Having brain tumour surgery

Before your surgery, you will need to have some tests and to start taking steroids and possibly drugs to stop fits. You may already be taking both of these, but if not you will have to start taking them a few days before your surgery. A physiotherapist may also show you how to do breathing and leg exercises that you need to do after the surgery. Your surgeon or specialist nurse will give you a detailed explanation of what to expect.

The tests you will have may include

• Blood tests to check your general health and your blood group
• A chest X-ray to check your lungs are healthy
• An ECG to check your heart is healthy

You may have had some of these tests while your brain tumour was being diagnosed. If so, you may not need to have them again.

You may also have

• Breathing tests (called lung function tests)
• An ECG while you are exercising

The lung tests and ECG are just to make sure you are fit enough to make a good recovery from your surgery.

Depending on the type of brain tumour you have, you may also have

• Blood tests to measure hormone levels (for pituitary tumours)
• Blood tests for chemical markers (for pineal region tumours and some pituitary tumours)
• An electroencephalogram (EEG)
• Neuropsychology tests

Markers are chemicals that are produced by certain types of cancer and can be picked up in the blood. With some types of tumours, the marker levels can be used to monitor the effect of the treatment and even to pick up signs of the cancer coming back.

An EEG is an electrical reading of your brain wave patterns. It may be used if you have fits as a symptom of your brain tumour. It is completely painless. To have an EEG, about 20 pads that pick up electrical signals are attached to your head with gel, sticky tape or by putting on a rubber cap. These pads are attached by wires to the EEG machine. You will be asked to lie down and relax. The doctor or technician may ask you to open or close your eyes and breathe deeply at points during the test, which usually lasts an hour or less. The EEG machine produces a print out of your brain waves, which your specialist will check for any signs of abnormality.

You may have neuropsychology tests if your tumour is affecting your thought patterns or memory. Your doctor will ask you to answer questions, some of which may seem a bit odd. The tests can give a baseline of how you are. This can be compared to the same tests done again after your treatment.

You will become very familiar with neurological observations (neuro obs) during your hospital stay. Your nurse will start these when you go into hospital. They will be much the same as the tests you had when you were being diagnosed and will include

• Asking you questions to see how alert you are
• Asking you to squeeze the nurse’s hand or push your foot against it
• Shining a light into your eyes to check that your pupils react
• Taking your pulse, temperature, blood pressure and breathing rate

These checks will be done before your operation to give a baseline. For example, you may have weakness in one hand before the operation. By checking and recording this, your nurses and doctor will know if it has got worse or better after your treatment. You may hear your doctor or nurse talk about your GCS score. This stands for Glasgow Coma Scale - it is just the form they use to record your neuro obs.

You may have already had an angiogram when your brain tumour was being diagnosed. An angiogram looks at blood vessels and blood flow under X-ray.

Angiograms are sometimes done before surgery if your tumour is near or around a blood vessel inside the brain. It helps the surgeon to plan the operation and avoid damage to the blood vessel if at all possible. There is information about having an angiogram in the section about diagnosing brain tumours.

Your nurse or physiotherapist will teach you breathing and leg exercises. You can help yourself to get better by doing these exercises after your operation. You should do them as often as you are told you need to.

Breathing exercises will help to stop you getting a chest infection. And leg exercises will help to stop clots forming in your legs. Both these complications of surgery can happen if you are not able to move around as much as normal. Your nurses will encourage you to get up and about as soon as possible after your operation. But if you have had major brain surgery, you may have to stay lying down for several days.

Below is a short video showing breathing and circulation exercises after surgery. Click on the arrow to watch it.
 

View a transcript of the video showing breathing and circulation exercises after surgery (opens in new window)

It is natural to be anxious about having brain surgery. It can be a frightening thing to think about. But specialist surgeons these days are very skilled. It can help to remember that

• Anaesthetics are safer than they have ever been
• Brain surgery is a well established speciality and is getting safer all the time
• Your surgeon would only do the operation if there is a very good chance of you making a good recovery

Do share your worries with your family if you can. They are probably worrying about the same things as you. Together you can talk things through and make a list of questions to ask your doctor. You can share your worries with your nurses too. They will have seen lots of patients have similar operations to you and make a good recovery afterwards. They will be able to tell you what will happen and how it is likely to affect you. You may find that the more you know about your operation and the likely recovery, the less frightening it will seem.

When you go into hospital for your operation, your surgeon, anaesthetist, physiotherapist and nurse will all come to talk to you about what will happen. Your surgeon will explain what is going to be done and what to expect when you come round from the anaesthetic.

You may worry that the medical team are keeping things from you. But your specialist will honestly tell you what the outcome of the operation is likely to be. You have to sign a consent form before your surgery. And it is a legal requirement that the potential risks and complications are fully explained to you.

Feel free to ask as many questions as you need to. It may help to make a list before you go into hospital for your operation. There are some suggestions for questions at the end of this section. The more you know about what is going to happen, the less frightening it will seem. Don’t worry if you think of more questions later. Just speak to your nurses or doctor again.

You may need to have some hair shaved in the anaesthetic room just before the operation. This is only done if it is absolutely necessary - not all surgeons remove hair, particularly for children. But having the area where the surgeon makes the cut (incision) free of hair may lower the risk of wound infection later. You may only have part of your head shaved, or the whole of your head. This will depend on where your brain tumour is. If you feel very strongly that you don't want your hair shaved, talk to your surgeon about it. There may be some room for negotiation. If you would like to have the shaved hair given back to you, do tell your surgeon beforehand. At the same time, you can also make sure your doctor and nurses know about any items you wish to keep on your body, for cultural reasons, while you are having the operation.

For pituitary tumours, you may not need to have your head shaved as your surgeon might remove the tumour via your nose.

For tumours in the brain stem or the cerebellum, the surgeon will operate through the muscles at the back of your neck, so you may only have a small area at the back of your head shaved.

You may be able to take medicine to help you sleep the night before your operation. Some surgeons won’t allow this, however, because it can affect their assessments during the surgery. You won’t be able to eat or drink anything for some hours before your operation is due to start. Your anaesthetist will decide the exact time.

Most neurosurgery units allow relatives to visit on the morning of the surgery and stay with you until you go down to the operating theatre. This can be reassuring for you and your family. The doctors will be able to tell your relatives how long the operation is likely to take, but this will only be a rough guide. Usually, brain tumour operations take between 3 and 5 hours. The waiting can be difficult for your relatives and friends. Unfortunately it is rarely possible for relatives to get updates while the operation is in progress. A member of the surgical team will come and talk to them as soon as they can after the surgery is over. Many factors can affect the timing of a brain operation, so your relatives should try not to worry too much if the surgery takes longer than they have been told.