Brain Surgery

What is brain surgery?

Brain surgery is a procedure that treats brain abnormalities or issues within your brain and the surrounding areas. The brain is part of your central nervous system. It controls your ability to speak, move, think and remember. Brain surgery treats underlying conditions in, on or around your brain without disrupting your body’s important functions.

There may be several reasons why someone would need brain surgery. A surgeon might remove some of your brain (for seizures) or a growth in your brain (brain tumor). Brain surgery can relieve pressure on your brain, whether it be from blood or increased cerebrospinal fluid (hydrocephalus). Surgeons can also treat blood vessels that are abnormal, such as aneurysms.

Risks are possible with brain surgery and you’ll need to stay in the hospital after your procedure so your care team can monitor your healing.

Who performs brain surgery?

A neurosurgeon will perform brain surgery. They’ll have a team of highly trained medical professionals supporting them during surgery, along with an anesthesiologist who will provide anesthesia so you don’t feel pain.

What are the types of brain surgery?

There are many types of brain surgery. Some of the most common include:

• Biopsy: A brain biopsy is the removal of a small piece of tissue or fluid sample from the brain. A pathologist examines it, usually to find out if a tumor is cancerous. A healthcare provider may do a stereotactic (computer-guided) needle biopsy by inserting a needle into your brain to get the sample. Or they may remove some tissue during open surgery.
• Craniotomy: A craniotomy is open brain surgery. A surgeon removes a piece of your skull to access your brain, then replaces the piece after surgery. You may need a craniotomy to remove a tumor, blood clot, arteriovenous malformation or epileptic tissue.
• Craniectomy: Similar to a craniotomy, a craniectomy is a procedure where a surgeon will access your brain by removing a piece of your skull, but not put it back in the same surgery due to concern for pressure on the brain. Your surgeon will replace the piece of your skull during a second surgery called a cranioplasty.
• Deep brain stimulation (DBS): DBS is a treatment for Parkinson’s disease, tremors and other neurological conditions. A surgeon places electrodes inside of your brain. A small device outside your brain controls when the electrodes deliver electrical impulses to the affected area.
• Endovascular surgery: Endovascular surgery occurs when a surgeon makes a tiny cut in your groin and inserts a catheter (a thin, flexible tube) into a blood vessel. They thread the catheter up to your brain without cutting into your skull. There, they can remove blood clots (thrombectomy) or repair aneurysms.
• Neuroendoscopy: Neuroendoscopy is a less-invasive form of brain surgery where a surgeon can access your brain through your nose or mouth. Your surgeon will insert an endoscope (a thin, lighted tube with a video camera on one end) into your nose or mouth. They’ll funnel surgical tools through the tube to treat and remove tumors without cutting into your skull.
• Laser ablation: Some conditions may be too deep in the brain for safe access through a craniotomy. In these cases, the use of a laser probe, passed through a tiny hole in your skull, may allow your surgeon to remove (ablate) a tumor or epileptic tissue.

What does brain surgery treat or manage?

There are many reasons why you may need to have brain surgery. Some of the most common include:

• Arteriovenous malformations.
• Blood clots.
• Brain aneurysms.
• Brain tumors.
• Epilepsy.
• Hemorrhages.
• Hydrocephalus.
• Nerve damage.
• Parkinson’s disease.
• Stroke.
• Traumatic brain injuries (TBIs) and skull fractures.

How should I prepare for brain surgery?

Brain surgery requires careful planning. Your healthcare provider will perform a physical examination and blood tests. They want to make sure you’re healthy enough for anesthesia and surgery.

You may also have a range of imaging tests, such as:

• MRIs (magnetic resonance imaging).
• CT (computed tomography) scans.
• PET scans (positron emission tomography).
• Angiography.

These imaging tests create highly detailed pictures of the tissues, nerves and blood vessels in your brain. The pictures help your surgeon locate the exact areas that need treatment.

Before your surgery, your surgeon will give you information about:

• Making adjustments to your health before surgery: If you smoke tobacco products, you should stop several weeks before surgery. Smoking increases the risk of surgical complications and can make it harder for you to heal.
• Stopping or starting certain medications before surgery: Some people take steroids before brain surgery to reduce the risk of swelling. Antibiotics reduce your risk of infection after surgery. Antiepileptic drugs reduce the risk of seizures. If you take blood-thinning medication you may need to stop this a few days or a week before surgery.
• What to expect during and after surgery: Your surgeon will give you information about the procedure, answer any questions you may have and explain the possible side effects. Depending on the type of procedure you have, there may or may not be a lengthy recovery period. And you may need neurological rehabilitation.

What happens during brain surgery?

The brain surgery procedure varies based on the type of brain surgery you need. Your surgeon will explain what will happen during your surgery when you meet with them before the date of your procedure.

You can expect the following during open brain surgery:

• An anesthesiologist will give you anesthesia.
• Your surgical team will shave your hair that’s near the incision site. They’ll clean the area after removing your hair.
• Your surgeon will make an incision (cut) into your skin.
• They’ll cut and move tissue and muscles.
• Your surgeon will use a surgical drill to make holes in your skull bone. They’ll use a surgical bone-cutting drill bit to cut in between the holes to remove a piece of your skull.
• Your surgeon will treat your brain. This could include removing a tumor, relieving pressure or repairing blood vessels.
• Your surgeon will replace the removed portion of your skull and secure the bone in place with plates and screws. Then, they’ll move muscles and tissue back into place.
• Your surgeon will close the incision in your skin.

