Need help now?Image guided craniotomy
Image-guided refers to the use of scans and a computer to precisely locate and target a lesion within the brain. This was previously commonly done by fixing a metal frame to the head with pins and carrying out a (CT or MRI) scan with the frame on (frame-based stereotaxy). Nowadays your scan can be performed in advance of your surgery (without a frame on), the data is uploaded onto a computer in the operating room, and a navigation system is used to locate the tumour (frameless stereotaxy or image-guidance). This technique is beneficial because it localises the tumour, so the operation is shorter and the area of the head that the surgeon must disrupt is often smaller.How is an image guided craniotomy performed?
This procedure will be performed either with a general anaesthetic or sedation. In the operating theatre you will be positioned on an operating table and your head will be supported on a headrest. A neuronavigation system (like a satellite navigation system) will then be used together with your pre-operative scan data to precisely locate the site for the tumour (target) and to determine an entry point, which can then be marked on the scalp. A small incision can then be marked on the scalp and a very small amount of hair shaved along the line of the incision before it is cleaned with antiseptic solutions and then surrounded by surgical drapes. A small injection of local aneasthetic is used to numb the incision site: this stings for a few seconds only. Nothing else should hurt at all.An incision is then made and the surgeon uses image guided navigation to determine the location of the bone flap and the tumour, which is then resected, or partially resected. The wound is then closed with stitches and staples for the skin.
What happens after surgery?
You will be transferred to the recovery area for a short time and then to the neurosurgery day-case unit where observations will be performed regularly. This will include an assessment of your conscious level (asking you to follow simple commands, opening your eyes and answering questions), examination of your pupil responses, tests of your limb strength and checks on your pulse, blood pressure and respirations. After 4 hours you will have a CT scan of the head before your discharge after about 6 hours (either home or back to your local hospital). Occasionally it is necessary to stay in for longer.This is not particularly painful but you will be given some tablets for any headaches and if you feel nausea you will be given drugs to relieve this symptom. You will often be given steroids to prevent swelling (in a slowly reducing dose) and anti-epileptic drugs to prevent fits in the early post-operative period. You can eat, drink and mobilise as soon as you feel able to, which is usually within a few hours of surgery.
What happens after discharge?
Your surgeon will arrange an appointment with you to discuss the results of the biopsy, usually 5-7 days after surgery. The staples can be removed from your wound at 5 days, usually at your post-op appointment and you can wash your hair after this time. Your surgeon will also explain to you any plans for further treatment and follow-up.You may have some mild headaches, which will lessen with time and you may feel tired and need to rest at home. If you are taking steroids, the dose will slowly be reduced, as prescribed by your surgeon, and if you have not had any fits your anticonvulsants will be stopped, as directed by your surgeon.
You will not be able to drive for a time determined by your symptoms and diagnosis. You should inform the DVLA of your diagnosis and give them the name of your treating surgeon by calling 0870 2400009. They will send a form to your surgeon for him to complete and will then inform you of the date on which you may return to driving. For further information, the DVLA’s guidelines are published on-line at http://www.dvla.gov.uk/welcome.htm. Because of the small risk of a fit, you should also avoid any other activities that may put you at risk if you were to suffer a brief loss of consciousness, such as, climbing ladders, operating certain machinery or swimming unsupervised.
What are the risks?
Every operation carries a risk. The degree of risk depends on a number of factors, for example, location and type of the tumour, your general medical health and age. Your surgeon will explain to you the particular risks associated with your operation and give you an indication of the likely chance of complications occurring. Complications include, but are not exclusive to, the following:- Temporary or permanent neurological deficit (stroke e.g. paralysis of limbs or loss of speech)
- Haematoma (blood clot)
- Brain swelling
- Infection
- Fits
Some of these complications might be serious enough to warrant further surgery and some can be life threatening. Overall, as a general guide, the incidence of serious complications causing severe permanent neurological deficit (stroke) or death is about 2%.
Will my symptoms improve?
This will depend on the tumour and the surgery. If the tumour has been causing headaches, there is a good chance these will improve following surgery. If you had weakness or paralysis in a limb caused by pressure on the brain by a tumour, then this may improve following surgery. However, if you had weakness caused by invasion of the tumour into the brain, then it is unlikely that this will improve following surgery. Seizures are sometimes improved by removal of a tumour but may not change or may occasionally worsen.What should I tell my doctor about after surgery?
You should tell your doctor about:- Headaches that are progressively worsening
- Fitting
- Fever
- Wound problems (increasing pain, swelling, discharge)
- Development of new or worsening symptoms (weakness, numbness, etc)
- Increasing drowsiness
- Rash
If you are at home you could discuss your symptoms with your GP, call your neuro-oncology specialist nurse (if you have one) or contact your surgeon and his team at the hospital.
