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Brain Surgery:
A guide to the procedure, risks and recovery

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1.What is brain surgery?

Neurosurgery or brain surgery refers to surgical procedures of the brain or structures around it and is done to correct any abnormalities such as tumors or aneurysms. It is a critical procedure and is performed by trained neurosurgeons in a highly specialized environment. Recent advances in brain surgery have allowed a higher number of doctors to prescribe it under some circumstances, and depending on the placement of the structural aberration, the health of the individual and the severity of the issue, the brain surgery types to be performed are suggested by the doctor. Minimally invasive brain surgery procedures through precision instruments have become possible today with more technological development on this front, reducing the number of brain surgery risks associated with the procedure.

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2.Why is brain surgery performed?

Brain surgery may be performed for any of the following reasons:

  • Prevent bleeding inside the brain because of an aneurysm
  • Operate on a tumor to remove it
  • Free a nerve in the brain area that is being pinched
  • Drain an abscess or blood from an injury and remove pressure on the brain

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3.Conditions that require brain surgery

Structural abnormalities of the brain that may require a brain operation include:

  • Congenital brain defects such as blood vessel malformation where connections between veins and arteries are formed in the brain region
  • Internal bleeding in the brain due to an aneurysm where an arterial wall weakens and ruptures
  • Blood clots and bleeding in the brain are corrected through brain operation to prevent further trauma to brain tissue surrounding the problem area
  • Epidural or subdural abnormalities such as hematomas are corrected through suitable brain surgery procedures
  • Edema of the brain is the buildup of fluid around the brain causing swelling and recurring headaches and pressure to the brain
  • Brain tumors are usually removed through critical brain surgery, especially in the case of cancer formations
  • Doctors may suggest brain surgery in certain cases of epilepsy caused by an abnormality in the brain structure, or pressure on a nerve
  • Neuropathic pain may occur when a nerve between the brain and the spine is damaged due to a stroke, tumor or accident, among other causes
  • Infection in surrounding areas or brain tissue may cause the area to be filled with the infected material, and a brain surgery may be suggested to drain the abscess
  • Parkinson's disease may be helped by brain surgery where the nervous signals required to control motor function are too weak or abnormal

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4.Types of brain surgery

Types of brain surgery

Biopsy

In a biopsy, a small amount of tissue is removed to be studied for abnormalities to prevent further symptomatic concerns. A biopsy may be performed during a brain surgery procedure to detect tumors or other abnormalities.

Craniotomy

In this brain surgery type, a cut has to be made to the scalp bone that exposes the brain tissue. That is why it is also called open brain surgery. A hole called the bone flap is created and the issue to be addressed through the brain surgery procedure such as an aneurysm, or fluid draining, is performed. The bone flap is then either removed in cases where postoperative swelling is expected or where tumor growth is possible to prevent further pressure and trauma to the brain. It is called craniectomy since a portion of the cranium is being removed. In most cases, the bone flap is secured back on the skull after the brain operation is complete through screws and plates.

Neuroendoscopy

In some cases, it may be possible for the brain surgery to happen through the use of an endoscope, where small holes may be made to the cranium and the endoscope is fed through them to guide the brain surgery procedure. This is considered minimally invasive as compared to open brain surgery and reduces the trauma on the patient's health while speeding up recovery time. Endoscopic brain surgery is usually used to address tumor formations in the brain and is also known as keyhole surgery since the holes made during this type of brain surgery are very small.

Deep brain stimulation

Deep brain surgery involves the placement of electrodes deep within the brain to stimulate nervous signals ordinarily missing in a patient. This is more usually carried out through minimally invasive brain surgery procedures that allow the neurosurgeon to place the electrode leads within the brain tissue. The pulse generator that will create the electrical impulses to signal the brain is placed in a box device similar to a pacemaker in the chest area. This type of brain surgery typically aids patients of neurodegenerative disorders such as Parkinson's disease, tremors and epilepsy.

Endonasal endoscopic surgery

A thin tube carrying an endoscope is passed through the nasal cavity up to the front regions of the brain, giving this brain surgery type its nomenclature. This brain operation addresses tumor formation in the frontal regions of the brain as well as the top of the spine without brain exposure common to the open brain surgery procedures. Recovery time is reduced, and the risk of infection is smaller in any endoscopic brain surgery as compared to a traditional one.

