Your Craniotomy

Neurointensive Care Unit (NICU) General Hospital 899 West 12th Avenue Vancouver BC V5Z 1M9 Tel: 604-875-4111

Neurosciences Critical Care Unit (NCCU) Lions Gate Hospital 231 East 15th Street BC V7L 2L7 Tel: 604-988-3131 Introduction What is a Craniotomy? The purpose of this pamphlet is to help you and your The surgical procedure you will undergo is a Craniotomy. family prepare for your brain surgery. When reading It is a temporary opening of part of the skull bone. (Crani this pamphlet, it is important to remember that medical refers to the skull bones; otomy means ‘to cut into’.) Your treatment and health care are tailored to each person’s Neurosurgeon performs a craniotomy to gain access to the unique needs. disease or injury affecting the brain, its coverings, its blood The information presented here is general information. vessels or its cranial nerves. Most of the time, at the end of The questions listed in the pamphlet are ones that are the procedure the bone is replaced. commonly raised by patients and families when facing brain surgery. Read the pamphlet carefully. Why is it done? If you have any questions or concerns, please feel free to A craniotomy is done to: discuss your concerns with your Neurosurgeon, Nurse and • Remove a tumour or cyst Health Care Team members (Physiotherapist, Occupational Therapist, Pharmacist, Social Worker, Speech Language • Obtain a biopsy (tissue sample) Pathologist, and Care Management Leaders). • Remove a blood clot known as a hematoma • Repair a ruptured blood vessel known as an aneurysm The patient’s responsibilities • Remove an abnormal collection of blood vessels known as an arteriovenous malformation (AVM) It is your decision to have surgery. Understand that your • Drain an abscess disease or injury may limit the potential success of surgery. Recognize that your physical fitness and mental attitudes • For epilepsy – removal of the area producing the seizures are key factors in your body’s ability to heal. Approach your • Repair certain fractures of the skull (most do not need surgery with confidence, a positive attitude and a thorough a craniotomy) understanding of the surgery and expected outcome. • To relieve the pressure of a blood vessel against a cranial Ask questions. nerve (microvascular decompression for hemifacial spasm) • Insert certain brain implants/hardware (such as deep brain stimulators, Ommaya reservoir, Ventriculoperitoneal shunts, etc) The goal of all craniotomies is to remove, repair, or prevent, as much of the problem as feasible with as little injury to the brain as possible.

2 3 Are there risks? Preparing for your surgery There are known risks with any surgical procedure. Before Admission Although complications are rare and every effort is taken • Arrange appropriate house sitting, childcare or pet care. to avoid complications, they may occur. Your Neurosurgeon will discuss with you and your family in detail the potential • Arrange for transportation home and support when you complications associated with your specific case. go home. • Limit the money you bring into hospital to an amount that will cover personal comforts such as newspaper, Will I be able to think telephone, taxi ride home. clearly after surgery? • Do not bring valuables (jewellery, credit cards, lap tops, This is a common concern, but unless there is a rare etc.) into the hospital. complication you should be able to think clearly after your • If you have been taking part in any complementary therapy, surgery. Your Neurosurgeon will discuss with you and your such as, Naturopathy, Herbal treatments, Qi Gong, etc., family in detail the potential complications associated with please inform the neurosurgeon so that these therapies can your specific case. Preexisting neurological deficits may be assessed for safety and compatibility with medications improve, stay the same, or worsen after surgery. you will be given before, during, and after surgery.

