Follow-up care for the brain to accelerate and facilitate recovery
It’s difficult to generalize about recovery from brain surgery, because there are over 100 different types of malignancies and the human brain contains hundreds of complex structures and billions of connections. The problems you’re going to have before and after surgery are dependent on where in the brain the tumor is and what kind of tumor it is. nearly all people who undergo surgery for a brain problems will face challenges in the months after the procedure.
Like any other invasive procedure, brain surgery is closely associated with many side effects. However, the likelihood of side effects increases significantly when it comes to the surgery of the brain as it is the master of all body controls.
Doctor Moradi, a neurosurgeon specializing in brain surgery, can help you to have a stress-free recovery period and severe complications. You can call 02833235232 for booking an appointment.
Brain Surgery
Although the working of the human brain is complex, the system is quite delicate and has a consistency similar to that of jelly. Even with the protection offered by bone, strong tissues and fluids, it remains susceptible to infections, trauma, and abnormal growths. Sometimes, surgery on the brain forms an important treatment option to save the lives of patients.
There are a variety of reasons for brain surgery, also known as a craniotomy or neurosurgery. It is a surgical procedure performed on the affected structures in or around the brain.
Alterations in the flow of blood within the brain (hemorrhages, changes in the cerebrospinal fluid (infections) and brain tissue (cancer, swelling) are conditions under which surgeons need to consider neurosurgery. The various types of brain cancer that require craniotomy are as follows: gliomas, lymphomas, pituitary tumor, medulloblastoma, schwannoma, secondary tumor, chordomas etc. Head injuries such as concussions, scalp wounds, contusions, hemorrhages or fracture of the skull due to accidents also require brain surgery. Strokes can lead to potentially fatal brain injury and the same is true when the blood flow increases, which can lead to the rupture of small vessels in the brain.
A Brief Description of a Craniotomy
Craniotomy is defined as a surgical operation that involves opening of the skull for access to the brain and treatment of the defect or infection. The scalp needs to be cut through to repair and ligate the ruptured blood vessels and to remove any abnormal growth or blood clot. Sometimes the patient is kept awake during the procedure.
Postoperative complications
Immediate side effects
After your brain surgery you might feel worse than you did before. This can be depressing if you are not prepared for it. Brain surgery is a lot for your body to cope with. It might be a while before you feel the benefit from having your tumour removed.
Brain surgery can cause swelling in the brain. Your surgical team monitor this closely and give treatment to reduce the swelling. But it might still cause symptoms such as:
- weakness
- dizzy spells
- poor balance or lack of coordination
- personality changes
- confusion
- speech problems
- fits (seizures)
Your symptoms might be worse at first. And you may notice symptoms that you didn’t have before.
This can be a difficult time for your friends and relatives. They might worry that your operation has not worked. But symptoms usually lessen and disappear as you recover. Your nurse and doctor will explain that this is normal and part of the recovery period.
Your surgeon can give you some idea of what to expect in the way of recovery. For some people, recovery will be complete. You might be able to get back to the same fitness level you had before your tumour. For example, you may be able to go back to your job if you have one. You might need extra support from your employer at first.
Longer term problems
The position of the tumour might cause long term problems with speech or with weakness of an arm or leg. Some people recover fully, but this will take some time. Some people might not get back to exactly how they were before surgery.
After surgery, in hospital
Read about what will happen in the first few hours and days after your operation and how you’ll feel.
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Most people wake up fairly quickly after brain surgery. But in a few situations, your surgeon might decide to keep you asleep for a few days more, to help you recover. They use sedatives to keep you asleep.
While you are asleep you might be on a breathing machine (ventilator). This can be frightening for those who visit. Your surgeon will talk through what is going to happen if this applies to you. They go through things with you and your family so that you can prepare as much as possible.
After a big operation, you wake up in the intensive care unit or a high dependency recovery unit. You usually move back to the ward within a day or so.
In intensive care you have one to one nursing care. In the high dependency unit you have very close nursing care. Your surgeon and anaesthetist also keep an eye on your progress.
