FAQs in Brain Surgery

What is Neurosurgery?

Most people think of neurosurgeons as brain surgeons, and this is true! However, neurosurgeons are more broadly defined as highly trained medical specialists who diagnose and treat disorders of the entire nervous system – including our brain, spinal cord, skull, and spine (bony vertebral column). Of course, they operate on the brain, but they spend more time helping patients with spine and peripheral nerve disorders.

Do I need surgery if I am being referred to a neurosurgeon?

Not necessarily. Your referring physician most likely believes you have a disease or disorder that would benefit from diagnoses, testing, and treatment by a neurosurgeon. Whether or not to recommend surgery is complex, is best handled by your neurosurgeon and his/her team.

What is the difference between a neurologist and a neurosurgeon?

A neurologist and a neurosurgeon are similar to a cardiologist and a cardiac surgeon: the neurosurgeon can offer a surgical solution to neurologic disorders, while the neurologist identifies neurological disorders through diagnostic testing and uses non-surgical treatment options.

What questions should I ask my neurosurgeon on my first visit?

Do I need surgery? Are there other options such as medication, therapy, or other treatment alternatives such as radiation or chemotherapy? What are the risks of treatment? What are warning signs that I should look out for that might make surgery necessary?

What does a neurosurgeon want to see?

• If you have been diagnosed with a brain tumor and are meeting with a neurosurgeon for a consultation, please bring any brain images with the report.

• If you had prior surgery and are meeting with a neurosurgeon, please bring a pre-op MRI along with the most recent MRI and pathology report (including slides, if possible).

• If you had chemotherapy or radiation and are meeting with a neurosurgeon, please bring notes from the oncologist and the radiation planning MRI on a disc.

Have all our non-surgical alternatives been exhausted?

A responsible doctor will not recommend surgery unless non-surgical alternatives have been explored and exhausted.

What happens if I elect not to have the surgery? Will my condition worsen?

It’s important to consider what your life might be like without undergoing surgery. Would you stay the same, get worse, or is there a chance for recovery without the procedure?

Any options apart from surgery?

Generally, in cases of brain tumors and brain hemorrhage, surgery is necessary if they are large and cause pressure on the brain. Thus, it becomes a life-saving procedure. But, it differs from patient to patient. In cases of brain hemorrhage due to high blood pressure, surgery may not be indicated if the hemorrhage is extensive (spread all over the brain) or if it is too small.

Can we wait for surgery/Can we do the surgery after 3 months?

Again, it differs from patient to patient. In general, it is not advisable to wait as delaying the surgery may cause permanent deficits and delay recovery. Brain tissue does not regenerate, once destroyed.

How risky is it?

Surgery on the brain and spinal cord is not without risks. They are specific to the underlying problem. Some of the risks that can arise during brain surgery are:

• Reaction to anesthetic medicines

• Breathing problems

• Blood clots and infections

• Speech and memory problems, weakness in muscles. These may last for some time and go away after that

• Bleeding in the brain

• Stroke

• Seizures

• Brain infection

• Brain swelling

I have blood pressure and diabetes for a long, is that a problem?

High blood pressure and diabetes affect the entire body (including the heart, kidneys), mainly the blood supply to the organs. It can create problems for any surgery.

Will I have permanent deficits after the brain surgery?

Many times, the primary disease (like say brain tumour, trauma, or brain hemorrhage) destroys the neural tissue, which can cause permanent deficits.

If I get a tumor, how long does it take to recover?

Every tissue has its own healing power. For example, skin stitches are removed on the 7th day, whilst plaster (applied for fractures) is removed after 6 weeks. Brain healing is still longer, anywhere between 3 months to a year.

Do you have adequate infrastructure for such surgeries?

Neurosurgery, like heart surgery, can not be done in a small setup. These specialties require extensive backup and facilities both during surgery and post-operatively. They require teamwork of skilled and trained personnel.

What are the chances that my children could have the same problem?

There are few diseases, which have genetic expression and can get transmitted to the next generation, like neurofibromatosis 2. Brain tumours generally don’t get transmitted to the next kins, except few exceptions.

What is the Golden hour in brain stroke?

Brain stroke is an emergency. The patient must reach the hospital within 3 hours of starting the symptoms, preferably within 60 minutes (called ‘door to needle time’) for the best possible outcome.

Is Brain surgery expensive?

Yes, brain surgery is expensive in private hospitals.

If I can’t afford the private hospital, is it safe to go to general hospitals?

Of course, yes. The General hospitals can be well equipped too.

Is it open surgery or Endoscopic?

