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

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

4.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.

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.

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.

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.
   
   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.

Q.   How long does it take to recover from a brain surgery procedure?

1. Recovering from a brain tumour operation can take some time. Every individual takes their own time to recover from a brain tumour surgery. You may need to stay in the hospital for about 3-10 days after the surgery is complete. However, the length of your stay in the hospital also depends on your operation and how long you take to recover. It’s not always easy to immediately join work after a brain surgery.

Q.   How risky is brain surgery?

1. A brain surgery is done to help treat problems that occur in the brain and its surrounding structures. Some of the risks that can arise during a brain surgery are:
• Reaction to anaesthetic medicines
• Breathing problems
• Blood clots and infections
• Speech and memory problems, weakness in muscles. These may last for some time and go away after that
• Bleeding in the brain
• Stroke
• Seizures
• Brain infection
• Brain swelling

Q.   How long do I have to stay in the hospital for brain surgery?

1. It often takes some time before you can return to your normal activities after a brain surgery. To completely heal, you will need to rest amply. Each person requires a different time to recover after their surgery. The healing time depends on
• The procedure followed to remove the brain tumour
• The location of the tumour
• The areas affected as a result of the surgery
• Your age and overall health at the time of surgery.
2. Generally, you may need to stay somewhere between 2-5 days in the hospital after the surgery.

Q.   Will I be able to drive after brain surgery?

1. Driving is a complex activity that requires several cognitive and behavioural skills and a decent amount of coordination. It’s possible that you retain part of your driving abilities and can go back to driving, however, it’s important to adhere to the legal requirements. It helps to take precautions such as taking a driving assessment. This is because, after a surgery, you may be at a risk of causing injury to yourself and others. As per law, you must inform the legal authorities if you plan to resume driving after a brain surgery. In case you fail to inform them, then you may have to pay a fine as well. As per medical standards, you shouldn’t resume driving until 6-12 months after your surgery.

Q.   How do I prepare for brain surgery?

1. Before your brain surgery begins, you will need to pass an assessment. This will help to check whether you’re fit for surgery. This includes tests to check if you’re fit for anaesthetic, fit for recovery, blood tests to check if your kidneys are working, ECG to check your heart functioning and X-rays and MRI scans. A week or two before the surgery, your doctor will brief you about the entire procedure. You can share any doubts or questions you have now with the surgeon. You may need to take some medicines before the surgery as per your doctor’s advice. There can be some breathing exercises too to help you deal with the anxiety.

Q.   What are the different types of brain surgery?

1. A brain surgery is done to treat the brain and its parts. There can be various types of brain surgeries:
• Craniotomy - This involves creating an incision for a bone flap for removing tumours, aneurysm, or abnormal brain tissues.
• Biopsy - This involves removing a small part of brain tissue to examine under a microscope
• Minimally invasive endonasal endoscopic surgery - In this case, surgeons remove tumours or lesions through nose and sinus with the help of an endoscope.
• Minimally invasive neuroendoscopy - In this case, endoscopes are used to remove brain tumours
• Deep brain stimulation - This involves inserting a small electrode in your brain to send electrical signals

Q.   What happens after brain surgery?

1. Immediately after the surgery, you’ll be monitored closely to ensure everything is working properly and that there are no complications. You’ll mostly be made to sit in an upright posture to prevent swelling of your face and brain. The recovery from the surgery depends on the type of surgery done. How long you stay in the hospital will depend on the success of your recovery. You may have to take pain medications during this time. Before leaving the hospital, your doctor will tell you how to take care of your wounds.