Admission to the Hospital Most patients are admitted the morning of their surgery. This allows most patients to rest comfortably at home in familiar surroundings. Very occasionally patients are admitted the day before surgery to have some special tests done. In terms of preparing yourself for surgery, you should know your surgery might be postponed. There are a number of reasons surgery is postponed. These include lack of patient beds, operating room time and appropriate Health Care Team members. Sometimes too many emergencies come to the hospital and fill the available beds. Or some patients may stay in hospital longer than expected and again decrease the beds available. Your surgery and care following surgery requires a Team of experts (e.g. nurses, doctors, and technicians). If the appropriate skilled Team member is not available, your surgery and admission date may be postponed 4 5 The night before your surgery The Operating Room When it is time for your surgery, escort will take you on Whether you are in the hospital or at home your a stretcher to the Preoperative Area. A nurse will admit preparation for surgery the night before is the same. Before you and you will wait here on the stretcher until the going to bed, shower with soap and shampoo your hair, operating room is ready. A family member or friend may which will help prevent infection. You must remember wait with you in the Preoperative Area. The neurosurgeon NOT to eat food or drink any alcohol after midnight. Your or designate will mark and confirm your craniotomy site. Anesthetist will tell you if you are allowed to drink clear At VGH you will be involved in the perioperative nasal fluids, such as tea or water, up to 3 hours before your decolonization study – involves nasal swabbing prior to surgery. Try to get a good night’s sleep since a well rested surgery. Other site specific procedures may be used. body helps you recover from your surgery. The nurse who will care for you during your surgery will take you to the operating room. The Anesthetist will then The day of surgery give you medication to put you to sleep. After you are The morning of your surgery asleep, your Anesthetist will place a tube through your mouth into your throat to help you breathe. When you wake up in the morning, shower and shampoo if you did not have a shower the night before. Make an Your Anesthetist may start another IV line (central venous effort to have a normal bowel movement before your catheter) in your neck vein to monitor your body’s fluid surgery. You may continue to take all your medications, needs. A small line may be put into your artery in your unless you receive different instructions from your wrist to monitor your blood pressure (BP) during surgery. neurosurgeon or anesthesiologist. A catheter may be put in your bladder to measure your If admitted on the morning of your surgery, please arrive urine output. All these lines and the catheter may stay in at the hospital’s Admitting Department at the time you for a couple of days after surgery to allow your nurse to were given. continue to monitor your body’s needs. Your Neurosurgeon, Neurosurgical Resident, or At the hospital other surgical staff will perform your surgery. You will be given a hospital gown to wear. You will have an intravenous (IV) line started in your arm. This IV line will provide you with fluids that you would normally get from drinking. Medications can also be given by the IV line.

6 7 Will I lose my hair? Who will be present This is a common concern for both women and men. in the operating room? The neurosurgeon will attempt to remove as little of your Your Neurosurgeon will hair as possible. be assisted by a number of people. There will be Where will the incision be? a neuroanesthesiologist, one or two neurosurgical The incision and length of the incision will depend on the residents, the scrub nurse part of the brain your Neurosurgeon needs to reach. who passes the instruments to the neurosurgeon, Will I look the same? and a circulating nurse who ensures the smooth Depending on where the skin incision is made and where functioning of the the bone is removed, you may or may not have a swollen operating room. Some complex tumours may require a and bruised face. This usually occurs surrounding the neurophysiologist and technicians for monitoring brain eye on the side of surgery. The swelling and bruising will function. An anesthesiology resident, medical students and disappear with time. Your staples will be removed in about nursing students may also be present. 7 to 10 days. A bandage will cover your incision. How long will my surgery be? Your Neurosurgeon will give you and your family an approximate length of time your surgery will take. Your family should not worry if the surgery is longer than expected, as your Neurosurgeon will utilize whatever time is needed to safely perform the surgery.

