Definition and Overview

Brain surgery is a major, highly invasive procedure that requires making a hole in the skull and removing a flap of the bone to gain access to the brain to treat a wide range of medical conditions including epilepsy and cancer. The procedure is usually guided by an endoscope, MRI, or a CT scan to give the surgeon a clear image of the brain and ensure the accuracy of the surgery. The surgery has its share of risks, but doctors only perform the procedure in cases when the benefits outweigh the risks.

Most brain surgeries are performed under general anaesthesia, but recent developments have allowed surgeons to perform brain surgeries, especially brain tumour procedures, while the patient is sedated but awake. This is called intraoperative brain mapping, or more simply, awake brain surgery. This is most often used when the area to be operated on is too close to the parts that control language, vision, and body movements, or when the tumour has spread to a large part of the brain and does not have a defined border.

Who Should Undergo and Expected Results

A brain surgery is usually performed for the following reasons:

  • To clip off or repair an aneurysm or a weak part of the blood vessels
  • Remove a tumour
  • Take a sample of a tumour for biopsy purposes
  • Remove arteriovenous malformations
  • Free a pinched nerve
  • Drain blood in case of bleeding/haemorrhage in the brain
  • Remove a blood clot or a hematoma in the brain
  • Drain an infected area or an abscess in the brain
  • Treat a skull fracture
  • Treat the underlying cause of severe face or nerve pain
  • Relieve pressure caused by a stroke or an injury
  • Treat epilepsy
  • Implant an electronic device for the treatment of brain diseases
  • Treat hydrocephalus

How Does the Procedure Work?

Given that brain surgery is a major procedure, several steps are required before a person may undergo the procedure. First, the doctor will examine the patient to determine whether he or she is in good condition to undergo the surgery. This involves x-ray and laboratory tests, so it is important to inform your doctor if you are:

  • Pregnant
  • Taking medications, vitamins, supplements, or herbs
  • Drinking alcohol
  • Taking aspirin or NSAIDs
  • Allergic to certain medications

In the days leading up to the surgery, the patient will not be allowed to take medications that may hinder the prompt clotting of blood. Patients are also asked to use a specific type of shampoo on the night prior to the surgery and to refrain from eating or drinking anything for about ten hours prior to the procedure.

Prior to a brain surgery, the patient’s head is prepared by shaving the hair on a part of the scalp. The area is then cleaned so the surgeon can make a clean surgical cut through the scalp. The location of the cut will differ based on the specific location of the brain problem. Once the cut is made, a flap of the bone will be removed and the surgeon will begin the procedure. The entire length of the procedure will also depend on the problem that is being treated.

Throughout the surgery, the patient’s vital signs will be closely monitored, especially if the procedure is an awake brain surgery.

After surgery, the bone flap will be replaced and will be held in place by small metal plates, wires, and sutures. However, there are instances where this step is skipped, such as when the surgery is done to remove an infection or tumour. It is also not placed back when there is still some swelling in the brain.

A team of health care professionals will closely monitor the patient following a brain surgery to ensure that the brain is functioning. There are many steps taken to check the performance of the brain, such as shining a light in the eyes or asking patients to do certain simple tasks. Patients will also be placed on oxygen support and given medications to relieve pain and physical therapy or rehabilitation, if it is necessary. Most patients stay in the hospital for up to a week after the procedure.

Possible Risks and Complications

The risks of brain surgery are greater compared to other types of surgeries. The possible risks and complications include:

  • Problems with speech, memory, balance, vision, and coordination (temporary or permanent)
  • Muscle weakness
  • Blood clot
  • Bleeding in the brain
  • Seizures
  • Stroke
  • Coma
  • Infection in the brain
  • Infected wound/incision
  • Infection in the skull
  • Brain swelling

There are also some risks associated with the use of anesthesia. These include:

  • An allergic reaction to the anesthetic
  • Difficulty breathing

Although these risks are possible, there is a low occurrence rate, especially when the necessary steps before and after the surgery are carefully followed.

References:

  • Gasco J, Mohanty A, Hanbali F, Patterson JT. Neurosurgey. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 68.
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