These units are busy and often noisy places that some people find strange and disorienting. You'll feel drowsy because of the anaesthetic and painkillers.
Your nurse will be taking your neurological observations. These are the same tests you had before your operation. For example, the nurse will check how alert you are. And shine a light into your eyes to check that your pupils react.
You have a blood pressure cuff on your arm and a little clip on your finger to measure your pulse and oxygen levels (called a pulse oximeter).
Your nurse will check your blood pressure and neurological observations every 15 minutes when you first come round.
When you wake up, you might have a dressing over your wound site. This is usually left alone for about 5 days. Stitches or surgical clips can usually come out between 5 to 14 days after surgery. Some surgeons use stitches that slowly dissolve by themselves and so you don't have these removed.
You might also have a tube to drain fluid, which your nurse will take out about 24 hours after your operation.
If your head was shaved when you went to theatre, it may be a shock when you first see yourself. Your hair will grow back but the speed at which it grows can vary between people. Your head may be itchy at first, but try not to scratch too close to your wound.
Your jaw might be stiff and painful if your operation was near your temple (between the side of your eye and your hairline). This might last a few days or weeks after surgery. You may find it difficult to open your jaw. This is because the surgeon had to move or cut the muscles of the jaw. The stiffness gets better by itself in a short time. Making chewing movements or chewing gum helps.
You might find that your forehead or face are swollen. This swelling will go down over time, this could take some days or longer for some people.
When you are fully awake, you notice that you have several different tubes in place. You might also have an oxygen mask on for a while.
All the tubes can be a bit frightening. But it might help to know what all the tubes are for. You might have:
- drips (IVs – intravenous infusions) to give you medicines, blood transfusions, and fluids until you are eating and drinking again
- a tube into an artery in your wrist or ankle for taking blood samples and accurately measuring your blood pressure
- one or more drains coming out of your wound (connected to bags or bottles) to drain blood and tissue fluid from the operation site
- a tube into your bladder (urinary catheter) so that your urine output can be measured
- a tube down your nose into your stomach (nasogastric tube) to stop you from being sick
Among the tubes coming out of your head bandages, there may be a drain called an external ventricular drain (EVD). This drains excess fluid from the brain to stop the fluid building up (hydrocephalus).
You might also have an intracranial pressure (ICP) monitor. A tube from your head is connected to a machine. This measures the pressure inside your head. It will be taken out after a day or so.
Your nurse will measure your urine output because this helps to show whether you have too much fluid in your body or too little. Too little fluid means that you are dehydrated. Keeping your fluid balance right helps to stop swelling around the operation site in the brain.
You might have a headache when you wake up. You will have painkillers to help control this. Your surgeon might not want you to have very strong painkillers because they could cover up important symptoms.
It is unusual to get a lot of pain after a brain operation. You might have more pain if you have had surgery on your spine. If so, you might have painkillers through a drip into your vein. Do say if you feel your painkillers are not controlling the pain. Your nurse can adjust the dose if necessary.
Recovery after brain surgery and necessary care
After brain surgery, as with any type of surgery, it will take time to recover. Recovery is different for everyone and depends on:
- The location of the tumor within the brain
- Areas of the brain affected by the surgery
- The patient’s age and overall health
At the time of discharge from the hospital, the patient and his/her caregivers will be provided with detailed written and verbal instructions about the transition to care at home. The instructions include care of their incision, prescriptions for medications, appointment for a post-operative examination with the surgeon and telephone numbers for any questions or concerns that may emerge after discharge.
Rehabilitation Therapy
Occasionally some patients may require additional care that is unable to be accomplished at home. If this is necessary the patient can be admitted to an in-patient rehabilitation facility for a short time to insure their safe and effective recuperation.
Rehabilitation Therapies include:
Physical therapy
Physical therapists will assess and, if necessary, help the patient to improve their ability to walk safely and climb stairs before being released from the hospital. They may also help the patient improve strength and balance.
Occupational therapy
Occupational therapists will assess the patient’s ability to perform more detailed activities involved in "real life" such as getting dressed, using the bathroom and daily personal hygiene.