8 9 Family waiting room After your surgery Family members describe their waiting time as a time of uncertainty, worry and anxiety. Some families have found The Recovery Room: waiting in the Critical Care Waiting Room very difficult After your surgery, you will be taken to the Recovery Room. as this room is shared with families waiting to hear news You will stay here for an average of one to two hours while about patients who have been in major accidents. Brain you wake up from your anesthesia. You are expected to be surgery often takes longer than other surgical procedures. able to respond to your nurse and doctors within 15 to 30 So the length of time waiting to hear the news is longer. minutes. When left undisturbed, you will drop off to sleep. This increases anxiety and stress. It may be best that your Your blood pressure (BP), pulse, level of consciousness, family go home or back to their chosen accommodation to and motor strength will be monitored. Your nurses will be wait for the call from the Neurosurgeon. assessing your motor strength by asking you to do certain Some family members find it best to go to work. Whatever tasks such as wiggling your toes, pushing down and pulling your family decides, they must designate one person back with your feet, and squeezing the nurse’s fingers as a contact and ensure that their phone or cell phone with your hands. Your nurses will check your level of number is left with your nurse who writes it on your chart. consciousness by asking such questions as: your name, the All family questions should be channeled through one date, the year, and where you are. They will also check your designated family member. Your Neurosurgeon will contact eyes with a small flashlight to see what size your pupils are your designated family member as soon as possible after and if they react to the light. You may have a foley catheter your surgery. in to help drain your bladder. The catheter can cause some irritation i.e. feeling as if you still have to pee, but it is best to keep the catheter in so the nursing staff can better evaluate you. Usually families are not allowed to visit in the Recovery Room except under special circumstances.

10 11 Neurointensive Care Unit (NICU) at swelling. The drain will be removed 24 to 48 hours following surgery. Its removal will not give you any discomfort. VGH & Neurosciences Critical Care Unit You will become aware of plastic sleeves (calf compressors) (NCCU) at LGH wrapped around your legs from ankle to groin. These From the Recovery Room, you will be taken to the NICU or sleeves are air-filled and massage your legs to promote NCCU. Your nurse will admit you and continue to assess you circulation of the blood in your legs. They will be removed hourly just as the Recovery Room nurses have. You may find once you start to get up. this bothersome but it is a necessary part of your care. The Your recovery will be enhanced by being active even though assessments will be less often as your condition improves. you are in bed. You will be assisted to turn every two After your nurse has admitted you, your family can visit. If hours. This turning will help your circulation, prevent you they have not already received one, they should ask for the from becoming too stiff and prevent complications such as information pamphlet Neuro Intensive Care Unit (NICU) - pneumonia. In a day or two you will have help to sit at the FM.022.N398 for VGH or Welcome to 7E NCCU Neurosciences side of the bed and then your activity will be increased to Critical Care Acute Stroke - JB.305.W45 for LGH. sitting in a chair and to walking. When you are awake in the NICU you will see and hear After your surgery, your nurse will check your stomach for a number of unfamiliar things. You will find that various bowel sounds with a stethoscope. You will be able to start cables will attach you to a bedside monitor that displays eating and drinking once your stomach starts to grumble, your vital signs and may also beep. You will hear other and when you are able to safely swallow. Your diet will move monitors/equipment beeping, buzzing, hissing or alarming. from clear fluids to solid foods as tolerated, and as long as These are all normal sounds of equipment used in the they can be safely eaten/swallowed. critical care areas. At some point the Foley catheter inserted into your bladder You may find that your eyesight seem a little blurry. This is will be removed. Some people may experience pain or from the ointment that the anesthesiologist placed in your difficulty going to the bathroom. Please let your nurse eyes to keep them moist during surgery. You will see clearly know if this happens. again after your eyes are wiped. You may have an oxygen mask over your nose and mouth to assure that you are getting enough oxygen to your healing tissues. You will be encouraged to deep breathe, and cough to help your lungs fill with oxygen-rich air. Your family may notice a tube (drain) coming from your head dressing. When used, this tube lies under your skin and above your skull bone. Its purpose is to reduce the fluid accumulating under your scalp to help control skull 12 13 How will I feel after surgery? Your head dressing A turban-like bandage will be applied to cover your incision A dull generalized headache is common after surgery. Your line but some patients may have a simple type dressing/ brain does not feel pain but your skin and skull bones are mepore dressing. This all depends on the surgeon and what pain sensitive. Your nurse will give you pain medication for type of brain surgery has been performed. To prevent an general discomfort. infection or swelling, it is very important that you do not You may develop puffy, swollen eyes about one or two days touch this dressing or your incision line. The dressing will after surgery. The nurses will elevate the head of your bed be removed approximately three days after surgery, or and apply cool saline compresses to reduce the swelling in changed as required. You will be given a paper ‘doctor’s cap’ your eyelids. to wear. Depending on where your incision line is, you may experience pain when you open and close your jaw. This is Your incision due to the fact that the muscles which move your jaw have Your incision will be closed with staples or sutures which been cut as part of the incision. The pain and limited jaw will be removed in 7 to 10 days. Sometimes the staples or movement will go away with healing and exercise. You must sutures may be left in for 10 to 14 days it just depends on do the exercises that your Neurosurgeon or other health the type of brain surgery performed by the surgeon. professionals shows you. You will be told when it is safe to wash your hair. You may find your stomach is upset after surgery. This is not unusual. Your nurse will give you medication to help Transfer to the Neurosciences Unit settle your stomach. After an average of one to three days, you will be transferred It is normal to feel tired and discouraged after brain to the Neurosciences Unit. You will continue to be cared for surgery. This is a normal reaction of your body to the stress by your Neurosurgeon, Neurosurgical Residents, and the of surgery. It is important not to let this emotional letdown Neuroscience Patient Care Team (Nurses, Social Worker, get in the way of your recovery. Physiotherapist, Occupational Therapist, Speech Language Pathologist, Dietitian).