With the advent of technology, Endoscopic brain surgery is becoming famous now. It is possible to use endoscopes, where the brain tumours could be accessed through the nose, like pituitary tumours, particularly if they are small. In general, large tumours which are causing severe pressure and involvement of multiple brain structures are operated on by removing a part of the skull (craniotomy).

Are you doing laser surgery on a brain tumour?

This technology is not available everywhere. It is very helpful for both benign and malignant brain and spinal tumours, those are deep inside the brain or hard to reach with open surgery. Stereotactic laser ablation is a treatment option for brain tumors. It is also called “Laser Interstitial Thermal Therapy,” abbreviated LITT. LITT uses focused light from a laser to heat and destroy tumors. A specially-trained neurosurgeon performs this procedure within an MRI scanner. LITT may be used on smaller brain tumors, for side effects of radiation therapy, and/or on tumors that grow despite radiation and chemotherapy.

Will you operate again after tumour biopsy?

A biopsy is a small representative piece of tumour that is sent for histology. Generally, it is a part of a single procedure, where the tumour is excised.

What’s next, if my tumour could not be removed completely?

There are various reasons why the tumour is or can not be removed completely during the first surgery. The common reason is when it is adherent or infiltrated into the vital structures of the brain or spinal cord. Such residual tumours either can be watched carefully for regrowth or treated with other adjuvant therapies like radiotherapy and or chemotherapy, depending upon the histological type.

What is the preparation required before surgery?

All the investigations are done prior to surgery. The risk factors for anesthesia and surgery are discussed with the patient. The blood thinners like aspirin are stopped for 5 days before planned surgery. Anti-hypertensives and anticonvulsants should not be stopped under any circumstances. On the night before surgery, detailed instructions are usually given on the pre-anesthesia visit, but as a general rule, you should not eat or drink after midnight. You may have a light snack before midnight so you will be less hungry on the morning of surgery.

What happens after brain surgery?

Immediately after the surgery, you’ll be monitored closely to ensure everything is working properly and that there are no complications. You’ll mostly be made to sit in an upright posture to prevent swelling of your face and brain. The recovery from the surgery depends on the type of surgery done. How long you stay in the hospital will depend on the success of your recovery. You may have to take pain medications during this time. Before leaving the hospital, your doctor will tell you how to take care of your wounds.

After surgery, when do I call my surgeon?

If you experience any of the symptoms below, please call your doctor immediately:

• Any fever greater than 101.5

• Any new weakness in arms or legs

• Change of mental status

• Any seizure activity

• Any drainage coming out of the incision

• Worsening headache unrelieved by any medication

• Increased swelling/redness at the incision site

• Pain/redness in leg(s)

• New confusion or increase in confusion

How long will I be in the hospital?

The usual length of stay for patients who undergo a craniotomy for a brain tumor, with no complications, is generally 5 days. Patients who have postoperative difficulties may be required to stay longer. Complicated brain tumours or those who come in an emergency situation (like brain hemorrhage or brain trauma) may need hospitalization for a much longer time. You may need to stay in the hospital for about 3-10 days after the surgery is complete. However, the length of your stay in the hospital also depends on your operation and how long you take to recover.

What should I expect after discharge?

A majority of patients who undergo brain tumor surgery feel surprisingly well afterward. However, you will be restricted to 4 weeks of non-strenuous activity. This includes:

• No heavy lifting >1-2 kgs for 4 weeks

• No pushing while moving bowels for 4 weeks

• No strenuous activities such as working out or running

Will I have a lot of pain afterwards? If so, how will it be managed?

Pain is usually minimal since there are only a small number of pain nerve endings in the head. Nevertheless, you may experience headaches and other tenderness in the area that was affected. This can be treated with non-narcotic medications.

Can brain surgery cause brain damage?

Brain surgeries are often complex and sometimes risky, and sometimes areas of the brain do not function as well for a while afterward. This can be due to local swelling of the tissues, as occurs in any type of surgery. Most often, any post-operative problems are temporary and settle fairly quickly. However, the risk of permanent impairment of function from a surgical procedure does need to be carefully assessed pre-operatively. The risk of intervention versus the risk from the disease process is a critical consideration in deciding whether or not surgery is appropriate, but your surgeon will take you through this decision-making process carefully.

Usually, your doctors would give you some idea about your recovery journey. Since brain surgery differs from person to person, your specialists are the best people to speak to for information.

With advances made by medical technologies, brain surgeries are able to be performed with a greater margin of safety than ever.

Can brain surgery be done awake?

Awake surgery can indeed be performed on the brain but it is only very rarely required. Awake surgery of your brain may have a role when the surgery is carried out in parts of your brain that control speech or movement. Your surgeon would determine if it is necessary to consider monitoring these functions of your brain while performing surgery. Awake surgery can potentially lower the risk of side effects post-surgery and can be performed without pain. It is however a daunting prospect for the patient and fortunately is only rarely necessary.

