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Preparation for Brain Surgery

INFORMED CONSENT

You have already decided on your neurosurgeon and his (or her) team. Now is the time to feel quite comfortable with your decision. You have established a relationship with your surgeon, and know a little about his (or her) personality. Now is also the time to ask all of the questions that you might have. Write them all down if you have to, so you don’t forget anything.

If there is anything that you don’t want to know, don’t be afraid to tell your doctor! With the growing adversarial climate of malpractice litigation, most surgeons bend over backwards to inform patients of all the potential disasters that might occur during and after surgery. This can cause patients to be frightened for days, making it impossible for them to function normally. Just be sure to learn all that you really want to, and nothing more. If, on the other hand, you are the type that reads all of the package inserts and the Physicians Desk Reference every time you take medication, be sure that your surgeon does not pull any punches. Insist that the surgeon bring it all out…in living color!

SERIOUS RISKS

In general, the statistics are quite good, depending upon the type of surgery that you are undergoing. (You can ask your surgeon to rate the degree of difficulty of this particular dive.) Overall, there is a 2% risk of serious morbidity (real postoperative problems) and mortality with most neurosurgical operations. Some operations have higher risks, because they are known to be exceedingly difficult and dangerous, and occasionally, because they seem too simple.

An example of a difficult operation is that for the large acoustic neuroma. There is a serious risk of loss of facial function on one side of the face, and a risk of swallowing difficulties after the operation. The latter could also lead to postoperative pneumonia.

An example of a simple operation with a fairly high postoperative morbidity is the placement of a “shunt” for something called “normal pressure hydrocephalus.” This patient is at serious risk of developing subdural hematomas or CSF accumulations, requiring further surgery(ies) and even possible removal of the shunt. (All of this can occur because a brain like this has become like a walnut in a shell: smaller than their supportive coverings.)

The bottom line is: ask for all of what you really want to know. But if you are the type who doesn’t want to know, don’t be afraid to say so!

PRE-OP NECESSITIES

The usual preoperative things that need to be done include bloodwork, heart function evaluation (e.g. EKG), medical clearance by your internist, a chest X-Ray, and possibly a localizing MRI or CT scan to help minimize the surgery. (A kind of “X marks the spot” idea). If you are undergoing stereotactic surgery, you may require an MRI with localization markers (usually felt-tip pen marks) on your scalp, or the placement of a sort of medieval “frame” that is literally screwed onto your skull, using local anesthetics.

Certain problems may require a cerebral angiogram to be performed, so that the surgeon has a “blood vessel” road map prior to surgery. Functional studies (special MRI, EEG, or magnetoencephalography) also may be necessary to guide the surgeon where not to go.

Cerebral blood flow studies (SPECT, Xenon studies or transcranial doppler studies) may be important to show the surgeon the state of your brain’s blood supply reserves. You’ll get an IV catheter the night before surgery; you’ll be given various medications to prevent seizures, temporarily remove brain water (like medically squeezing a sponge), so the surgeon doesn’t need to retract too much during surgery. You’ll also be given antibiotics to prevent infection. If you have an allergy to an antibiotic, make sure everyone knows it.

The night before surgery is usually full of anticipation. More often than not, you’ll be the one comforting your family and friends. If you’re afraid, thats only normal. Sometimes sleep is difficult, so don’t hesitate to ask for sleeping medication if you want it.

Now is usually a good time to plan for how you will approach the postoperative recovery period. Many patients tell me that it is very much like gearing up for a sporting event, important business meeting, or even making a New Year’s resolution. You can leave the surgery to the doctors, but you are in charge of your recovery. Think about just how well you are going to be after surgery. A positive attitude is your surgeon’s best ally. The two of you are really in this together.

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