If you’re undergoing endovascular surgery or a neuroendoscopy, your surgeon won’t make an incision on your head and they won’t need to open your skull. Instead, they’ll use specialized tools and techniques to reach your brain through your nose, mouth or blood vessels in your groin.

Will I be awake for brain surgery?

You may be awake for brain surgery.

Some types of brain surgery require general anesthesia, which means you’re completely unconscious and asleep. But other procedures only need sedation, meaning you’re partially asleep but can still respond to certain stimuli.

During certain surgeries, you need to be awake. This is the case for some tumors, epilepsy, deep brain stimulation or neurological conditions. When you’re awake, you’ll receive anesthetic on your head, so you don’t feel pain from the incision. You’ll also receive sedation to put you into a light sleep. Your surgeon and anesthesiologist will wake you up during the surgery and ask you to perform tasks. You may need to speak, move a body part, look at objects or remember information. This process helps your surgeon avoid important areas of the brain during surgery.

Where will a surgeon make an incision during brain surgery?

The location of the incision (cut) during brain surgery depends on what your surgeon needs to treat. Sometimes brain surgery requires opening your skull to make an incision in your brain. But many procedures can access your brain through your nose or mouth. Minimally invasive brain surgery poses fewer risks than open brain surgery and helps you heal faster.

How long does brain surgery take?

Brain surgery can take anywhere from two to six hours or more, depending on the complexity of your surgery.

What happens after brain surgery?

After brain surgery, you’ll stay in the hospital for observation. For less invasive procedures like endovascular surgery, you might only need to stay for one to two days. But after an open craniotomy, you might need to stay in the hospital for up to 10 days. You may be in intensive care after open brain surgery overnight so your care team can monitor your vitals before you move to another area of the hospital to rest.

While in recovery, you may feel tired, sore or have a headache. Your care team will give you medications to help you feel comfortable. Your healthcare providers may recommend you continue taking medications they prescribed to you before your surgery to make sure you don’t have complications.

You can expect to get regular imaging tests of your brain after surgery. You’ll also schedule times to meet with your care team within days, weeks and months so they can continue to monitor your healing progress.

Rehabilitation may be part of your recovery. This can help you restore certain functions that surgery may affect, like your strength, mobility and ability to talk. Your care team may include physical therapists, speech-language pathologists (SLPs) and occupational therapists.

What are the benefits of brain surgery?

Benefits of brain surgery include, but aren’t limited to, the following:

• Saving your life or preventing life-threatening complications.
• Treating an underlying medical condition.
• Removing a tumor.
• Reducing pressure on your brain.
• Repairing a brain abnormality.

How successful is brain surgery?

The success of brain surgery varies depending on the type of procedure and your general health at the time of surgery. Your surgeon will explain the risks and benefits of surgery before the procedure so you can make an informed decision about your health. Advances in medical technology make brain surgery safer than ever before.

What are the risks or complications of brain surgery?

As with any surgery, brain surgery carries risks. The most common complications of brain surgery include:

• Bleeding.
• Infection.
• Reactions to anesthesia.
• Headaches.

Common side effects after brain surgery include:

• Aphasia (difficulty speaking).
• Brain swelling.
• Confusion or delirium.
• Dizziness.
• Movement or balance problems.

The most common long-term risks after brain surgery include:

• Behavior changes.
• Brain damage.
• Difficulty walking.
• Memory loss.
• Problems with speech.
• Weakness in your arms or legs.

Complications of brain surgery can be life-threatening. Newer, less invasive procedures are available, greatly reducing risks and complications.

What is the recovery time for brain surgery?

Your recovery time varies based on the type of brain surgery you need. On average, it can take a few weeks to recover from a less invasive form of brain surgery. For open brain surgery, the recovery time can range from six weeks to several months. Your surgeon will explain a time estimate of when you should expect to feel better.

Talk to your healthcare provider about when it’s safe to return to work and normal activities. Depending on the surgery you had, they can give you specific recommendations. It’s important to go to your follow-up appointments in the weeks and months following surgery. You may need imaging tests to review your healing progress.

When should I call my healthcare provider?

It’s normal to experience side effects and to even feel worse after your brain surgery before you feel better. But some problems aren’t normal, and you should contact your surgeon or healthcare provider about them:

• Difficulty peeing (urinating). Loss of control of urination or bowel movements.
• Trouble staying awake or waking up.
• Fever or nausea/vomiting.
• Severe confusion, big changes in mood or behavior or hallucinations.
• Difficulty with your seeing (vision), hearing or speaking.
• Trouble walking or weakness in your legs or arms.
• A stiff neck or headaches that are worse than before.
• No feeling, numbness or pins and needles in your arms, legs or face.
• Fainting.
• New weakness or numbness.

Call 911, your local emergency services number or go to the emergency department if you experience:

• Difficulty breathing.
• A seizure.
• Signs of a stroke.

Is stereotactic radiosurgery brain surgery?

Stereotactic radiosurgery is a type of radiation therapy for brain cancer. One of the most commonly used technologies is Gamma Knife® radiosurgery. Despite its name, it’s not a type of surgery because there are no incisions. A healthcare provider aims beams of radiation at your head to destroy or shrink tumors.

A note from Cleveland Clinic

Brain surgery can treat a variety of serious medical conditions, including brain tumors, aneurysms and epilepsy. Some types of brain surgery require an incision in your skull and brain. Other procedures are minimally invasive and may not require any incisions. The biggest risks with brain surgery include loss of function, such as your ability to speak, walk or think. Rehabilitation after surgery can help you regain these functions. Your care team can answer any questions you may have about the procedure and they’ll be available to help you during your recovery.