Side effects of neurosurgery
Its important to remember that neurosurgery is a major operation. After surgery you will need to rest for a number of days.
As a general anesthetic is used, you'll normally stay in hospital for a few days, though some hospitals may do biopsy surgery as a day case.
Waking up after neurosurgery
Where you wake up after surgery
Following surgery, you're likely to wake up in the recovery room of the operating theatre, where there may be other patients waking from their operations. Different hospitals have different systems, some have specialist post-operative neurosurgery wards where you may be taken for observation. In others, you might wake up in a high dependency unit (HDU) or occasionally an intensive care unit (ICU).
While there, you'll have one-to-one personal care and attention.
In the first few hours, you'll have frequent neurological observations (neuro-obs). They include:
- checking how alert your are
- testing your reflexes
- checking that your pupils react to light
- checking your pulse and blood pressure
- checking the amount of oxygen in your blood and the number of breaths you take each minute.
You may also be linked to a machine that controls your breathing (ventilator) to give your brain a chance to recover.
The amount of time it takes to wake up after surgery varies. Many people wake up very soon afterwards, but some people remain unconscious for a number of hours or a few days.
How you will look after neurosurgery
When you wake up after surgery, you'll have a number of tubes running in and out of your body. This unfamiliar experience can be upsetting - it can help if you know what the tubes are for.
You may be linked to the following devices:
- Drips. These are tubes that give you water and nutrients until you are able to eat normally. They may also deliver medicines into your blood stream
- External ventricular drain (EVD). This drains fluid from the brain to prevent the build-up of cerebrospinal fluid (CSF), which can cause hydrocephalus
- Tubes from your wound that drain excess blood and fluid
- Intracranial pressure (ICP) monitor, which monitors the pressure in your brain
- Urinary catheter. This goes into your bladder and gives a measure of how much urine you're producing. It's used to monitor whether you have an appropriate amount of fluid in your body and also drains urine.
- Nasogastric tube. This tube goes down through your nose to your stomach and provides liquid food.
- Blood pressure monitors.
When you wake up after surgery, you may have a dressing or bandage on your wound, but not always. If a dressing is used, this usually stays on for up to about 5–10 days after surgery.
You might have some swelling and bruising on your face.
How you will feel after neurosurgery
Many factors will influence how you feel after surgery, including the type of surgery you've had, and the size and location of your tumour.
You may experience some or all of the following temporary effects:
- Sickness and nausea, due to the anaesthetic. Anti-sickness tablets can be given to help with this
- Sore throat, due to the tube used during surgery to regulate your breathing and oxygen levels
- Headaches, caused by swelling in your brain. The swelling should die down within a couple of days and painkillers can be used to help relieve the headaches
- Momentary dizziness or confusion
- Difficulty swallowing. You may have your swallowing checked by a speech therapist before you're allowed to eat or drink anything
- New symptoms, which might include personality changes, poor balance and co-ordination, speech problems, weakness and epileptic seizures (fits)
- You may also continue to feel tired.
For the first few days, one of the top priorities for your healthcare team will be ensuring that the pressure in your head doesn't increase.
Nurses will ensure that you're moving your arms and legs around enough to allow blood flow and to prevent blood clots (thrombosis) or your muscles from stiffening up. You won't be kept in bed any longer than is necessary and hospital staff are always keen for their patients to get up and get moving as soon as is safe.
You will have physiotherapy and occupational health assessments to prepare for and support your discharge from hospital.
The list of side effects may seem over whelming, but it's important to remember that such effects usually disappear fairly soon after surgery and that a team of health professionals will be taking care of you.
What happens next?
Your consultant should talk through your treatment plan with you, so that you know what to expect.
Due to the swelling in the brain after surgery, it's common to be given steroids. You may be prescribed a type of steroid called Dexamethasone. Steroids help to reduce the swelling and increased pressure in your head. Under the guidance of your consultant, you'll gradually be able to stop taking steroids.
Some people experience seizures (fits) after brain surgery. You may be given anti-epileptic medication. The length of time people take this for varies from person to person, but it's not uncommon to take anti-epileptics for up to a year after brain surgery. You may need to stay on them for life.
The clips or stitches will usually be removed 1-2 weeks after surgery. If you have dissolvable stitches, they don't need to be removed. Over time, in most cases, the bone flap will fuse with the surrounding skull.
Frequently asked questions
If you wish to travel by plane after brain surgery, you should ask for advice from your healthcare team. Normally, you wouldn't be able to fly for a little while after neurosurgery. The Civil Aviation Authority, which is responsible for air travel safety, advises avoiding air travel for approximately 7 days following neurosurgery. This is because neurosurgery may leave gas trapped within the skull, which may expand at altitude.
Travel insurance may also be more expensive or difficult to obtain following neurosurgery. It's essential that you make sure you are fully covered to travel before you do so, to prevent incurring heavy costs if you fall ill while away. There are some specialist insurers who may insure you to travel.
If you wish to play sport after your surgery, ask for advice from your doctor. Once you've recovered from surgery, it should be fine for you to play sport, though you may need to avoid sports that involve significant physical contact between players (contact sports), such as rugby and wrestling.
Your healthcare team will be able to advise you on when you can begin playing sport again after brain surgery.
You're likely to have a brain scan a few days after surgery. This will give your healthcare team a good idea of whether any of the tumour remains and how much swelling of the brain you have.
The success of surgery is measured on the aim of the surgery and not on curing a tumour. Even if all of the visible tumour is removed, this may or may not mean that all of the actual tumour has been removed.
Surgery as a cure depends on tumour type and your individual case. Before surgery, your consultant will discuss with you what to expect from surgery and whether they are hoping to remove all or part of the tumour.
Often, surgery does not cure a tumour completely, but removing part of it can make any remaining tumour cells more responsive to other treatments, such as radiotherapy and chemotherapy.
Long-term difficulties after surgery are possible. Nerves, or the brain itself, can be damaged during surgery, affecting the functions that they control within our bodies.
The nature of these will depend on which part of the brain has been operated on, or which nerve has been affected.
The result of this damage is sometimes called a deficit and can be permanent or temporary. Such difficulties could include problems with speech and movement or problems with thought processes.
Before you have surgery, where possible, a health professional from your healthcare team will talk to you and/or your carer about what to expect and the risks involved.
It's important that you fully understand the level of risk, so you can make an informed decision about whether to agree to the surgery.
The exact level of risk depends on the exact procedure performed, but any surgery on the brain does carry risks, some of them serious. You should have been given a key worker within your healthcare team who you can contact - feel free to ask them as many questions as you wish, at any point.
If you're left with any long-term difficulties, professionals, such as speech and language therapists, physiotherapists and clinical psychologists, can work with you to improve these functions. Don't be afraid to ask for such support if you feel it's necessary.
Surgery is not always the preferred option to treat a brain tumour - it depends where in the brain the tumour is.
Sometimes, it would be too risky to operate as the tumour may be very close to, or wrapped around, an important structure in the brain. In this case, the benefits of surgery would be outweighed by the dangers.
If your consultant doesn't think surgery is appropriate for you, you may like to ask them to explain their decision.
If you're still unhappy with their decision, you could ask for a second opinion from another consultant. Your current consultant or your GP can help to arrange this.
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