Awake brain surgery

As suggested by the term, awake brain surgery is a type of open brain surgery that is carried out while the patient is awake and responsive, under local anaesthesia. This brain surgery type allows doctors to note responses of a patient to stimulation of certain areas in the brain and check that the signals for eye movement and vision, speech, motor function and memory are not impacted during surgery for tumor removal or epilepsy correction. This type of brain operation is performed in critical conditions where the abnormality is in an area of the brain that is responsible for critical functions such as movement, speech and vision.

During awake brain surgery, the surgeon or the nurses may continue to ask you questions about how you feel or generally keep you responsive through the brain surgery procedure to determine inadvertent nerve damage occurs during tissue removal or device placement.

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5.Are you the right candidate for brain surgery?

Criteria for brain surgery

Brain surgery is suggested only after a condition is determined to be too severe to be resolved through medication or therapy. A neurosurgeon may determine the requirement of brain surgery in some of the following cases:

Spine disorder:

Pain, numbness and tingling sensation at extremities may signal spinal damage. After testing for damage, a brain operation may be recommended after determining the issue causing these concerns.

Recurrent headaches:

While migraines are a common concern, chronic and recurrent headaches might signal a deeper issue, and a test for brain-related disorders may be suggested. In case a cause requiring brain surgery is determined, a neurosurgeon will address the concern through one of the brain surgery types.

Trauma due to accident:

A major accident or even a fall can result in head injury and brain damage. This is typically addressed by brain surgery. It is best to get tested for brain damage soon after the incident to prevent risk on brain edema, abscess or haemorrhage.

Stroke:

A stroke can leave a portion of the brain damaged, and deep brain surgery may be recommended to restore functioning to all regions of the brain. Brain surgery may also be done to prevent a stroke due to plaque build-up or clots in major arterial vessels if diagnosed in time.

CSF build-up:

Cerebrospinal fluid (CSF) is present in the region surrounding the brain and is necessary for normal brain function. In a case known as hydrocephalus, the CSF is formed and circulated in excess around brain tissue, causing brain swelling and pressure. Patients, especially children, suffer episodes of nausea and vomiting along with fever, and the underlying cause is resolved through brain operation involving draining of the fluid from affected regions.

Tumors:

If a patient is known to be suffering from brain tumors, a brain surgery will be performed for biopsy. If treatment is possible only through further surgery, a brain operation to remove the tumor will be done after the biopsy. Brain surgery can be recommended to remove both benign and malignant tumors.

Epilepsy:

Epilepsy patients do not always require brain surgery, but in several cases, seizure control is made possible through specialized brain surgery. It helps to improve the quality of life for the patient. Deep brain surgery or awake brain surgery may help a patient of epilepsy who will undergo tests to determine the possibility of a successful brain surgery procedure.

Trigeminal neuralgia:

A painful and chronic condition known as trigeminal neuralgia involves the trigeminal nerve in the face. Patients may experience extreme pain in the lower jaw regions. Brain surgery can address the nerve damage here.

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6.How do I prepare for brain surgery?

Several assessments are performed by doctors to determine if brain surgery can be performed on a patient. These tests include blood tests to check for hormonal imbalance and other chemical factors, an electro echocardiogram (EEG) to determine heart function and X-rays and MRI scans.

These tests allow a neurosurgeon to determine if a brain surgery puts you at an elevated risk for future concerns and assessments that typically occur over 1-3 weeks before brain surgery. This also allows the doctor to decide which brain surgery procedure will be most suited to a patient, and the expected results on brain surgery recovery.

Brain surgery preparation will also include a discussion with your doctor on what medication should be continued, and which ones need to be stopped prior to the operation. They will also discuss the drug or food allergies to help determine the diet and post-operative medication. Medical history, family history of blood or brain disorders and alcohol usage are all part of the preparatory steps undertaken during a consultation with the neurosurgeon prior to the brain surgery procedure. Psychological support may be recommended for some patients.