Speech language pathology
Speech language pathologists will assess and, if necessary, help improve problems with speech, language or thinking. They are also able to assess patients who may have problems with swallowing.
Home care
Before being released from the hospital, the patient’s doctors and nurses will teach the patient and his/her family about home care and what to expect during the healing process. The instructions will also cover when to call or the doctor:
Call right away if the patient:
- Has trouble breathing
- Has a seizure and has not had one before
- Has more seizures than usual
- Has a different type of seizure than usual
Call the doctor if the patient:
- Has trouble urinating (peeing)
- Cannot control the timing of urination or a bowel movement
- Is confused or has trouble remembering things
- Has hallucinations
- Has major changes in mood or behavior
- Has difficulty seeing or hearing
- Is much more tired than usual or has difficulty waking up
- Is nauseous or vomits
- Feels weakness in the arms or legs or you has trouble walking
- Has more or worse headaches than usual
- Has a tingling feeling (pins and needles) or numbness (no feeling) in the face, arms or legs
- Faints or has a seizure
- Has difficulty talking
- Is more sensitive to light, has a stiff neck, or has a fever higher than 38º Celsius
- Has a red, swollen or painful calf
Driving
Driving after surgery is dependent on the extent of the surgery and the patient’s recovery; additionally, having seizures may limit driving for a time. Usually post-op visits are approximately 2 weeks after surgery and clearance to drive is evaluated at that time.
Driving during surveillance only treatment and radiation, also depends on the presence of seizures, otherwise driving is not restricted.
Traveling
Traveling after surgery depends on the extent of the surgery, the patient's recovery and planned treatment. It is also dependent upon the destination. Traveling after surgery and during surveillance and radiation should be discussed with the healthcare practitioner on an individual basis.
Working
Working after surgery depends on the extent of the surgery, the patient’s recovery and the type of activity involved in the job. Generally returning to work in 6 to 8 weeks is reasonable. Certainly the ultimate decision will be decided upon individually between the and the patient.
Working during radiation can be arranged to fit in to the patients work schedule. Stereotactic radiation is a single treatment and fractionated radiation takes only minutes each day. If a patient lives a long distance from the hospital the possibility of having daily radiation at a local facility may be an option.
Eating and Drinking (Nutrition)
Prior to surgery patient will have been instructed to stop eating and drinking after midnight the evening before. After surgery the patient's diet will be progressed slowly as the patient tolerates, beginning as soon as the day of surgery. Due to general anesthesia and pain medications affecting the digestive system the patient may experience bowel changes. The most common is constipation which will be treated with medication.
Digestive issues related to radiation therapy are not common, though keeping in mind the differences of each patient, any discomfort can be treated.
Activity/Exercise/Sports
Activity after surgery depends on the extent of the surgery, the patients recovery and the type of activities in question. Patients are typically assisted with getting out of bed on the first or second post-operative day. Moving around is encouraged, should start slowly and progress as the patient is able. The ultimate decision regarding extreme sports/activities will be decided upon individually between the health care practitioner and the patient.
Activity/exercise/sports during surveillance and radiation are not limited.
Medications
Regular medications such as vitamins, and many other prescription medications will be continued while the patient is in the hospital and can be continued upon discharge after surgery. Regular medications are not disrupted during surveillance and radiation.
Medications specific to the brain tumor and/or surgery such as steroids, anti-seizure medications, medications for dizziness, pain and nausea/vomiting will be adjusted by the health care practitioner after surgery according to the patient's individual needs. Also these medications are not disrupted during surveillance, radiation.
Sexual Activity
Sex before and after surgery is only limited by the patient’s ability and desire. Sex during surveillance and radiation is not discouraged.
Pregnancy
Pregnancy prior to surgery and during radiation is not advised due to the risks of anesthesia, certain medications and radiation on the unborn embryo/fetus. The timing of pregnancy after surgery and radiation, and during surveillance should be decided upon individually between the and the patient.
Pregnancy Prevention
Pregnancy prevention methods that require hormone administration may have an effect on certain types of tumors and their use in general should be discussed with the; any barrier method of contraception is acceptable at any time and with any type of treatment.
