Your Craniotomy Neurointensive Care Unit (NICU) Vancouver 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 North Vancouver 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.