Brain surgery

Overview

Brain surgery is a medical procedure used to treat issues in and around your brain and the surrounding areas. Your brain is like the control center of your body, responsible for important functions like speaking, moving, thinking, and remembering. The goal of brain surgery is to fix problems in your brain while keeping these vital functions intact.

There are different reasons why someone might need brain surgery. It could involve removing a part of the brain to stop seizures or getting rid of a brain tumor. Brain surgery can also help relieve pressure on the brain, caused by factors like excess blood or cerebrospinal fluid (called hydrocephalus). Additionally, surgeons can repair abnormal blood vessels, such as aneurysms.

It’s important to be aware that brain surgery does come with certain risks, and after the procedure, you’ll stay in the hospital for a while to allow your healthcare team to closely monitor your recovery.

Types of brain surgery

• Brain biopsy: A brain biopsy involves the extraction of a small sample of brain tissue or fluid for diagnostic purposes. This procedure is typically conducted to ascertain the malignancy of a tumor. It can be performed through a stereotactic needle biopsy or as part of open surgery.
• Craniotomy: Craniotomy constitutes a surgical procedure where a section of the skull is temporarily removed to access the brain. Following the surgical intervention, the removed skull segment is repositioned. Craniotomies are employed to address conditions such as tumors, blood clots, arteriovenous malformations, or epileptic foci.
• Craniectomy: Much like a craniotomy, a craniectomy entails the removal of a portion of the skull to access the brain. However, in this case, the removed skull fragment is not immediately replaced due to concerns about intracranial pressure. A subsequent procedure called cranioplasty is performed to restore the skull.
• Deep brain stimulation (DBS): DBS serves as a therapeutic approach for neurological disorders like Parkinson’s disease and tremors. Surgeons implant electrodes within the brain, and an external device regulates the delivery of controlled electrical impulses to targeted areas.
• Endovascular surgery: In this minimally invasive procedure, a small incision is made in the groin, and a catheter (a slender, flexible tube) is threaded through a blood vessel to reach the brain, obviating the need for cranial incisions. Endovascular surgery is instrumental in tasks such as thrombectomy (removing blood clots) and the repair of aneurysms.
• Neuroendoscopy: Neuroendoscopy is a less invasive form of brain surgery, allowing access through the nasal or oral cavity. An endoscope with a built-in camera is inserted through these openings, enabling surgeons to navigate surgical instruments to treat and excise tumors without the necessity for cranial incisions.
• Laser ablation: When addressing conditions deep within the brain that are challenging to access via traditional craniotomy, laser ablation is employed. A laser probe is introduced through a small cranial opening to precisely ablate tumors or epileptic foci.

Risks

Brain surgery, like any surgical procedure, comes with potential risks. These risks can be categorized into three main categories: common complications, common side effects, and long-term risks.

Common complications of brain surgery:

• Bleeding: There is a risk of bleeding during or after the surgery.
• Infection: Infection is another potential complication that can occur.
• Reactions to Anesthesia: Some individuals may experience reactions to the anesthesia used during the procedure.
• Headaches: Post-surgery, headaches are a common issue that may arise.

Common side effects after brain surgery:

• Aphasia: This is difficulty in speaking or understanding language.
• Brain swelling: Swelling of the brain can occur after surgery.
• Confusion or delirium: Patients might experience confusion or delirium.
• Dizziness: Dizziness is a common side effect.
• Movement or balance problems: Some individuals may face difficulties with movement or balance.

Long-Term Risks After Brain Surgery:

• Behavior changes: Changes in behavior can develop over the long term.
• Brain damage: Brain damage is a potential long-term risk.
• Difficulty walking: Walking difficulties might persist.
• Memory loss: Long-term memory problems can occur.
• Problems with speech: Speech issues can be a lasting concern.
• Weakness in arms or legs: Weakness in the limbs may persist.

It’s important to note that complications of brain surgery can be life-threatening. Fortunately, there are newer, less invasive procedures available that significantly reduce these risks and complications. Always consult with your healthcare provider to discuss the specific risks and benefits of brain surgery for your individual case.

Before the procedure

Brain surgery necessitates thorough preparation. Your healthcare provider will conduct a physical examination and blood tests to ensure your suitability for anesthesia and the surgical procedure.

You may also undergo various imaging tests, including:

• Magnetic Resonance Imaging (MRI)
• Computed Tomography (CT) scans
• Positron Emission Tomography (PET) scans
• Angiography

These imaging tests generate highly detailed images of your brain’s tissues, nerves, and blood vessels, aiding your surgeon in pinpointing the precise areas requiring treatment.

Before the surgery, your surgeon will provide you with guidance on:

• Preparing your health before surgery: If you are a tobacco smoker, it’s essential to quit several weeks before the surgery. Smoking heightens the risk of surgical complications and impedes the healing process.
• Adjusting medications: Depending on your situation, you may need to discontinue or start certain medications before the surgery. Steroids may be prescribed to reduce swelling, antibiotics to lower the risk of infection, and antiepileptic drugs to prevent seizures. If you are taking blood-thinning medication, your surgeon may advise stopping it a few days to a week before the surgery.
• Understanding the surgery process: Your surgeon will explain the procedure, address any questions you may have, and outline potential side effects. The recovery period can vary based on the type of procedure, and you may require neurological rehabilitation.

During the procedure

Brain surgery procedures vary depending on the specific type of surgery required. Here is a concise overview:

• Anesthesia is administered by an anesthesiologist.
• Hair near the surgical site is shaved, and the area is cleaned.
• A skin incision is made.
• Tissue and muscles are cut and moved as necessary.
• Skull bone is drilled to create access, and a section of the skull may be removed.
• The brain is treated, which may involve tumor removal, pressure relief, or blood vessel repair.
• The removed skull portion is replaced and secured with plates and screws, and muscles and tissue are repositioned.
• The skin incision is closed.

For endovascular surgery or neuroendoscopy, no head incision or skull opening is needed. Specialized tools are used to access the brain through the nose, mouth, or blood vessels in the groin.

After the procedure

After brain surgery, the duration of your hospital stay depends on the type of procedure. Less invasive methods, like endovascular surgery, typically require just one to two days of hospitalization. Conversely, an open craniotomy may necessitate an extended stay of up to 10 days, often starting with an overnight stay in intensive care for close vital sign monitoring before moving to a regular hospital room. Throughout your recovery, you may experience fatigue, soreness, or headaches, but your medical team will provide medications to keep you comfortable. They may also recommend continuing any previously prescribed medications to prevent complications. Regular brain imaging tests will be scheduled to monitor your healing progress, and follow-up appointments with your care team will be set up in the days, weeks, and months ahead to ensure your recovery is on track. Rehabilitation, which may involve physical therapists, speech-language pathologists (SLPs), and occupational therapists, could be part of your recovery plan to help you regain functions affected by the surgery, such as strength, mobility, and speech.

Outcome

Recovery time for brain surgery varies depending on the type of procedure. Less invasive surgeries typically require a few weeks for recovery, while open brain surgery can extend from six weeks to several months. Your surgeon will provide a personalized recovery timeline. It’s crucial to consult your healthcare provider for guidance on when it’s safe to resume work and regular activities, as they can offer specific recommendations based on your surgery. Additionally, attending follow-up appointments in the subsequent weeks and months, which may include imaging tests to assess healing progress, is essential for a successful recovery.