Brain surgery at Parkside Hospital

What is brain surgery?

Brain surgery is an operation on your brain, or the structures closely around it, carried out by a specialist called a neurosurgeon. It's used to treat a wide range of conditions, from tumours and aneurysms to severe epilepsy and head injuries.

What conditions does it treat?

Brain surgery may be used to treat:

• brain tumours
• aneurysms (a weakened, bulging blood vessel) and other blood vessel problems, such as arteriovenous malformations
• a build-up of fluid on the brain (hydrocephalus)
• bleeding on the brain (haemorrhage), including after a stroke
• some forms of epilepsy that haven't responded to medicine
• some movement disorders, such as advanced Parkinson's disease
• head injuries, including skull fractures and blood clots
• infections such as abscesses, and some nerve damage.

What are the benefits of having brain surgery?

Brain surgery can be life-saving, or can prevent a life-threatening complication from developing further. It treats the underlying problem directly, whether that's removing a tumour, repairing a blood vessel, or relieving harmful pressure on your brain. Newer, less invasive techniques have also reduced the risks involved compared with older approaches, where these techniques are suitable for your condition.

Are there different types of surgical approaches?

• Craniotomy: the most common type of brain surgery. A piece of skull bone is removed to reach the brain, then replaced and secured afterwards.
• Awake craniotomy: used when the area being treated is close to parts of the brain controlling speech, movement, or feeling. You may be awake for part or all of the operation while your surgeon checks these functions.
• Neuroendoscopy (keyhole surgery): a thin tube with a camera is passed through a small hole in the skull, or through the nose or mouth, causing less disruption than a craniotomy.
• Endovascular surgery: your surgeon reaches the brain through a blood vessel, usually via a small cut in the groin, without opening the skull, to remove blood clots or treat aneurysms.
• Biopsy: removing a small sample of tissue to check under a microscope, sometimes with a needle guided by a computer, or as part of another operation.
• Deep brain stimulation: electrodes are placed in the brain and connected to a small device that sends electrical signals, used for conditions such as Parkinson's disease.
• Craniectomy: similar to a craniotomy, but the piece of skull isn't replaced straight away, usually to relieve pressure on the brain; it's put back later in a separate operation.
• Transsphenoidal surgery: removing a pituitary tumour through the nose rather than the skull; not suitable for larger tumours, which may need a craniotomy instead.
• Laser ablation: a laser probe passed through a small hole in the skull, used for areas too deep to reach safely with a craniotomy.

What happens before the operation?

• You have a physical examination and blood tests to check you're fit for anaesthetic and surgery.
• You have imaging scans, such as an MRI, CT, PET, or angiography scan, to give your surgeon detailed pictures of your brain.
• You usually attend a pre-assessment clinic appointment a week or two beforehand for fitness tests and to meet your treatment team.
• If you smoke, you're advised to stop several weeks beforehand.
• You may start steroids, antibiotics, or antiepileptic medicine, and may need to stop blood-thinning medicine a few days to a week before surgery.
• Some or all of your hair may need to be shaved, though this depends on your operation; for example, it isn't needed for a pituitary tumour removed through the nose.
• You usually go into hospital the day before, or on the day of, your operation.

What happens during the procedure?

1. You're given anaesthetic appropriate to your operation: usually a general anaesthetic so you're fully asleep, though some operations need you to be awake for part of the procedure.
2. Hair near the incision site is shaved and the area is cleaned, and your surgeon cuts through the skin and moves the tissue and muscle beneath.
3. For a craniotomy, your surgeon uses a surgical drill to remove a piece of skull bone, giving access to your brain; scans taken before and during surgery help guide them to the exact area involved.
4. Your surgeon treats the affected area, for example removing a tumour, repairing a blood vessel, or relieving pressure, using tools such as fine scissors, a suction device, an operating microscope, or a special fluorescent light to tell affected tissue from healthy tissue.
5. If you need to be awake for part of the operation, your surgeon reduces your anaesthetic partway through and asks you to speak, move, or describe what you feel; you won't feel pain, as the brain itself has no pain receptors.
6. Your surgeon replaces the piece of skull bone, securing it with small plates and screws, then moves the muscle and tissue back into place and closes the incision.

What does recovery look like?

In hospital

After surgery, you're moved to a recovery area, and, particularly after open surgery, often to an intensive care or high dependency unit overnight so your team can monitor you closely, before you move to a ward. How long you stay in hospital depends on your operation: some less invasive procedures need only a day or two, while recovery from an open craniotomy can mean up to 10 days in hospital.

You'll likely have a scan within a few days to check on your operation and any swelling, and you may be given steroids to reduce swelling and pressure, along with antiepileptic medicine to help prevent seizures.

At home

It's common to feel worse before you feel better, and to feel tired, sore, or have a headache for some time; your team gives you medicines to help with this. Recovery time varies enormously, from a few weeks for less invasive surgery to 6 weeks or several months for open surgery.

You may need rehabilitation, such as physiotherapy, speech and language therapy, or occupational therapy, to help you regain strength, mobility, or communication. You'll have regular follow-up scans and appointments in the weeks and months afterwards, which usually become less frequent over time, and if any tumour cells remain, you may be offered chemotherapy, radiotherapy, or both.

Many people find it helps to arrange extra support at home for the first few weeks after surgery, and a supportive pillow can make lying down more comfortable while your wound heals.

What are the risks and complications?

• Bleeding, infection, reaction to anaesthetic, or headaches.
• Short-term side effects such as difficulty speaking, brain swelling, confusion, dizziness, seizures or problems with movement or balance.
• Longer-term risks, including changes in behaviour, brain damage, difficulty walking, memory loss, speech problems, seizures or weakness in the arms or legs.
• For surgery through the nose specifically: rare risks include damage to the nerve controlling eyesight, a stroke or bleeding in the brain, infection of the brain's lining (meningitis), or reduced hormone levels.

Pain after brain surgery can be significant but your team will offer you pain relief options to keep you comfortable. Newer, less invasive procedures generally carry fewer risks and complications than open surgery.