The most commonly performed operation for brain tumors is Craniotomy.
During the operation, if needed, a neurosurgeon places some tabs into the affected region. The purpose is to release chemotherapeutic agents to destroy the remaining abnormal cells.
Preparation
Patients are admitted to the hospital the morning of the craniotomy.
Depending on the underlying problem being treated and complexity, the procedure can take 3 to 5 hours or longer.
THE PROCEDURE
With an intravenous (IV) line placed in your arm, general anesthesia is administered while you lie on the operating table. Once asleep, your head is placed in a 3-pin skull fixation device, which attaches to the table and holds your head in position during the procedure. Insertion of a lumbar drain in your lower back helps remove cerebrospinal fluid (CSF), thus allowing the brain to relax during surgery. A brain-relaxing drug called mannitol may be given.
After the scalp is prepped with an antiseptic, a skin incision is made, usually behind the hairline. The surgeon attempts to ensure a good cosmetic result after surgery. Sometimes a hair sparing technique can be used that requires shaving only a 1/4-inch wide area along the proposed incision. Sometimes the entire incision area may be shaved.
The skin and muscles are lifted off the bone and folded back. Next, one or more small burr holes are made in the skull with a drill. Inserting a special saw through the burr holes, the surgeon uses this craniotome to cut the outline of a bone flap. The cut bone flap is lifted and removed to expose the protective covering of the brain called the dura. The bone flap is safely stored until it is replaced at the end of the procedure.
After opening the dura with surgical scissors, the surgeon folds it back to expose the brain. Retractors placed on the brain gently open a corridor to the area needing repair or removal. Neurosurgeons use special magnification glasses, called loupes, or an operating microscope to see the delicate nerves and vessels.
Because the brain is tightly enclosed inside the bony skull, tissues cannot be easily moved aside to access and repair problems. Neurosurgeons use a variety of very small tools and instruments to work deep inside the brain. These include long-handled scissors, dissectors and drills, lasers, ultrasonic aspirators (uses a fine jet of water to break up tumors and suction up the pieces), and computer image-guidance systems. In some cases, evoked potential monitoring is used to stimulate specific cranial nerves while the response is monitored in the brain. This is done to preserve function of the nerve and make sure it is not further damaged during surgery.
With the problem removed or repaired, the retractors holding the brain are removed and the dura is closed with sutures. The bone flap is replaced back in its original position and secured to the skull with titanium plates and screws. The plates and screws remain permanently to support the area; these can sometimes be felt under your skin. In some cases, a drain may be placed under the skin for a couple of days to remove blood or fluid from the surgical area. The muscles and skin are sutured back together. A turban-like or soft adhesive dressing is placed over the incision.
The hole may be left open in the case of tumors, infection, or brain swelling. When the scull is left open, the procedure is known as a CRANIECTOMY.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation we require detailed medical information in the form of a medical questionnaire. Although not all the tests may be required for each patient, they usually include:
All of this information will allow the doctors that we work with to determine your eligibility for the procedure. Your surgeon will give you specific instructions about any dietary changes or activity restrictions you should follow before surgery.
Stop taking all non-steroidal anti-inflammatory medicines (and blood thinners 1 week before surgery. Additionally, stop smoking and chewing tobacco 1 week before and 2 weeks after surgery, as these activities can cause bleeding problems
Also bring a complete list of your current medications (including over-the-counter drugs, vitamins and herbal supplements), allergies, your medical records and any health insurance information.
If you develop a cold, fever or sore throat within a few days of your surgery, or have other questions or concerns, contact our offices immediately.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Upon arriving in Cyprus, as part of the pre-surgery tests done at our partner hospitals you will again receive chest X-rays, blood tests, an electrocardiogram and any other tests shall be performed. Your surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Wash your hair with antiseptic soap for 3 consecutive days prior to surgery.
Getting your house ready before surgery
It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Day before surgery
Your surgical nurse will provide you with these instructions the night before surgery:
Morning of surgery
On the day of your surgery, your designated Salus Patient Concierge along with a nurse may talk with you and your loved ones. They shall tell you what to expect. You will most likely feel a little nervous before surgery, so the Salus team and the hospital staff will do all they can to answer your questions and help you relax.
Make sure all your medicines in their original containers with you to the hospital.Some medications will need to be continued or stopped the day of surgery. Bring a list of allergies to medication or foods.
You will be scheduled for presurgical tests (e.g., a blood test, electrocardiogram, chest X-ray, and CT scan) several days before surgery.
You will meet with the anesthesiologist who will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery.
