Brain Surgery

Overview

What is brain surgery?

Brain surgery is any procedure that addresses abnormalities in your brain. The brain is part of your central nervous system. It controls your ability to speak, move, think and remember. Brain surgery aims to treat problems without disrupting these important functions.

During brain surgery, a surgeon might remove some of your brain or an abnormal growth in your brain, like a tumor. Surgeons can also repair parts of your brain that have damage, such as leaky blood vessels.

Sometimes brain surgery requires an incision (cut) in your brain. But there are also many procedures that can access your brain through your nose, mouth or even a tiny cut in your leg. Minimally invasive brain surgery poses fewer risks than open brain surgery and helps you heal faster.

Who needs to have brain surgery?

There are many reasons you may need to have brain surgery, including:

What are the different types of brain surgery?

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

  • Biopsy: A brain biopsy is an examination of a tissue or fluid sample from the brain, 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).
  • 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, epileptic tissue or to relieve pressure in your brain.
  • Deep brain stimulation (DBS): DBS is a treatment for Parkinson’s disease, tremor and other neurological conditions. A surgeon places electrodes inside your brain. A small device outside your brain controls when the electrodes deliver electrical impulses. DBS regulates abnormal brain activity.
  • Endovascular surgery: 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: Sometimes a surgeon can perform brain surgery through your nose or mouth. First, they insert an endoscope (a thin, lighted tube with a video camera on one end). Then, the surgeon funnels surgical tools through the tube. This way they can 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, use of a laser probe, passed through a tiny hole in the skull may allow destruction of a tumor, radiation injury or epileptic tissue.

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 actually a type of surgery because there are no incisions. A healthcare provider aims beams of radiation at your head to destroy or shrink tumors.

Procedure Details

How do I prepare for brain surgery?

Brain surgery requires careful planning. First, your healthcare provider does 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 exams such as MRIs, CT scans, PET scans or an angiography. These scans 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.

Your surgeon or other healthcare providers will also give you information about:

  • Making adjustments to your health before surgery: If you smoke, 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. Anti-epileptic 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 after surgery: 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?

Brain surgery is different for each person. Sometimes the surgical team needs to shave part of your head to operate, or they may just shave a tiny area to make an incision (cut). Your head won’t need to be shaved at all for most minimally invasive surgeries.

Some procedures require general anesthesia, which means you’re completely unconscious. But other procedures only need sedation, meaning you’re partially asleep but can still respond to certain stimuli. During certain surgeries, you may even be awake during surgery. This is the case for some tumors, epilepsy or neurological conditions.

During an awake craniotomy, you receive anesthetic on your head, so you don’t feel pain from the incision. You also receive sedation to put you into a light sleep. But your surgeon and anesthesiologist 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. Prior to surgery, they may monitor your brain function using a functional MRI. Providers call this interoperative brain mapping. This process helps your surgeon avoid important areas of the brain during surgery.

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

What happens after brain surgery?

After your 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 continue to receive steroids or anti-seizure medications to prevent brain swelling and seizures. You may also need neurorehabilitation to restore certain functions. This may include care from physical therapists, speech-language pathologists and occupational therapists. They can help you regain strength, mobility, speaking skills and the ability to perform daily tasks, if needed.

Risks / Benefits

What are the risks of brain surgery?

As with any surgery, brain surgery carries risks of bleeding, infection or reactions to anesthesia. Other side effects that can occur immediately after surgery include:

The biggest long-term risks after brain surgery include:

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

What are the benefits of brain surgery?

Brain surgery can be a life-saving procedure. It can treat strokes, brain bleeds, tumors and other serious medical problems. Advances in medical technology have also made brain surgery safer than ever before. Newer, less invasive procedures are available, greatly reducing risks of complications.

Recovery and Outlook

What is the outlook after brain surgery?

Everyone recovers differently after brain surgery. It can take weeks to recover from less invasive brain surgeries. Or it may take months for you to heal from a major procedure like a craniotomy.

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 scans to make sure the problem hasn’t returned.

When to Call the Doctor

When to Call the Doctor

It is normal to experience side effects, and to even feel worse after your brain surgery before you feel better. But, there are some problems that are not normal, and you should contact your surgeon or other 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 sight, hearing or speaking.
  • Trouble walking or weakness in the 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.
  • Seizure.

Call 911 or go to the emergency department if you experience:

  • Difficulty breathing.
  • A seizure, when you haven’t had one before.
  • A different type of seizure than what you’ve had before.

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 (cut) 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 the ability to speak, walk or think. Some people need rehabilitation after surgery to regain function.

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