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7.Complications and risks that may arise

As with every invasive procedure, brain surgery comes with a few risks despite much progress made in terms of safety and precision. Some of the more severe brain surgery side effects involve:

Bleeding: Brain surgery can cause unforeseen bleeding in the brain region which may be resolved if it happens under medical observation.

Allergic reactions: Reactions to anaesthesia have been noted in some cases, but is otherwise rare.

Blood clots: Thrombosis in the brain can cause a stroke if left unattended and a brain surgery may sometimes have this as a side effect.

Brain swelling: Swelling can occur due to trauma or fluid build up in the brain after a brain operation.

Coma: If brain surgery is unsuccessful, a patient may fall into a lengthy period of unconsciousness called coma, and sometimes may go into a vegetative state. However, most brain surgeries today show a high rate of success, and the occurrence of such a case is rare.

Infection: Infection in the area where the brain surgery procedure was carried out can cause complications such as swelling and further brain damage.

Amnesia: Short-term or long-term memory loss may occur due to nerve damage during brain surgery.

Impairment of bodily functions: Speech, vision and motor coordination are all controlled by the nervous system, and brain damage due to brain operation can affect any of these functions.

Seizures: Seizures may be triggered during brain surgery in certain cases, and may be caused by damage to the nerve centres in the brain.

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8.How do I recover from brain surgery?

Brain surgery recovery

Brain surgery recovery is a gradual process and can take two months, and sometimes more. It eventually improves the quality of patient’s life and is worth the patience. A recovery plan is created by the team treating you. All steps of the treatment plan after brain surgery must be followed so that subsequent complications are avoided.

Typically, a brain surgery procedure requires that a patient be monitored in the hospital for a few days, depending on the type of brain surgery performed. In case of a minimally invasive brain operation, the patient can leave within 2-3 days after the procedure, depending upon overall patient health and determination of risk of subsequent complications by the doctors. Post-operation assessment is continual for the duration of the hospital stay and involves frequent testing of responses and blood flow.

Brain surgery recovery is often aided by lifestyle changes involving a more active lifestyle with less stress, reduction in consumption of alcohol and frequent check-ups to monitor symptoms. Brain surgery is known to make patients very weak and tired immediately after the procedure, and it is necessary for the body to have adequate rest at this time.

In some cases, physiotherapy or speech therapy is recommended to patients who have undergone the brain surgery procedure to help with rehabilitation. Psychological therapy may be necessary if major life and lifestyle changes are foreseen due to brain operation.

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9.Precautions to take after brain surgery

  • Caring for the wound made during the brain surgery procedure is vital during the recovery time. Inadvertent poking or stretching in the area of the wound may cause a suture to open and involve risk of further brain damage.
  • Rest and lowered stress are two major factors that aid in a speedy recovery after a brain surgery. Check with your doctor to understand what steps would help to ensure a holistic recovery after the procedure.
  • Follow up visits to the clinic to discuss any symptoms and postoperative assessments are suggested even after brain surgery recovery.

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10.Brain surgery FAQs: All your concerns addressed

Q.   What can I expect after my brain surgery procedure?

  1. In most cases, a return to normal life with improved energy and activity levels, and removal of any impairments resulting from brain damage are expected after brain surgery. Depending on the specific concern and the brain surgery type, as well as overall health, you can expect to live a healthier life with a prolonged lifespan. In some cases, major life changes, such as changing a job, may become necessary. Diet and exercise plans may also be different from what was followed before the surgery. You can expect some tiredness in the initial weeks following brain operation.

Q.   What is the survival rate after the brain surgery?

  1. Brain surgery survival rates depend on the severity of damage to be corrected, the brain surgery type to be performed and the age and health of the patient. On average, brain surgery long-term survival rate can be between 50-70% except in cases of malignant tumors where chances are lowered. In cases of brain operation performed for non-tumor related brain damage, the chances of survival are significantly enhanced.

Q.   Can I work out after brain surgery?

  1. Working out involving heavy lifting and strenuous running is to be strictly avoided after a brain operation. Any activity that may cause sudden internal movements and strain, such as pushing or swimming, is also not recommended.
  1. It is necessary to consult with your doctor after a brain surgery before starting any intense physical activity and get a complete follow-up assessment performed.

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