You should leave jewelry, watches, money and other valuables with the person who accompanies you or with our staff member who will place them in our safe.
Proceed with your routine morning care:
You will have an IV or intravenous line put in to give you fluid and medicine during your surgery.
When it is time for you to go to surgery, your family/ companion will be asked to wait in the waiting area. Your doctor will talk to your family/ companion there after your surgery is done.
RECOVERY AFTER SURGERY
After surgery, the patient is moved to the Intensive Care Unit where family members can visit the periodically. Heart rate and blood pressure monitoring devices continuously monitor the patient for 24 hours. Medications that regulate circulation and blood pressure may be given through the I.V. (intravenously).
You may experience nausea, unsteadiness, and headache after surgery. Medication can control these symptoms. When your condition stabilizes, you will be transferred to a regular room, where you will continue to be monitored and will begin to increase your activity level.
Patients usually stay in our partner hospitals for 2-3 days or longer if necessary, after surgery. During this time, some tests will be done to assess and monitor the patient’s condition.
Hospital discharge and home instructions
Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.
You will be able to leave the hospital when you are:
You will remain hospitalized for about 2-3 dayswhile your heart is monitored and your vital signs are checked frequently.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.
YOUR ACTIVITY
It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of a major operation.
After release from the hospital, the patient may experience side effects such as:
Many of these side effects usually disappear in one or two weeks, but a full recovery may take a few months or more. The patient is usually enrolled in a physician-supervised program of cardiac rehabilitation. This program teaches stress management techniques and other important lessons (e.g., about diet and exercise) and helps people rebuild their strength and confidence.
Doctors also often recommend following a home routine of increasing activity- doing light housework, going out, visiting friends, climbing stairs. The goal is to return to a normal, active lifestyle.
Most people with sedentary office jobs can return to work in four to six weeks. Those with physically demanding jobs will have to wait longer. In some cases they may have to find other employment.
Lifting and Reaching
Do not lift, push or pull objects heavier than 5 pounds until your doctor says it is okay to do so.
Physical Activities
You may do light, quick activities where your arms are above your shoulders, such as brushing your hair. But do not do any activities where your arms are above shoulder level for a long time, such as washing a window or dusting a high shelf. Do not do any activity that causes pain or pulling across your chest.
To get the most out of your day, plan to do the most important activities first. Don't try to do everything at once, and schedule unfinished activities for another day. Make sure that you get plenty of rest in between activities.
Climbing Stairs and Steps
Unless restricted by your doctor, it's okay for you to climb stairs and steps. Because you may be off-balanced after surgery, be careful and hold the handrail when walking up and down stairs. If you need to, stop and rest before you finish walking up or down a full flight. Try not to use the stairs immediately after surgery, and try to plan your activities so that you use the stairs only when necessary.
Fatigue
Fatigue is probably the number one patient complaint following surgery. Fatigue results from an extended lack of sleep while in the hospital, energy used by your body to heal its wounds, and energy used to fight off pain. To combat fatigue, listen to what your body is telling you. Space your activities to allow for rest periods. Take plenty of naps, walk regularly, eat well, and use your pain medication as needed. It's important that you rest and get a good night's sleep. Even if it's early in the night, if you feel tired, go to bed.
Driving and Riding in a Car
You should not drive for 3-4 weeks from the date of your surgery or while you are still taking narcotic pain pills. During this time your reaction time may be dulled, and if an incision was made on your sternum, your breastbone will still be healing. You may be a passenger in a car at any time. Make sure to wear your seat belt. You may cushion your incision with a soft towel or pillow.
Returning to Work
Returning to work depends upon the type of work you do and your energy level. It usually takes 4-6 weeks before most patients feel they have returned to their full energy level. The decision to return to work should be made jointly between you and your surgeon. You may want to consider working half days at first.
Traveling
Delay vacations or extended trips away from home for approximately 2-3 weeks, or until after the first post operative visit with your surgeon. Avoid air travel for two weeks from the date of your discharge. This restriction is designed to prevent you from being too far away from your surgeon should a problem arise.
Exercise
Proper exercise will help your healing and recovery, as well as increase your stamina, maintain your ideal weight by burning calories, and lower stress in your everyday life.
Tips for exercising:
Make sure you are not exercising too hard. Stop if you are exhausted, short of breath or feel dizzy. Call your doctor if these symptoms persist and you are not able to do your regular exercises.
Your diet
Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Call your surgeon rigth away of you have:
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.Your surgeon will plan your post operative and routine follow up appointments with you and your local physician.
In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.
Any time before your appointments, you should call your doctor if you: