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Pre-Op: Preparation Before 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 you 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 hang it all out...and 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 of the large acoustic
neuroma. There is a serious risk for loss of facial function on one side
of the face, and a risk for 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 for 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 walnuts in a shell, smaller than their supportive
coverings.)
The bottom line is: ask for all of what you really want to know.
If you are the type that doesn't want to know, don't be afraid to say so!
PRE-OP NECCESSITIES
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 might 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 and God are your surgeon's
best allies. The two of you are really in this together.
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