomide. The MDT considers alternative regimens and trial enrolment.
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Refractory oedema and hydrocephalus
Rising steroid requirements or new hydrocephalus need re-imaging and, sometimes, a shunt or repeat surgery. Not routine, but planned for.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever approach was used, the note the neurosurgeon sends you keeps to the same shape.
A quiet reminder
Surgical and molecular language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note and molecular report before your MDT review, just ask.
- 01 Header
Tumour location and preoperative plan
Where the tumour sat, which lobes and tracts were involved, and whether awake mapping was planned.
- 02 Technique
Adjuncts used in theatre
5-ALA, neuronavigation, intraoperative ultrasound or MRI, cortical mapping — the tools that shaped the resection.
- 03 Findings
Extent of resection and molecular status
Gross-total, subtotal or biopsy only, with the post-operative MRI reference. IDH, MGMT, EGFR and TERT status when available.
- 04 Impression
Recovery, chemoradiation and follow-up
Read this first: the plan for the Stupp protocol, Optune eligibility, surveillance MRI schedule and MDT review date.
Recognised by major UK insurers
Glioblastoma surgery and the Stupp protocol are usually covered by major UK insurers for eligible policies. Optune is more variable — we confirm cover before booking.
Frequently asked
Everything we get asked about craniotomy for glioblastoma.
Quick answers on awake craniotomy, 5-ALA, the Stupp protocol, MGMT status and Optune.
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What is a glioblastoma?
Glioblastoma (GBM) is a WHO grade 4 astrocytoma — the most aggressive primary brain tumour in adults. It grows quickly, spreads within the brain along white-matter tracts, and almost always recurs after first treatment.
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Why is surgery done for glioblastoma?
Surgery has two goals: to remove as much tumour as safely possible (extent of resection correlates with survival) and to provide tissue for molecular profiling — IDH status, MGMT methylation, EGFR and TERT — which drive the rest of the treatment plan.
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What is an awake craniotomy and why might I need one?
If the tumour lies near cortex controlling language, movement or vision, the surgeon may wake you during the operation to map function with direct electrical stimulation. It is the safest way to remove tumour close to eloquent brain while preserving function.
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What is 5-ALA and why is it used?
5-aminolevulinic acid is a dye you swallow a few hours before surgery. Tumour cells metabolise it and glow pink under blue light in theatre, helping the surgeon see the edge of the tumour and improving the extent of resection.
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What is the Stupp protocol?
The international standard of care after glioblastoma surgery. Six weeks of radiotherapy given alongside daily oral temozolomide, followed by a short break, then six cycles of adjuvant temozolomide. It usually starts four to six weeks after surgery.
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What does MGMT methylation mean for me?
MGMT is a DNA repair gene. When its promoter is methylated (roughly 40% of GBMs), the tumour responds better to temozolomide and survival is longer. An unmethylated MGMT tumour still receives TMZ in most protocols, but the benefit is smaller and trials should be discussed.
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What is Tumour Treating Fields (Optune)?
A wearable device that delivers low-intensity alternating electric fields through arrays placed on a shaved scalp. Added to adjuvant temozolomide in eligible patients, it has been shown to extend both progression-free and overall survival.
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What is the prognosis for glioblastoma?
Median survival with best modern care is around 14 to 16 months, longer in patients who are younger, have a good performance status, achieve a gross-total resection and have MGMT-methylated tumours. Five-year survival remains under 10%. Trials continue to move the number.
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What happens if the tumour recurs?
Recurrence is expected, usually at six to twelve months. Options include repeat surgery, re-irradiation, bevacizumab, second-line chemotherapy, Optune if not already used, and clinical trial enrolment. The MDT rewrites the plan.
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What is pseudo-progression and why does it matter?
A treatment effect that looks like tumour growth on the three-month post-radiotherapy MRI, in perhaps a quarter of patients. It usually settles on subsequent imaging. Perfusion MRI and short-interval repeat scans help distinguish it from true progression.
Related treatments
Looking for something else?
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Craniotomy
The procedure itself — approaches, adjuncts and recovery.
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Craniotomy for glioma
Lower-grade glioma resection and adjuvant strategy.
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Craniotomy for meningioma
Surgical planning for meningioma of the skull base and convexity.
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All tests & procedures
Every test and procedure we arrange.
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Migraine
Related condition guide.
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Multiple Sclerosis
Related condition guide.
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Eeg
Related diagnostic test.
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Nerve Conduction Studies
Related diagnostic test.
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In practice, in London
The honest picture around craniotomy for glioblastomas in London
For craniotomy for glioblastomas, the private London route is mostly about consultant fit and hospital choice rather than raw waiting time. Public provision for craniotomy for glioblastomas is competent but constrained by capacity. Private London clinics tend to have shorter diaries and longer appointment slots, so you get the same specialists with more time. For people who’ve been going round in circles with primary care, that first proper conversation is often what shifts things.
A private craniotomy for glioblastomas pathway in London usually looks like this: an initial consultation, any diagnostics booked at a nearby facility (most within Zone 1 or 2), and a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists, which keeps the standards consistent across both settings. For craniotomy for glioblastomas in particular, we bias towards consultants who do this every week rather than every month.
The value of going through a concierge for craniotomy for glioblastomas isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.