You have a pre assessment appointment 1 or 2 weeks before your brain tumour surgery. This appointment prepares you for the operation and checks that you are fit for surgery. You also meet some of the members of your treatment team.
Tests to check you are fit for surgery
You have tests before your operation to check:
- your fitness for an anaesthetic
- that you’ll make a good recovery from surgery
You might not need all of these tests if you had them when you were diagnosed. Tests include:
- blood tests to check your general health and how well your kidneys are working
- an ECG while you are resting and exercising to check that your heart is healthy
- breathing tests (called lung function tests)
- an echocardiogram (a painless test of your heart using sound waves)
- a chest x-ray to check that your lungs are healthy
- scans such as MRI scan or CT scan
Depending on the type of brain tumour you have, you might also have some of the following tests:
You might have blood tests to:
- check the level of hormones if you have a pituitary gland tumour
- check for certain substances (chemical markers) if you have a pituitary gland, pineal region or germ cell tumour
Chemical markers are substances such as proteins, that can be picked up in the blood. They can help to tell how well the treatment is working and pick up signs of the cancer coming back.
An electroencephalogram (EEG) is an electrical reading of your brain activity. You might have an EEG if you have fits (seizures).
To have an EEG, the technician attaches about 20 pads to your head with a gel, sticky tape, or by putting on a rubber cap. The pads are attached by wires to the EEG machine. The technician then asks you to lie down and relax. It usually takes between 20 to 40 minutes and you won’t feel any pain.
The technician then removes the pads and the gel, tape or rubber cap. You can usually go home straight away. Your doctor will check the electrical reading and look for any abnormal changes.
You might have neuropsychology tests if you have a tumour near the area of your brain that controls thinking and memory. Your doctor or psychologist will ask you a range of questions about different subjects. The tests can give a baseline of how you are. Your doctors can then compare the results to the same test done again after your treatment.
An angiogram is an x-ray that can show blood vessels. You might have a brain angiogram before surgery if your tumour is near or around major blood vessels in the brain.
You might have a neurological examination before surgery and at regular intervals after the operation. A neurological examination is also called neuro exam or neuro obs. You may also hear your doctor or nurse talk about your GCS score. This stands for Glasgow Coma Scale and is the form they use to record your neurological examination.
During a neurological examination, your doctor or nurse:
- asks you questions to see how awake you are
- asks you to squeeze their hand or push your foot against it
- shine a light into your eyes to check your pupil reaction
- gently taps your knee with a rubber hammer to check your reflexes
Pre assessment clinic
A week or two before your surgery you have an appointment at the hospital pre assessment clinic.
Your pre assessment appointment prepares you for your operation. You meet members of your treatment team at this appointment.
Your doctor or nurse will tell you what to do on the day of your operation. This includes instructions about when to stop eating and drinking, and whether to stop any of your medicines. Do not stop taking your regular medicines unless the doctor tells you to.
Ask lots of questions. It helps to write down all your questions beforehand to take with you. The more you know about what is going to happen, the less frightening it will seem.
You can ask more questions when you go into hospital so don’t worry if you forget to ask some. At the hospital you might meet:
A member of the surgical team will tell you about:
- the operation you are going to have
- the benefits of having surgery
- the possible risks
- what to expect afterwards
The anaesthetist gives you the anaesthetic and they look after you during the operation. The anaesthetic is the medicine that keeps you asleep during your operation. They make sure you’re fit enough for the surgery.
The clinical nurse specialist
The nurse checks your:
- general health
- blood pressure
The nurse also checks what help and support you have. Then they can see what you will need when you go home. They are your point of contact and will care for you throughout your treatment.
The dietitian gives you help and advice about managing your diet. They:
- help you get as well as possible before your operation
- explain how the surgery affects your diet
- give useful tips on how to increase your nutrients and calories
They might give you nutritional supplement drinks to have before surgery.
Some people need a feeding tube in their stomach or small bowel. This makes sure you get the nutrition you need before your surgery.
The physiotherapist assesses how well you can move around. They let the doctors know if there is anything that could affect your recovery.
The physiotherapist also teaches you leg and breathing exercises to do after your operation to help with recovery. Learning how to do the exercises beforehand makes it easier afterwards.
Medicines you might need to take
Brain surgery can cause swelling in the brain. This can increase the pressure inside your head and make your symptoms worse for some time.
Steroids are drugs that can help to reduce the swelling and pressure around the brain. So your doctor might ask you to start taking steroids a few days before the operation. Once you have recovered from surgery, you slowly reduce the dose of steroids until you stop them.
You may also take drugs to stop fits (seizures).
Learning breathing and leg exercises
Breathing exercises help to stop you from getting a chest infection after surgery. If you smoke, it helps if you can stop at least a few weeks before your operation.
Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.
You start the injections after your operation. You might also wear compression stockings and pumps on your calves or feet to help the circulation.
Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.
This 3-minute video shows you how to do the breathing and leg exercises.
Breathing and circulation exercises after surgery
These exercises help prevent you developing a chest infection or blood clots in your legs after surgery. These problems are more likely when you are not moving around as you would normally.
You can do these breathing exercises while sitting up in a chair or in a bed or whilst lying down.
Relax your shoulders and upper chest.
Take a slow, deep, comfortable breath in and hold for a couple of seconds, then slowly breathe out.
Repeat this 3 times.
You can start these breathing exercises as soon as you come round from your anaesthetic.
You should try to do them every hour when awake until you are fully mobile.
If you need to cough, support your wound with your arms, a pillow or a rolled up towel.
If you are struggling to clear any phlegm, try a hu. This is where you breathe out in a short, sharp manner as if you were trying to steam up a mirror.
You should move about as soon as possible after your operation. But while you are not as mobile, try to keep your legs moving to encourage better circulation.
You can do these exercises in a bed or in a chair.
One foot at a time point your toes away from you then pull your toes towards your chin.
Try to do 10 of these on both feet at least 2-3 times an hour.
The next exercise is circling your ankles. One at time circle your ankles, clockwise and then anticlockwise. Repeat this 10 times with each ankle 2-3 times an hour.
It is natural to feel anxious and frightened about having brain surgery.
Talk about any worries with your family and friends if you can. They are probably feeling and thinking 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 be able to tell you what will happen and how it is likely to affect you. Some people find that the more they know about their operation, the less frightening it seems.