Recovery of patients after 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 tumours 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.

Why Brain Surgery performed?

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

1. Prevent bleeding inside the brain because of an aneurysm
2. Operate on a tumour to remove it
3. Free a nerve in the brain area that is being pinched
4. Drain an abscess or blood from an injury and remove pressure on the brain

Conditions that require brain surgery

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

1. Congenital brain defects such as blood vessel malformation where connections between veins and arteries are formed in the brain region
2. Internal bleeding in the brain due to an aneurysm where an arterial wall weakens and ruptures
3. Blood clots and bleeding in the brain are corrected through brain operation to prevent further trauma to brain tissue surrounding the problem area
4. Epidural or subdural abnormalities such as hematomas are corrected through suitable brain surgery procedures
5. Oedema of the brain is the build-up of fluid around the brain causing swelling and recurring headaches and pressure to the brain
6. Brain tumours are usually removed through critical brain surgery, especially in the case of cancer formations
7. Doctors may suggest brain surgery in certain cases of epilepsy caused by an abnormality in the brain structure, or pressure on a nerve
8. Neuropathic pain may occur when a nerve between the brain and the spine is damaged due to a stroke, tumour or accident, among other causes
9. 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
10. Parkinson’s disease may be helped by brain surgery where the nervous signals required to control motor function are too weak or abnormal

Types of Brain Surgeries:

1. 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 tumours or other abnormalities.
2. 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 tumour 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.
3. 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 tumour formations in the brain and is also known as keyhole surgery since the holes made during this type of brain surgery are very small.
4. 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.
5. 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 tumour 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.
6. 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 tumour 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.

Conditions when brain surgery is normally suggested:

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:

1. 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.
2. 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.
3. 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 oedema, abscess or haemorrhage.
4. 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.
5. 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.
6. Tumours: If a patient is known to be suffering from brain tumours, a brain surgery will be performed for biopsy. If treatment is possible only through further surgery, a brain operation to remove the tumour will be done after the biopsy. Brain surgery can be recommended to remove both benign and malignant tumours.
7. 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.
8. 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.

Complications & Risk after Brain Surgery:

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:

1. Bleeding: Brain surgery can cause unforeseen bleeding in the brain region which may be resolved if it happens under medical observation.
2. Allergic reactions: Reactions to anaesthesia have been noted in some cases, but is otherwise rare.
3. 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.
4. Brain swelling: Swelling can occur due to trauma or fluid build up in the brain after a brain operation.
5. 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.
6. Infection: Infection in the area where the brain surgery procedure was carried out can cause complications such as swelling and further brain damage.
7. Amnesia: Short-term or long-term memory loss may occur due to nerve damage during brain surgery.
8. 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.
9. Seizures: Seizures may be triggered during brain surgery in certain cases, and may be caused by damage to the nerve centres in the brain.

Recovery from Brain Surgery:

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.

You should call your neurosurgeon in the following situations:

Recovery in Home settings:

Brain surgery especially the ones caused by blood clots take more time to heal. Hospital is best equipped with men, materials and technology to ensure proper recovery of brain operated persons. Hospital stay in Brain surgery cases is very costly. Hence most of the patients are discharged within 7 to 15 days after the operation from the hospital. At the time of discharge the patient would have gained consciousness and in case Tracheotomy has been with the endotracheal tube removed. Very often that’s all.

1. Usually brain surgery patients are discharged with the following tubing:
   1. Riles tube for liquid feeding.
   1. Urine catheter
   1. Drainage tube
   1. Cannula
2. The patient will be drowsy and may not be in a position to move any part of the body.
3. The patient may not be able to speak or one the mouth or even to cry.
4. Body will often be stone stable and to move it either a mechanical lift is required or more than two persons are required. It is better to have a fowlers cot with air bed to avoid bed sores.
5. The recovering patient may develop fever and, in such situations, medication has to be administered on SOS basis as per the prescription of the surgeon.
6. It is better to get a doctor and a trained nurse to examining the patient on a daily basis for possible infection, management of fever if any and also to ensure dressing of the wound. There are other aspects to be mentioned and they are indicated in the previous section.
7. The patient is basically on liquid food for about 4 to 6 weeks. One should know what to feed and how to feed.

Unfortunately, as hospital stay is costly, patients are forced to be home settings.