14 15 Discharge from hospital You should: Though the amount of time spent in hospital may be Activity different for each patient, the average length of stay • Get plenty of rest - take naps. can range from 2 to 5 days following brain surgery. Your Neuroscience’s Health Care Team members (Neurosurgeon, • Exercise by taking short walks. Stop and rest if tired. Nurses, Social Worker, Dietitian, Physiotherapist and • Avoid heavy physical activities (e.g. lifting heavy objects) Occupational Therapist) will closely monitor your progress and contact sports. and help you and your family plan for your discharge. • Gradually increase your activity. It is important to prepare for your discharge prior to • Ask your Neurosurgeon before going home about coming into hospital: specific activities such as going back to work, driving a car or travelling. • Discharge from hospital is before noon. • Arrange for pick-up and transportation home. Diet • Arrange for a family member or friend to stay with you • Resume your normal diet as soon as you are able. for the first few days. • Avoid alcohol, which may cause side effects when taken • Arrange for help to care for young children, pets, and to with your medications. do household chores. • Avoid smoking (cigarette and cigar), that slows the healing process. Recovery at home Bathing Recovery is a process that takes time. It may take a month • You may shower but this will depend on your surgeon. or longer for your energy level to return. It is important to rest when you are tired. It is also important to focus on • You should avoid baths/soaking. your improvement and not on your symptoms that remain. • It will be up to your individual surgeon regarding when Maintaining a positive attitude will speed your return to you can wash your hair. daily activities. • Keep your incision dry.

Medications • Before you go home review your medications with your Neurosurgeon or nurse. • Take your medications as directed by your Neurosurgeon.

16 17 Follow-up Appointment Notes: • At the time of discharge, please call your Neurosurgeon’s office to arrange a follow-up appointment. • You may also need to arrange appointments with other health care professionals or facilities. Notify your Neurosurgeon if you have: • Increased redness, swelling or drainage from your incision line • Fever • Any new deficit, such as confusion, drowsiness, weakness, difficulties walking, changes in your vision, speech or ability to swallow • Increasing headache Call your Neurosurgeon with any questions/concerns or if you are unsure.

18 19 We hope that this pamphlet has offered you valuable information about your surgery, hospital stay, and return to home. If you have any further questions or if something within this pamphlet that is unclear, please ask your Nurse or Neurosurgeon.

For more copies, go online at http://vch.eduhealth.ca or email [email protected] and quote Catalogue No. FM.130.YO88 © Vancouver Coastal Health, July 2016

The information in this document is intended solely for the person to whom it was given by the health care team. www.vch.ca