Brain Surgery

Many medical conditions, such as tumors, blood clots, aneurysms, epilepsy, and Parkinson's disease are treated with brain surgery which comes in a variety of types. Depending on the location of the brain and the ailment being treated, the type of surgery is selected. 

Medical technology advancements have made it possible for surgeons to perform certain brain operations without making any incisions inside the head or close by. As a result, by using more accurate diagnosis and therapy, surgeons carry out more successful surgeries. (1)

Definition and Overview

The term "neurosurgery" describes a wide range of medical procedures which treat structural issues with the brain. The procedures are carried out by a neurosurgeon with the assistance of an anesthesiologist who is well-versed in all aspects of anesthetic, monitoring, and post-operative care needed for these delicate surgeries. This anesthesiologist may occasionally be a neuro anesthesiologist who has had advanced clinical training in anesthesia for spinal cord and brain procedures.

The process of neurosurgery is crucial and intricate. The condition that is being treated has a significant impact on the type of brain surgery performed. For instance, a catheter placed into a groin artery can be used to treat a brain aneurysm. An open surgery termed a craniotomy may be utilized if the aneurysm has ruptured. Surgeons treat each surgery individually, taking the greatest care and diligence possible. (2)

Types of Brain Surgery

There are numerous various kinds of brain surgery. The procedure to be taken depends on the problem being treated. 

• Brain biopsy

A brain biopsy may be suggested by the doctor if brain scans reveal an unexpected growth in the brain. By performing this procedure, a small amount of brain tissue is removed for testing in a lab. A small needle is typically inserted into the brain during a brain biopsy to remove tissue.

• Craniotomy

For many various types of brain conditions, particularly cancer and other growths, a craniotomy is the preferred surgical procedure. After making the skull cut, the doctor can operate on the brain to fix broken blood vessels or remove dangerous growths.

• Deep brain stimulation

To administer electrical stimulation to particular brain regions, a medical device known as an implantable pulse generator is implanted. For movement disorders like Parkinson's disease, DBS is most frequently employed.

• Posterior fossa decompression

The cerebellum and brainstem are both involved in this treatment. For instance, the surgeon may make an incision at the back of the patient's head and remove a small amount of the bone from behind the skull to cure a Chiari malformation. The cerebellum now has additional space to grow, and the spinal cord is less stressed as a consequence of this removal.

• Thrombectomy

Surgery called a thrombectomy is used to clear blockages or clots from blood vessels in or near the brain. Usually, no section of the skull needs to be removed. Instead, a medical professional inserts a tube into the desired vein or artery through a blood vessel. After having a stroke, a person might need this surgery.

• Neuroendoscopy

Neuroendoscopy is the practice of operating with an endoscope. This is a type of minimally invasive surgery in which the medical professional passes a long camera through the nose. It is typically used by doctors to remove tumors in the pituitary gland located just under the nose. (3,4)

Candidates

To treat neurological disorders in the brain, neurosurgery is performed. These may result from an illness, accident, congenital defect, or other issue. Brain surgery may be an option for patients with any of the following conditions in or around the brain.

• abnormal blood vessels
• aneurysm
• bleeding
• blood clots
• damage to the protective tissue called the “dura”
• epilepsy
• abscesses
• nerve damage or nerve irritation
• Parkinson's disease
• pressure after head injury
• skull fracture
• stroke
• glioma
• fluid buildup in the brain

Not all of these conditions require brain surgery, but if they pose a risk for more serious health problems, surgery can greatly help. For instance, a brain aneurysm does not require open brain surgery, but the patient might need it if the vessel ruptures. (5)

Brain Surgery Risks and Side Effects

Surgical procedures all include some risks. Brain surgery is a significant medical procedure and it entails more risk and side effects. Following are some potential risks and side effects of brain surgery:

• brain damage that can affect its function
• paralysis
• anesthesia-related complications such as breathing difficulties
• infection
• a blood clot
• headache
• excessive bleeding
• coma
• memory problems
• seizures (6)

Post-Procedure and Follow-up

The patient is closely monitored following surgery to make sure everything is operating as it should. To prevent facial and brain swelling, the patient is placed in an elevated position.

The doctor outlines the procedure's next steps before the patient leaves the hospital. This covers how to treat the surgical wound, as well.

Anesthesiologists are experts in managing pain in diseases related to surgery. After the operation, the anesthesiologist sees the patient and modifies the treatment based on the level of pain.

The anesthetist also takes into account other aspects, such as a painkiller's potential impact on breathing and oxygenation during initial recovery or its potential impact on the patient's capacity to engage right away during the post-operative evaluation of neurological status. For painkillers given within the first 24 hours of any significant neurosurgical treatment, this benefit-risk analysis is especially crucial. (7)

Recovery

Depending on the procedure employed, recovery from neurosurgery varies. Brain surgery typically necessitates a stay of a week or longer in the hospital. Depending on how well the body recovers from the procedure, the hospital stay will vary. The patient takes painkillers throughout this time. (8)

Results

Most of the time, a person will need to wait several weeks before engaging in complicated activities like driving a car. A person may require ongoing care while recovering. This could entail regular neurologist visits, speech therapy, physical therapy, and continued testing to look for brain tumors.

There is a good rate of survival and a low risk of complications even in major neurosurgery. When a doctor advises brain surgery, it is because doing so carries a lower risk than not having it.

The dangers and advantages of surgery, potential side effects, the length of the recovery period, and the likelihood of success should all be discussed. Getting a second opinion might give one more perspective and assurance that they are making the right choice.