Can brain surgery change your personality?

Brain surgery is a major event in a person’s life, and it can be a while before you recover from it. It is common for patients to notice side effects like confusion, mood swings, or issues with speech. However, the impact of brain surgery on personality differs from person to person. There are many factors that contribute to the changes in your behavior like the type and size of the tumour, the effects of other treatments like chemotherapy and radiotherapy, or the overall fitness of the patients. Occasionally personality change can result from the presence of a tumour within a part of the brain that regulates aspects of personality (typically the frontal lobes of the brain), or from surgery to treat it.

Can brain surgery be fatal?

The vast majority of surgeries can be performed safely and effectively, with minimum risk. The risk to one’s life from an operation on the brain is very small, but it does vary from one procedure to another, depending on the structures that are involved in the disease process for which the surgery is being performed.

In general, one should only elect to have brain surgery when the alternative to the operation (ie the risk or degree of incapacity from the disease) is of higher risk than the operation itself. The vast majority of surgeries can be performed safely and effectively, with minimum risk. However, no intervention is without risk and the pros and cons of any surgical procedure need to be carefully considered and discussed before proceeding.

Can brain surgery cause dementia?

Brain surgery doesn’t cause dementia. A dementia–like process can sometimes result in the long term after radiotherapy to the brain for treatment of some tumours, but not from surgery itself.

Can brain surgery help autism?

There is no evidence that brain surgery plays any role in the treatment of autistic spectrum disorder.

Can brain surgery cause depression?

Brain surgery is a major event in someone’s life. It is not unusual for a patient to feel mood swings, sudden emotional responses etc. Occasionally some people can develop depression after surgery, although it is usually temporary and treatable. This is most commonly seen after some surgical procedures to cure epilepsy.

The recovery journey post brain surgery can be challenging with people suffering from some kind of emotional issues within weeks lasting shorter durations and some might find it difficult to control their emotions for a period of time.

Can stress lead to brain tumors?

No, being stressed doesn’t directly increase the risk of cancer. The best quality studies have followed up many people for several years. They have found no evidence that those who are more stressed are more likely to get cancer.

Can a brain tumor come back after surgery?

Unfortunately, many brain tumors can recur even after successful surgery and standard treatments. You need to be aware that tumor recurrence is a potential reality during the brain tumor path. If a meningioma tumor is not removed completely, it is likely to regrow within 10 to 20 years

How do I know if my brain tumour has come back?

If your brain tumour comes back after treatment or starts to grow again, you are likely to have similar symptoms to when you were diagnosed.

Does only backache be an indication for surgery?

The cause of backache needs to be determined by X-rays, CT scans, and or MRI. Just backache can not be an indication for surgery unless it is because of fracture, instability, severe stenosis, or tumour.

Back surgery might be an option if conservative treatments haven't worked and the pain is persistent and disabling. Back surgery often more predictably relieves associated pain or numbness that goes down one or both arms or legs. These symptoms often are caused by compressed nerves in your spine.

Who will operate on my spine, neurosurgeon or orthopaedic?

Both specialities are trained for such surgeries. Each of these surgical specialists has their own areas of expertise however, their skill and expertise overlap in the area of spinal surgery. Generally, when spinal cord is involved, the neurosurgeons are preferred.

Will a neurologist be there for my surgery?

Only if there is neurophysiological monitoring during surgery.

How long will I survive after brain surgery?

Brain surgery survival rates depend mainly on the type of tumour, the extent of removal, and the age and health of the patient. On average, brain surgery's long-term survival rate can be between 50-70% except in cases of malignant tumors where chances are lowered.

How soon can I join my work after brain surgery?

It differs from case to case. Working out involving heavy lifting and strenuous running is to be strictly avoided after a brain operation. Any activity that may cause sudden internal movements and strain, such as pushing or swimming, is also not recommended.

It is necessary to consult with your doctor after brain surgery before starting any intense physical activity and get a complete follow-up assessment performed.

How soon can I join my work after spine surgery?

Generally, a good rest for 6 weeks is recommended after spine surgery, though complete bed rest is not necessary.

Can I drive a car after brain surgery?

No. Driving is a complex activity that requires several cognitive and behavioral skills and a decent amount of coordination. It’s possible that you retain part of your driving abilities and can go back to driving later.

Does insurance cover brain or spine surgery?

Yes.

Do I need a second opinion?

You may go for it, if you have any doubts about the indication for surgery or if your symptoms persist or aggravate even after surgery.

SECOND OPINION SHOULD BE TAKEN ONLY FROM SENIOR OR EXPERIENCED SPECIALIST FROM THE SAME FIELD.